Department of Pharmaceutical Sciences

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Browsing Department of Pharmaceutical Sciences by Subject "Namibia"

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    A retrospective review of the utilization of Benzodiazepines and Z-drugs in selected private community pharmacies in Namibia: 2017-2022
    (University of Namibia, 2024) Iipinge, Taimi; Kibuule, Dan
    ackground: Overuse of benzodiazepines and Z-drugs is a considerable global public safety concern. In Namibia, despite the rising burden of mental illnesses, there is a paucity in data regarding the utilization of benzodiazepines and Z-drugs. Aim: The study aimed to determine the patterns and factors associated with the utilization of benzodiazepines and Z-drugs in community pharmacies to guide medicine policy reforms. Methods: A descriptive multicenter longitudinal study as per the World Health Organisation (WHO) medicine utilization design. The consumption data on benzodiazepines and Z-drugs were retrospectively abstracted from the Unisolv® dispensing software in selected pharmacies over a six-year period, 2017-2022. Consequently, key informants were interviewed to identify the drivers of the use of benzodiazepines and Z-drugs. Data were exported to SPSS v25 for analysis of the patterns and factors of use of benzodiazepines and Z-drugs. Results: Of the 10 selected-pharmacies, a total of 867 168 medicines were dispensed over the six-year review period and 2% of these were benzodiazepines and Z-drugs (n=17 840/867 168). Benzodiazepines (BZD) were the most dispensed (56%, n=9993/17 840), mainly to male patients (53.6%). The consumption of benzodiazepines and Z-drugs was highest with Zolpidem (6.07 DDDs/1000 population) compared to other benzodiazepines and Z-drugs. Over 54% of the dispensing encounters of benzodiazepines and Z-drugs were repeat prescriptions of Z-drugs. From 2017 to 2022, the consumption of Z-drugs increased but declined for benzodiazepines. Stakeholders identify the thematic drivers of the use of benzodiazepines and Z-drugs as irrational prescribing, marketing, and patient drug dependency. Conclusion: Whilst, the consumption of benzodiazepines and Z-drugs in Namibia is lower than global estimates, there is an increase in the use of benzodiazepines and Z-drugs in the private health sector. There is a need for a regulatory framework and an education strategy to empower pharmacists’ led interventions towards safe use of new benzodiazepines and Z-drugs in the community pharmacies
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    Anticoagulation control in a standard of care versus a pharmacist-managed warfarin monitoring service at Windhoek Central Hospital, Namibia
    (University of Namibia, 2024) Thikukutu, Moses Mukwipure; Verbeeck, Roger
    Introduction: Warfarin remains the drug of choice for treating thromboembolic diseases in Namibia. A historical control study reported a patient’s mean time in the therapeutic range (TTR) at the Warfarin Outpatient Clinic of Windhoek Central Hospital (WCH) to be suboptimal (29.4%). Interventions to improve anticoagulation control were instituted and they involved a pharmacist-directed warfarin therapy. The main objective was to improve anticoagulation control in the intervention group and compare it to the historical control group. Methods: A prospective cohort design was used. Adult patients who attended the warfarin clinic on Wednesdays and gave consent were exposed to the intervention study. The main outcome measure was the TTR computed using the Rosendaal method. Binary logistic regression was used to identify factors associated with poor anticoagulation control. A between groups comparison of anticoagulation control was based on the paired and unpaired patient cases. A p value < 0.05 was considered statistically significant. Results: A total of 330 patients were part of the present study (control (215) and intervention (115)). The majority (63.4%) of the patients in the intervention group were females. The mean (± SD) age was 45 ± 17 years. The top three prevalent clinical indications for warfarin in the intervention study were deep vein thrombosis (49.6%), mitral valve replacement (13.9%), and pulmonary embolism (13%). Only the baseline INR (OR 0.34 [95%CI: 0.13-0.86]) and warfarin dosage adherence (OR 0.17 [95%CI: 0.04-0.84]) were significant predictors of good anticoagulation control in the intervention group. The Mann-Whitney U test showed an 18% (p<0.050) improvement in the median %TTR when the unpaired cases between the groups were compared. The paired t-test showed a 10% (p=0.220) improvement in the mean %TTR when the paired patient cases between the groups were compared. Conclusion: Interventions involving a pharmacist-directed warfarin therapy were associated with improved anticoagulation control at the WCH warfarin clinic. Baseline INR and warfarin dosage adherence were statistically significant predictors of good anticoagulation control
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    Evaluation of treatment outcomes in patients receiving Dolutegravir- containing first -line anti-retroviral therapy at the Katutura Intermediate Hospital in Namibia
    (University of Namibia, 2024) Amakutuwa, Naambo Taimi; Hachey, Dave
    There is currently insufficient information regarding the safety and effectiveness of Dolutegravir (DTG)-based ART regimen in Namibia. This study was conducted to evaluate the treatment outcomes of dolutegravir containing first line antiretroviral therapy (ART). Methods: This was a retrospective quantitative study that included ART-naïve adults who initiated dolutegravir containing first-line ART from January 2020 to March 2021 at the Intermediate Hospital Katutura (IHK) in Namibia. Results: 120 patients were included in the study. Most (n=89, 74%) experienced weight gain, and 15 experienced treatment failure. At the end of 18 months, 75% of the cohort remained virally suppressed. The prevalence of treatment failure was found to be 12.5% with the prevalence rate of treatment failure of 8.3 cases per 100 patient years. But considering the switching as confirmation of virological failure, the prevalence rate was 2.2 cases per 100 patient years. Active tuberculosis (TB) was found to be statistically associated with treatment failure with a P value ˂ 0.001. PLWH co-infected with TB on TLD were 18 times more likely to have treatment failure (OR=18.1,95% CI: 4.65,70.45). Only 3.3% (n = 4) had their DTG-based ART regimen changed or switched due to treatment failure. The only reported adverse effect observed in the study was weight gain. The proportion of patients who experienced clinically significant weight gain (defined as weight gain ˃ 3kg) after 18 months of ART initiated was 20.2%. The prevalence rate for clinically significant weight gain was 13.5 cases per 100 patient years. The mean weight gain was found to be 4 kg (SD 59.45 ± 16.89). There was statistical significance between weight gain and gender with a p-value =0.026 with females being four times more likely to have gained weight (OR=3.9,95% CI: 1.3,12.4). Conclusion: DTG-containing regimens effectively achieved viral suppression among treatment-naive HIV patients, with weight gain reported as the only adverse effect. More research with a larger patient sample across multiple centres is needed to explore the long-term treatment outcomes of DTG