Articles in the journal
John Mwangi Waweru , Nadia Butt
Machogu, L. S.
Nyamu G. D , Guantai A. NKeywords:
Anticoagulation, Anticoagulation prescribing practices, Warfarin, County HospitalAbstract:
Background: Anticoagulation services are substantially underutilized in Kenya, especially in the absence of local clinical guidelines, resulting in avoidable fatal and disabling complications such as bleeding and thromboembolic disorders.
Study Objectives: To describe the patterns of ambulatory anticoagulation services and determine factors impacting on its practice at Mbagathi District Hospital, Nairobi County.
Study design and Setting: Cross-sectional study at Mbagathi District Hospital, medical outpatient clinic.
Participants and Methods: Eighteen consenting prescribers to anticoagulants were interviewed using universal sampling. Information on their sociodemographics, prescribing habits of anticoagulants, utilization of anticoagulation guidelines in prescribing and factors impacting on the uptake of anticoagulation were assessed.
Data Analysis: Database was created into Microsoft Access version 2013 and exported to IBM Statistical Package for Social Sciences version 21.0 for analysis. Continuous variables were further analyzed using measures of central tendencies. Student-t-test and Pearson’s chi square were used to draw associations and inferences. Confidence interval was set at 95% with p-values ≤0.05 being statistically significant.
Results and Discussion: The prescribers were aged 30.1(±7.4), ranging 22-48 years. The male to female ratio was approximately 1:1. Two-thirds of the prescribers were registered clinical officers and almost three-quarters (72.2%) had practiced for less than four years. The principal prescribing for anticoagulant therapy was deep vein thrombosis (55.9%) and prevention of thrombosis after heart valve surgery (39.2%). Initial prescribed warfarin doses were inconsistent with guidelines (p=0.01). Prescribers were unaware of the availability of various strengths of warfarin tablets. Additionally, there were inconsistencies in the management of patients presenting with under or over anticoagulation. There was lack of multidisciplinary team approach in anticoagulation services as over 70% were either nurses, clinical officers or medical officers but few pharmacists. Uptake of anticoagulation services could be increased by participation of pharmacists as well as hospital management support in formulation of local guidelines and provision of equipment for testing the level of anticoagulation.
Conclusions and Recommendations: Ambulatory anticoagulation clinic services in the hospital are poor because there is underutilization of international guideline coupled with lack of local clinical guidelines and inadequate hospital support. In addition, multidisciplinary team approach is recommended for improvement of anticoagulation services.
Babra A. ,Tirop L. J. ,Aywak D. A.Keywords:
Pharmaceutical product physical quality defect, pharmacovigilance, Kenyatta National HospitalAbstract:
The quality of pharmaceutical products is of utmost importance in the management of various life-threatening conditions. A retrospective study of physical quality defects in pharmaceuticals at Kenyatta National Hospital was carried out for the period January 2015 to December 2016. The aim of the study was to investigate the different types of physical quality defects encountered in pharmaceutical products. A total of 58 defects in 44 products were reported. Organoleptic changes, physicochemical changes of solids and physical package problems were the most frequently encountered defects (32%, 28% and 21% respectively). Oral dosage forms (39%) and parenteral preparations (36%) were the most common dosage forms with defects reported. Most (79%) defects occurred in less than a year after manufacture, suggesting inadequate preformulation studies. Imported products had the most (80%) defects. Majority (56%) of defects were reported by pharmacists. Apart from pessaries that required refrigeration (4-8°C), all other products with defects were stored at room temperature (20-25°C), as per the manufacturer’s recommendations. The classification system used by the researchers to study quality defects was clear and consistent. Methods should be created to sensitize health care providers as well as patients on how to detect and report physical defects in pharmaceutical products.
Aluda A.T , Amugune B.K , Abuga K.O , Kamau F.N.Keywords:
Capillary column, monoterpene, organic layer, carrier gas, total menthol, cold-cough syrupAbstract:
Common cold is the most common infection of the upper respiratory tract and cold-cough syrups are often prescribed. Although menthol is one of the common constituents of these syrups, quality checks on cold-cough syrups normally target the major active pharmaceutical ingredients without regard to menthol content.
To develop and validate a gas chromatography method for determination of menthol in cold-cough syrups.
A simple, rapid, robust, accurate and reliable Gas Chromatography method was developed and validated for the determination of menthol in cold-cough syrups that may also contain ambroxol, chlorpheniramine, guaifenesin, bromhexine and salbutamol.
