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Pharmaceutical Journal of Kenya, Volume 23, No. 1 (2016)

Volume: 23, No. 1 (2016)
Publisher: The Pharmaceutical Society of Kenya
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Articles in the journal

Editorial: Let's put a Stop to Non-Adherence to Treatment Guidelines in Clinical Practice

Author: Orwa JA

Factors Influencing the Management of Non Hodgkin's Lymphoma in Children at Kenyatta National Hospital

Author: Winnie W. Mwangi , Peter Karimi , Apollo Maima , Charles Githinji , Abdallah Fatumad
Keywords: Non Hodgkin's Lymphoma, Oral chemotherapy, adherence, side effects, cumulative doses
Background: Non-Hodgkin's lymphoma is one of the common childhood cancers. The three main types are lymphoblastic lymphoma, small non cleaved cell lymphoma (Burkitt's and non Burkitt's lymphoma) and largecell lymphoma. Burkitt's lymphoma is the most prevalent.
Objectives: To assess the factors that influence the management of Non-Hodgkin's lymphoma in pediatricpatients during the maintenance phase of therapy at Kenyatta National Hospital.
Methodology: This was a cross-sectional study, involving a universal sample of 19 pediatric patients withNon-Hodgkin’s Lymphoma in the maintenance phase of therapy at Kenyatta National Hospital. Data was collectedthrough interviews and abstraction from patient files andrecorded in a structured questionnaire. Analysis was doneusing descriptive and inferential statistics by employingStatistical Package for Social Sciences version 17.0.
Results: Of the 19 patients, 13(68.4%) were male. The meanage for all the patients was 9.84 years (95% CI: 8.3, 11.3).Eight (42.1%) patients had missed their oral medication.The method of acquisition of oral medication, estimatedexpenditure on medication per month and whether theguardian was counseled on the side effects of themedication, were found to be statistically significant (pvalue 0.037, 0.02 and 0.037 respectively) with adherence.The most prevalent side effects was loss of hair followed bychange in nail/skin pigmentation, dizziness, constipationand tingling sensation of lower extremities. Twelve (63.1%)patients received a cumulative dose of doxorubicin between 200-400mg/m while only 10% had cumulative dose above 400mg/m. Conclusion: The overall adherence to cytotoxic therapywas slightly above average. The reasons for this findingwere high cost and unavailability of the medications as wellas methods of acquisition of the oral medications. Counseling on side effects of the drugs was a significantbarrier to adherence.

Determinants of Neonatal Mortality in a Public Urban Maternity Hospital in Kenya

Author: Tele A. K , Nyamu D.G , Juma R. , Gitonga I.
Keywords: Neonatal mortality, Determinants, Pumwani maternity hospital
Background: The neonatal period carries the highest risk of death in the human lifespan. Published data on prevalence and determinants of neonatal mortality in Kenya remain scant.
Objectives: To find out the prevalence, causes and determinants of neonatal mortality at Pumwani Maternity Hospital in Kenya.
Design and Methodology: A retrospective study was conducted through audit of 600 neonatal records with detailed analysis of child’s health outcome in the first 28 days of life. The health outcome included post delivery complications such as respiratory distress, asphyxia prematurity and birth weights. Maternal bio-demographic and socio-economic variables were also abstracted. The socio-economic variables listed included maternal’s highest education level, occupation, and marital status. The bio-demographic variables included maternal age at delivery, gender of the child and type of birth while and utilization of antenatal care. Data analysis was done using SPSS Version 20 computer software. Descriptive, cross tabulation and logistic regression analysis were done to examine the association of neonatal mortality and the individual risk factors for death while adjusting for covariates.
Results: Prevalence of neonatal mortality was 12.8%, with neonatal respiratory distress accounting for 49.8% of all deaths followed by asphyxia (11.7%) and prematurity (11.2%). The odds of neonatal death were found to be highest among neonates born to mothers who did not utilize antenatal care services [OR=6.52; CI= 2.76 -15.37, p<0.001] and in neonates whose birth weight was less than 2500 grams [OR=10.25, CI= 3.57 -18.49, p<0.001]. A reduction in the odds of neonatal deaths occurred as the level of mothers’ education increased (p=0.008). In addition, neonates born to young mothers (15-19 years) and older mothers (45-49 years) were less likely to die compared to other age categories.
Conclusion: Neonatal mortality rate at Pumwani hospital is high and multiple factors associated with death have been identified. These factors may be modifiable through intensification of antenatal and intrapartum care.

