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Item 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, RogerIntroduction: 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 controlItem 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, DaveThere 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 DTGItem Monitoring of gentamicin concentrations in obstetrics and gynaecology patients at Windhoek Central Hospital and Katutura Intermediate Referral Hospital(University of Namibia, 2018) Singu, Bonifasius SiyakaThe aim of this study was to assess whether the gentamicin dosing strategy as presently performed at Katutura Intermediate Referral Hospital and Windhoek Central Hospital produces gentamicin serum concentrations that are within the recommended therapeutic ranges. This was a quantitative, prospective and observational/non-interventional study. Patients (n=35) Patients who were admitted and receiving gentamicin therapy in the obstetrics & gynaecology wards of the two hospitals (Katutura Intermediate Referral Hospital and Windhoek Central Hospital) were recruited and two blood samples taken from each patient. The first sample was drawn at 1 hour after starting the infusion and a second sample after 6 hours. Serum gentamicin and serum creatinine concentrations were determined using a Thermo Scientific Indiko Plus® autoanalyser and plots of serum gentamicin concentration vs time on semi-logarithmic paper were used to deduce the pharmacokinetic characteristics. Data were analyzed using descriptive statistics. The study revealed that 80.0% of non-PID patients received doses that were lower than the 5-7 mg/kg recommended for once daily dosing. In addition, 86.3% of patients had Cmax values that were below the recommended 17-25 μg/mL. All patients treated against PID had their doses falling within the recommended 3-5 mg/kg, but no guiding literature was found to act as a reference for the serum gentamicin levels in PID patients. The results from this study led to the following recommendations: i) discontinue the use of standard dosing of gentamicin, ii) use mg/kg dosing method in determining gentamicin doses, iii) monitor the gentamicin levels to ensure safety and efficacy, iv) studies to evaluate the antimicrobial effectiveness of the 3-5 mg/kg PID dose should be carried out.