Optimized chromatographic conditions were: A ZB-WAXplus 60m ×0.25mm; 0.25μm fused silica capillary column. Oven temperature program of 110 0C (2 min), ramp 10 0C/min to 190 0C (2 min). Injector port temperature maintained at 240 0C. Injection volume of 1.0 μl split in the ratio of 50:1. Carrier gas as nitrogen at 1.0mL/min which also serves as make up gas (30 mL/min) in the flame ionization detector (260 0C). Other detector gases were hydrogen (30 mL/ min) and industrial air (300 mL/ min) and the diluent for samples and standards was grade chloroform.
From recovery studies, 97.56 to 102.97 % recovery was reported. Repeatability studies had a coefficient of variation of 0.55 while intermediate precision was 0.32. The method was linear over a range of 0.042 to 0.169 mg/mL with a coefficient of determination (R2) 0.9986.
Of the 21 samples analyzed, only 10 samples (47.6 %) complied with assay specifications of 90.0 to 110.0 % label claim for finished products according to the United States Pharmacopeia 2016.
Development and Validation of a Gas Chromatographic Method for Determination of Menthol in Cold-Cough Syrups
Aluda A.T , Amugune B.K , Abuga K.O , Kamau F.N.
Department of Pharmaceutical Chemistry, School of Pharmacy, University of Nairobi, P.O. BOX 1967-00202, Nairobi, Kenya, Email: firstname.lastname@example.org
Conclusion and recommendation
A gas chromatographic method was developed and validated for the determination of menthol in cold-cough syrups in Kenya. This method can be used together with a validated high-performance liquid chromatography method to assay cold-cough syrups that may also contain ambroxol, bromhexine, chlorpheniramine maleate, guaifenesin and salbutamol.
This method can be useful in routine analysis such as pre-registration studies as well as post market surveillance to curb substandard and counterfeit cold-cough syrups.
Ogoya, D.A , Kimotho J.H. , Okalebo F.A. , Osanjo G.O.Keywords:
immunogenicity, antibody, vaccine, protective responseAbstract:
Hepatitis B vaccine has been instrumental in reducing the prevalence of hepatitis B virus by preventing transmission of infection. However, the vaccines that come into the Kenyan market do not undergo quality control checks for efficacy due to lack of expertise, capital and infrastructure. This study compared the immunogenicity of hepatitis B vaccines in the Kenyan market in mice. Engerix™-B (Glaxo-Smithkline Biologicals s.a., Belgium); Euvax B (LG life Sciences, Korea) and Shanvac®-B (Shantha Biotechnics, India) were evaluated. Six to 10 week old male and female Balb/c mice were immunized and their sera assayed for hepatitis B surface antibodies (HBsAb) by the Competitive / Inhibition ELISA method. All three brands elicited a protective antibody response (> 10mIU/ml) from the mice, with sero-protection rates of 83.3%, 100% and 83.3% observed for Engerix™-B, Euvax B and Shanvac®-B respectively. Comparisons across the brands showed statistically insignificant (p = 0.793) differences in the mean concentrations. The study confirmed that the vaccines elicit a protective response, and that the two biosimilar brands, Euvax B and Shanvac®-B perform at per with the originator brand, Engerix™-B. Future studies evaluating the efficacy and effectiveness of the vaccines and their ability to offer long-term protection are recommended.
Kodhiambo M.O. , Amugune B.K.Keywords:
Household, Paediatric malaria, Prevention, Health seeking behaviour, Homa-BayAbstract:
Decisions and practices on paediatric malaria prevention and care seeking depends significantly on household characteristics.
To investigate the influence of household factors on paediatric malaria prevention and health seeking behaviour in Homa-Bay County.
We performed a population based cross sectional survey for a period of four months. A total of 406 households, representing all households in Homa-Bay County, were sampled by multistage cluster sampling. We administered questionnaires to consenting household heads. Data was analyzed by an R statistical software where descriptive summary statistics were run followed by chi square statistic to assess associations.ResultsMost households (60%) were urban, headed by a father (75%), majority being Christians (93%), with secondary education (35%), in self-employment (54%) and monthly income below KShs. 10000 (80%). Up to 42% of the respondents knew malaria as an infection, transmitted by mosquito bite (82%), manifesting mainly with fever and headache (71%). Main source of information was electronic media (43). Majority (91%) had bed nets with 48% having 2-3 nets. Most of respondents (92%) slept under the nets the night before the survey and most treated their nets within two months to the survey. 91% of the households had a child with fever in the month preceding the survey with majority (54%) seeking care on the same day. Government hospitals (58%) were preferred for seeking care and most patients (83%) underwent microscopic diagnosis. Choice of place of care seeking was influenced by knowledge on malaria, occupation, severity of fever, education and income, all with p-values<0.001. Time taken before care seeking was associated with occupation (p=0.02), fever severity (p<0.001), drugs at home (p<0.001), education (p=0.035) and income (p<0.001).
Owning nets alone is not enough to prevent malaria. Net use, treatment and care also matter. Household characteristics influence prompt care seeking.