Adherence to National Guidelines for the Diagnosis and Treatment of Malaria at the Kisii Teaching and Referral Hospital in Kenya

Author: Bichanga K.P*, Karimi N.P, Guantai E.M
Keywords: Clinical guidelines, ACTs, AL
Background: The Ministry of Health has developed specific national guidelines for diagnosis and treatment of malaria in Kenya. These guidelines assist health workers in making decisions on appropriate management of patients with malaria.
Objectives: The main objective of this study was to determine the proportion of patients with suspected malaria who were treated in accordance with the national guidelines.
Methodology: The study was a hospital-based cross-sectional study involving retrospective review of 430 patient files. Medical records of malaria patients were scrutinized to determine the proportion that was treated according to the guidelines. Data was collected using pre-tested data collection forms. The data was analyzed using descriptive and inferential statistics. The level of significance was set at 0.05.
Results: Majority of the patients [78.1% n=336] were aged <13 years. The mean age of the patients was 11.2 years [± SD 15.0 years]. The median age was 6 years with a range of 0.1 years to 84 years. Only 65% of the suspected cases were tested for malaria by either microscopy or Rapid Diagnostic Test (RDT). All the patients were expected to have been tested for malaria in accordance with the guidelines. Approximately 35% were not subjected to either confirmatory test. Of those tested, 78.4% tested positive and 25.5% tested negative for malaria with 95.8% of those who tested negative being issued antimalarials. Of the 208 patients who tested positive, 109 were classified as uncomplicated malaria but 99.1% of these patients received treatment for severe malaria. The most common co-morbidity in the patients treated for malaria was anaemia [29.9%] followed by gastroenteritis [9.9%]. Patients with co-morbidities were more likely to receive appropriate treatment [p=0.033] compared with those with none. The most commonly used combination of drugs was quinine and Artemether-Lumefantrine (AL) [44.7%] followed by artesunate and AL [43.3%]. The outcomes in these patients were discharge [95.6%], re-admission [2.6%], death [1.4%] and transfer [0.5%].
Conclusion: Malaria management was characterized by poor adherence to diagnosis and treatment guidelines. Antimalarial prescription in patients who test negative and those who are untested is still practiced in Kenya.

Competitiveness of the Kenya pharmaceutical manufacturing industry: Price comparison of local and imported pharmaceutical products

Author: Vugigi S. K. Ogaji I. J. and Thoithi G. N.
Keywords: Local, imported, pharmaceutical equivalents, price
The World Health Organization has identified affordability as a contributory factor to medicine access. The Kenya National Pharmaceutical Policy (2012) aims to promote access to affordable essential medicines through local production. The objective of this study was to compare the trade price of local and imported pharmaceutical equivalents in Kenya. A list of locally manufactured essential medicines was prepared by examining the Kenya Essential Medicines list and local manufacturers’ product lists. Medicines with three or more local and imported pharmaceutical equivalents were subjected to price comparison using Excel® functions and scatter diagrams correlation. There was no significant variation between mean price values for local and imported products. Standard deviation values were higher for the majority of imported products. A local pharmaceutical equivalent was cheaper for 39.5 % and an imported for 47.4 % of the products. Scatter diagrams demonstrated prevalence of cheaper imported products. Majority of imported pharmaceutical equivalents were cheaper than local products making the Kenya pharmaceutical industry non-competitive.

