HOME > Journals > Pharmaceutical Journal of Kenya, Volume 23, No. 4 (2018)

Pharmaceutical Journal of Kenya, Volume 23, No. 4 (2018)

Volume: 23, No. 4 (2018)
ISSN: 2411-6386;
Publisher: The Pharmaceutical Society of Kenya
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Articles in the journal

EDITORIAL: SUBSTANDARD AND COUNTERFEIT DRUGS; A THREAT TO HEALTH

Author: Judy Asin , Nadia Butt

Amphotericin B toxicities among HIV infected adults with Cryptococcal Meningitis in Kiambu District Hospital

Author: A.W. Karita , D.G. Nyamu , P.N. Karimi , S.C. Gitau
Keywords: Amphotericin B, Cryptococcal meningitis, HIV/AIDS, Toxicity
Abstract:
Background: HIV infection is a worldwide epidemic with the highest prevalence in sub-Saharan Africa. This has increased the prevalence of cryptococcal meningitis which is a common AIDS-related opportunistic infection with a high rate of morbidity and mortality. Amphotericin B is the standard treatment for cryptococcal meningitis but its use is limited by toxicities resulting from a number of factors such as cumulative dosage and concomitant drugs. Published local studies on patterns of toxicities are scanty.Objectives: The main objective of the study was to assess toxicities associated with Amphotericin B in the management of cryptococcal meningitis among HIV infected patients aged 18 years and over in Kiambu District Hospital.Methodology: A cross- section design was used that involved review of patients’ records at Kiambu District Hospital medical records department between January 2010 to December 2014. One hundred and six files of HIV infected adults with cryptococcal meningitis and treated with amphotericin B were used. Data on amphotericin B toxicities, risk factors, and preventive strategies were extracted from the files using a predesigned semi-structured data collection form. This data was entered into Microsoft Access version 2013 to create a database and then exported to IBM Statistical Package for Social Sciences Version 22.0 for analysis. Bivariate analysis using chi-square test and logistic regression were used to determine statistical significance at 0.05. P values that were equal or less the 0.05 were considered significantResults: Prevalence of infusion-related toxicities was high at 87.7%, with fever being the most common (58.1%). The overall prevalence of nephrotoxicity was at 27.4% but principally characterized by hypokalemia (41.4%) and elevated creatinine at 58.6%. Dosing of the drug was not weight based and higher amphotericin B doses were important risk factors for toxicity (p=0.045). Prevention of toxicities associated with amphotericin B involved monitoring of serum levels of potassium (p=0.028) and creatinine (p=0.019) as well as patients hydration status(p=0.026). Monitoring of toxicity was only prevalent (70%) at the initiation of therapy but declined to less than 20% in the course of treatment.Conclusion and recommendation: Prevalence of toxicity of amphotericin B in Kiambu District Hospital was high and related to the dose given. Therefore, care should be taken when dosing the drug. In addition, frequent patient monitoring, adequate hydration, and premedication are key to preventing the toxicity and should be encouraged.

Impact of devolution on the trends of Paediatric Malaria Admissions and Mortality in Homa-Bay County, Kenya- An Interrupted Time Series Analysis

Author: Kodhiambo M.O., Amugune B.K.2, Oyugi J.O.
Keywords: Devolution, paediatric malaria, admissions, mortality, Homa-Bay
Abstract:
Background: Malaria is a leading cause of paediatric admissions, morbidity and mortality. Its burden is borne mainly in the endemic areas, like Homa-Bay in Kenya, which are also the poorest. It is therefore important for the County to prioritize preventing paediatric malaria. Paediatric malaria admission and mortality have recently increased in the lake region unlike the rest of Kenya. It is also not clear whether after devolution was implemented in the year 2013, the trend has changed. The objective of the study was to investigate the impact of devolution on paediatric malaria admission and mortality trends in public health facilities in Homa Bay County.Methodology: A retrospective quasi-experimental study was performed. The study population comprised all public health facilities in Homa-Bay County. We purposively sampled 164 public health facilities from which six-year data on paediatric admissions and mortality was collected. Sub-County level data was obtained on excel from the electronic health records at the County headquarters. Hard copy data from the health facilities were also inspected at the 8 sub-Counties. Data was analyzed by the Interrupted Time Series (ITS) method. Devolution, which was taken as the intervention, occurred around the 36th month of the follow-up period.Results: From January 2013, deaths increased gradually until around the 33rd month when it rose abruptly to nearly 800 then declined to below 200 in the 34th month around the time of devolution. This was followed by a period of stability. Admissions had a similar trend.Conclusions and recommendations: Paediatric malaria admission and mortality rates in Homa Bay increased around the time of devolution. More studies are necessary to assess progress towards universal access to care post devolution.

Evaluating Corchorus Olitorius Plant Mucilage in the formulation of Oro-Dispersible Paediatric Sildenafil tablets

Author: Njoroge A. N. , Tirop L. J.
Keywords: Oro-dispersible tablet, Sildenafil citrate, Superdisintegrant, Corchorus olitorius mucilage
Abstract:
Sildenafil citrate, used in management of pulmonary arterial hypertension, is available in adult tablet dosage forms, from which paediatric doses are prepared extemporaneously. Sildenafil citrate oro-dispersible tablets in paediatric strengths, made from Corchorus olitorius (jute) plant mucilage as the natural superdisintegrant, provides for a dose specific, more stable, cheap and convenient dosage form in this population.
Typically synthetic superdisintegrants, namely croscarmellose sodium, crospovidone and sodium starch glycolate, are used in the formulation of oro-dispersible tablets. This work aimed to formulate paediatric oro-dispersible tablets of Sildenafil citrate, using mucilage of jute plant (Corchorus olitorius) as a novel natural superdisintegrant. The mucilage was successfully extracted with 96% ethanol and characterized, demonstrating favorable parameters for use as a tablet superdisintegrant. Twelve batches of Sildenafil oro-dispersible tablets were formulated by direct compression, at three levels of the novel superdisintegrant as well as the common synthetic superdisintegrants, and evaluated.
The Corchorus olitorius mucilage batches showed characteristic mean in-vitro dispersion times of 20.67, 19.33 and 18.67s for the 5 mgs, 7.5 mgs and 10 mgs (4%, 6%, 8% w/w) tablet concentrations, respectively. The in-vitro dispersion time of tablets containing Corchorus olitorius mucilage compared closely with that of tablets containing croscarmellose sodium and sodium starch glycolate. The in-vitro dispersion time was observed to decrease with increasing concentrations of the mucilage powder. The tablets complied with all compedial tests for quality with the exception of the friability test. Corchorus olitorius mucilage may be used safely at higher concentrations to achieve lower in-vitro dispersion times. Further studies to establish the optimum superdisintegrant concentration should be considered.


Presence of Potentially Harmful Alcohol Excipients in Paediatric Medicine Dispensed in Nairobi

Author: Maureen W Chege , Sylvia A Opanga
Keywords: Paediatric medicine, Alcohol, Ethanol, Excipient, Propylene glycol
Abstract:
Background: Alcohol, as an excipient in pharmaceutical preparations, serves as a preservative and solvent. It is commonly found in oral and topical formulations, elixirs and spirits. Although it has been widely used in paediatric formulations, its safety in children has not been well characterized though toxicity has been reported.
Objective: The aim of the study was to document the presence and content of alcohol excipients in paediatric drug products dispensed in pharmacies in Nairobi.
Method: A cross sectional study was conducted at seven randomly selected pharmacies in Nairobi. The investigators selected all paediatric products and perused their packages, labels and package inserts for information on presence of alcohol, content, type of alcohol excipients and recommendations for use. The data was entered into Microsoft Excel 2010 worksheet, and descriptively analysed.
Results: Out of 290 products sampled, 87 (30%) were found to have alcohol excipients. Ethanol was the most common type of excipient (46.0%), followed by propylene glycol (27.6%). Syrups had the highest number of products with alcohol (58.6%). Antihistamines recorded the highest number of products with alcohol (39.1%). Most of the products with alcohol were over the counter drugs (79.3%). Of the drugs that contained alcohol, 53% (n=46) were not recommended for use by patients less than 6 years of age. The daily dose of alcohol in the drug with the highest alcohol content was equivalent to 28.8 ml of beer.
Conclusion: Over the counter drugs had more products containing alcohol than the prescription only drugs. Ethanol and propylene glycol were the most commonly used excipients. The propylene glycol content was not stated in all its products. The highest amount of alcohol per daily dose of drugs was equivalent to 28.8 ml of beer. Nearly half of the products were not recommended for children less than 6 years old.