Inventory Management Practices Influencing the Availability of Essential Tuberculosis Medicines at Health Facilities in Nakuru County

Author: Momanyi L B , Adoyo M. & Muthoni E.
Keywords: Inventory management system, Tuberculosis medicines, Availability, Information tools, Storage
Introduction Kenya ranks fifteenth among the twenty two high tuberculosis burden countries that contribute to 80% of the global tuberculosis burden. It is imperative to scale up tuberculosis eradication interventions in order to reduce morbidity and mortality and promote health for all. To achieve this, it is critical that drugs are consistently available to treat patients, prevent spread of the disease and minimize drug resistance. Health facilities within Nakuru County have been experiencing severe shortages of various anti-tuberculosis medicines. This is likely to be due to weaknesses in the tuberculosis medicines management practices at the facility level. The objectives of the study were to establish the effect of inventory analysis method practiced and the information tools in use on the availability of essential anti-tuberculosis medicines at health facilities in Nakuru County.MethodsThe study was conducted in January 2015 at 31 health facilities in Nakuru Central, Gilgil and Naivasha Sub-counties. These were purposefully selected as they had 90.4% of the total tuberculosis cases in 2012. Ethics approval was obtained from the Kenya Methodist University Research and Ethics Department. Permission to conduct the study was obtained from the Nakuru County Health Department. This was a cross sectional study. Stratified sampling was used to randomly select the 31 health facilities from sub-county and facility level strata. Each facility had one respondent hence the study involved 31 health care staff involved in tuberculosis medicines inventory management. Data was collected through self-administered structured questionnaires. There was a 100% response rate.ResultsMajority of the health facilities that had good availability of tuberculosis medicines practiced the maximum-minimum method of inventory analysis. Facilities practicing ABC system were 15 times more likely to experience unavailability of TB commodities as compared to those practicing Maximum –Minimum (Odds ratio = 15.0(1.5-149.7), p =0 .021). The information tools were available in all facilities; however, the proportion of use was always lower than proportion of availability. The association between availability of the data tools and availability of tuberculosis medicines was not significant (Daily Activity Register (DAR) odds ratio = 0.9 (0.2-4.3), p-value = 0.981); Facility Consumption Data Requisition & Report Form (F-CDRR) odds ratio = 0.7(0.1-3.8),p-value = 0.679; Requisition & Issue vouchers (SLLs) odds ratio = 1.8(0.2-15.0),p-value = 0.576)).Majority 26 (83.9%) of the respondents had adequate storage capacity. They however cited storage challenges which varied insignificantly with availability of tuberculosis medicines (P =.056).

The Qualification Statuses of Community Pharmacy Managers in Nairobi County, Kenya

Author: Mugumura J.R.
Keywords: Highest level of education, pharmacy training status, qualification, regulatory approval, professional body membership, continuous medical education.
The aim of this study was to determine the proportion of qualified community pharmacy managers. The indicators for qualification included pharmacy training, registration with the Pharmacy Board, professional body affiliation and continuous medical education. It was executed in Nairobi County. Twenty six electoral wards were selected randomly. Mapping of the selected clusters yielded a study sample of 477 community pharmacies. A self-administered, structured questionnaire in English was administered to the pharmacy managers.
The response rate was 57.4% with roughly half below 30 years of age while 93% were below 45 years of age. Slightly over half of the respondents were males while the rest were female. Over 62% had diploma level education while 18.6% were degree holders. About 19% had either post-secondary certificates or were secondary school leavers. About two thirds had pharmacy experience ranging 0-5 years while 29% had 6-10 years’ experience. Only 4.7% had over 10 years’ experience. The majority of respondents (92.3%) had some form of pharmacy training. Out of these, 16% had a pharmacy degree, 68% diploma and 16% pharmacy certificates. This means only 75% of respondents had acceptable qualifications (pharmacy degree or diploma). Similarly, 77% had Pharmacy and Poisons Board registration. About 70% belonged to professional bodies while 73% regularly attended continuous medical education. Of those affiliated to professional bodies, 28% were affiliated to the Pharmaceutical Society of Kenya, 68% to Kenya Pharmaceutical Association and about 4% belonged to other professional bodies.
The majority of community pharmacy managers met the qualification criteria. However, about 25% did not meet the minimum acceptable level of training, and were therefore not licensed by the regulator. This situation raises concern given the sensitivity of the position. It is recommended that pharmacists and pharmaceutical technologists should combine forces with the regulatory authority to eliminate illegal operators.