The Occurrence of Glucose 6 Phosphate Dehydrogenase Deficiency amongst Blood Donors at the Regional Blood Transfusion Centre-Mombasa, Kenya

Author: Wigina, R. N1 , Kaggia S. N , Kahato M. N , Mzee S. S
Keywords: Transfusion, Glucose-6-Phosphate dehydrogenase, deficiency, blood donors
Abstract:
Glucose-6-phosphate dehydrogenase deficiency (G6PDd) is an X-linked hereditary genetic defect that is estimated to affect 400 million people worldwide. This deficiency is associated with hemolytic disorders that may manifest depending on the molecular variant present, exposure to hemolytic triggers such as consumption of foods including fava beans and exposure to drugs including dapsone and primaquine. This disorder has been found to be more prevalent in malaria endemic zones of Asia, Africa and South America. This study determined the occurrence of G6PD deficiency among the donors at the Regional Blood Transfusion Centre-Mombasa, and whether any correlation existed between the occurrence of G6PD deficiency and either ABO blood type or haemoglobin concentration. Methaemoglobin reduction test was used to check for the presence of G6PDd among the blood donors, anti A and anti B sera were used to determine the blood types. Haemoglobin concentration was estimated using haematology analyzer. Multivariate analysis was done to establish the point prevalence of G6PDd in the donor population, the relationship between G6PD and ABO blood types and the correlation between G6PDd and haemoglobin concentration. Out of the 676 donors 9.6% were deficient of G6PD activity while 13.17% had red cells exhibiting partial activity. The point prevalence for all forms of G6PDd was found to be 22.79%. Blood group AB donors were least likely to exhibit G6PD deficiency compared to the rest of the ABO blood types. The association between G6PDd and haemoglobin concentration was inconclusive. The current findings indicate that G6PD deficiency exists among healthy donors without manifestation of clinical symptoms. G6PDd screening as part of donor blood testing regime would therefore allow for the discriminate use of G6PDd blood in transfusion dependent patients and
The Occurrence of Glucose 6 Phosphate Dehydrogenase Deficiency amongst Blood Donors at the Regional Blood Transfusion Centre-Mombasa, Kenya
Wigina, R. N1 , Kaggia S. N , Kahato M. N , Mzee S. S
Technical University of Mombasa, Faculty of Applied and Health Sciences, Department of Medical Sciences, PO Box 90420, – 80100 Mombasa. Email: wigina@tum.ac.ke
Jomo Kenyatta University of Agriculture and Technology, College of Health Sciences, Department of Human Pathology, PO Box 62000 – 00200 Nairobi. Email: drserahkaggia@jkuat.ac.ke
Jomo Kenyatta University of Agriculture and Technology, College of Health Sciences, Department of Medical Laboratory Sciences, PO Box 62000 – 00200 Nairobi. Email: mikekahato@gmail.com
Technical University of Mombasa, Faculty of Applied and Health Sciences, Department of Medical Sciences, P.O Box 90420, – 80100 Mombasa. Email: suleimanmzee@gmail.com
*Corresponding author
neonates. It would also aid in establishing risk in the use of drugs associated with triggering clinical manifestations.


Provider perspectives on the Strengths and Weaknesses of the Devolved Health Care in a Rural County in Kenya

Author: Kodhiambo M.O. , Ogweno J.O.
Keywords: Devolution, health care, provider perspectives, Homa-Bay County.
Abstract:
Background: Devolution of health services in Kenya was intended to enhance access to health care services. It is not clear to what extent this has been achieved.
Objective: To establish the perspectives of health care managers on the impact of devolution on health systems within Homa Bay County.
Methodology: We performed a health facility based qualitative study, adopting a phenomenological approach. The study population comprised all health care managers in eight public health facilities in Homa Bay County. The study used quota sampling involving different cadres of health care providers. Seven informants were interviewed in each sub-county leading to a total of 56 informants. Data was collected by use of structured interview guides and analyzed by a thematic approach.
Results: Progress of devolution was reported to be experiencing several challenges. The factors that were cited as bottlenecks to achieving full benefits of devolution were poor medical supplies, poor human resource recruitment and retention practices, remuneration uncertainties, corruption, nepotism and political interference. The main positive outcome of devolution was cited as enhanced community participation in health care issues. Opinion was divided as to whether devolution of health care should stay or be reversed.
Conclusions: From the foregoing, it is evident that devolution of health care is yet to be embraced fully by health care managers. Further studies to enhance evidence informed decision making is necessary.