Browsing by Author "Suleman, Fatima."

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Accessing antiretroviral treatment in the rural Eastern Cape : patients' perceptions of a decentralised pre-packing model of care and the impact on direct out-of-pocket spending.
Lines, Monique.; Suleman, Fatima.
Background: With an estimated 5.51 million HIV infected South Africans, HIV/AIDS contributes significantly to the burden of disease in the country, with far-reaching socio-economic implications particularly for poor and vulnerable groups. High out-of-pocket health expenditure associated with HIV/AIDS care has a serious impact on vulnerable individuals and is likely to severely affect the wellbeing of the affected household. Geographic inaccessibility of centralised, hospital-based antiretroviral treatment (ART) services and excessive transportation costs may contribute to patient attrition and these barriers are exacerbated in rural populations. Aim: The objectives of this study are to ascertain the out-of-pocket expenses that are incurred by patients travelling to their ART down-referral site, and compare this with the out-of-pocket expenses of those patients from the same catchment area still receiving their ART from the central hospital. The study also aims to determine whether or not the down-referral programme has impacted the patients’ economic status and improved their treatment experience. Methods: A semi-quantitative cross sectional study design was employed. Zithulele Hospital ARV Clinic and five different PHC collection points within the hospital’s catchment area were selected as the study sites. Included in the study were 44 hospital-based patients and 73 clinic-based patients registered on the Zithulele Hospital HIV Programme. Using a standard questionnaire, all socio-economic data and information related to mode of transportation and associated costs, as well as other out-of-pocket spending associated with accessing ART, was collected. Clinical data was recorded from patient medical records during the interview. Results: The average monthly household income was R1653 (R301.05 per capita) for hospital-based patients and R1617 (R392.66 per capita) for clinic-based patients. Income was predominantly sourced from either child support or pension grants. Study participants had an overall unemployment rate of 94% and, subsequently, 75% of hospital-based patients and 68.5% of clinic-based patients were living below the food poverty line of R400 per month. A higher proportion of hospital-based patients used taxis (80.5% versus 28.8%) while more clinic-based patients walked to the facility for their treatment (71.2% versus 14.6%). In terms of monthly transport costs, hospital-based patients spent on average R71.92, significantly more than the R25.81 spent by clinic-based patients. With a point estimate of 1.169, regression analysis indicated that for every one Rand increase on transport, the odds of the patient being hospital-based rather than clinic-based are 16.9% higher. There were higher levels of satisfaction recorded amongst the hospital-based group (95.5% compared to 89%) but despite this, 100% of the clinic-based patients listed their respective clinic as their preferred ART collection point. Conclusion: Decentralisation and down-referral of patients to their nearest primary healthcare clinic minimises out-of-pocket spending in rural communities while maintaining good levels of satisfaction with the healthcare service provided. It is important to consider the social, geographical and cultural context of the individuals seeking and utilizing healthcare before interventions are implemented.
A case study on the impact of international benchmarking on the price of medicines in South Africa using immunosuppressive medicines for transplant recipients for comparison.
(2019) Cassar, Kerry-Louise.; Suleman, Fatima.
No abstract available.
Community pharmacists’ perceptions and experiences of medicine shortages in disruptive situations, in Durban, South Africa.
(2024) Bachoolall , Rivana.; Suleman, Fatima.
Background: Medicine shortages are a challenge in upper, lower and middle-income countries, including South Africa. In recent years, community pharmacists in Durban, South Africa, have experienced disruptions such as the COVID-19 pandemic, flooding, civil unrest and electricity disruptions. Little is known about the impact of these disruptive situations on medicine shortages in community pharmacies. Aim: Exploring the perceptions of community pharmacists and their experiences with medicine shortages during the COVID-19 pandemic and other disruptive situations. Method: A qualitative methodology was employed to explore the topic in-depth. Convenience and snowball sampling were used to recruit 15 community pharmacists in Durban, South Africa. Semi-structured interviews were conducted in person or via an online video conferencing platform. All interviews were audio-recorded and transcribed verbatim. The transcripts were coded deductively on NVivo 14 software, using the Framework Method of thematic analysis. Initial codes and themes were informed by a literature review and final themes were identified on review. Results: A total of fifteen community pharmacists were interviewed. Five major themes were identified from thematic analysis, viz. the perceptions of medicine shortages, the impact of disruptive situations, the consequences of medicine shortages, mitigation strategies; and further suggestions and resources. Perceptions were that shortages were exacerbated by the disruptive situations. Participants perceived a negative financial impact on patients and pharmacies, with out-of-pocket costs affecting the former and loss of income affecting the latter. The mitigation strategies used were contacting stakeholders, medicine substitution and stock management. Conclusion: Community pharmacists felt that medicine shortages required improved communication, collaboration, policies, notification systems and guidelines to mitigate the problem further. These should be investigated for possible implementation to create more transparency in the event of shortages.
Cost-analysis of Misoprostol and Mifepristone versus Misoprostol and Methotrexate when used for medical termination of pregnancy in women of gestational age of 7 weeks and less at Embhuleni Hospital in Elukwatini, Mpumalanga.
(2019) Siyaya, Thembelihle Nomsa Qiosandra.; McGee, Shelley.; Suleman, Fatima.
Background: The purpose of the Republic of South Africa Choice on Termination of Pregnancy Act 92 of 1996 is to provide a safe and effective alternative to the rife illegal abortions taking place in South Africa. The Department of Health’s standard treatment guidelines recommend a regimen of 200mg Mifepristone orally stat followed by 800mcg of Misoprostol sublingually after 24 to 48 hours (for up to 9 weeks or 63 days gestation) for termination pregnancy. Mifepristone has a relatively high cost and cost-effective alternatives would be beneficial to alleviate the strain on the National Healthcare budget caused by the official termination of pregnancy regimen. Aim: To perform a budget impact analysis and calculate potential savings if Methotrexate/Misoprostol combination is used for termination of pregnancy in women of gestational age less than or equal to 7 weeks compared to the current regimen of Mifepristone/misoprostol Setting: This study was undertaken at Embhuleni hospital, a 220-bed district hospital located in the Chief Albert Luthuli sub-district in Mpumalanga. Method: Three hundred and twelve (n=312) medical records of patients who visited the Choice of Termination of Pregnancy clinic during the 2017/2018 financial year, were retrieved and analyzed. Only medical termination of pregnancy medicines cost was considered. The total cost for the medicine (Misoprostol and Mifepristone) used to bring about an abortion was calculated using the information gathered from personal details and treatment regimen. Tender prices for 2017 were used for the medicines on national tender. Results: The current regimen of misoprostol/mifepristone costs R289.25 per case. The total cost incurred by the hospital in the 2017/2018 financial year for this medicine regimen was R90, 246.00 for a total of 312 patients. The proposed regimen comprising of methotrexate tablets and misoprostol costs R32.50 per patient whilst the total cost of using methotrexate injection and misoprostol tablets is R61.61 per patient. The current regimen impacted the medicine budget by 0.95% (0.51% if used for women of gestational age 7 weeks or less), 0.05% using the Methotrexate (MXT) tablets and 0.11% using the MXT injection. The alternative regimens were still cost-saving when tested through a sensitivity analysis. Conclusion: Both MXT injection and tablets are registered in South Africa and have local manufacturers and distributors. Currently in the public sector, Mpumalanga Department of Health formulary, the MXT 2.5mg tablets are on tender. If MTX tablets had been used, the total cost savings would have been 48% and 43% for the injection. In order to bring about change which will recommend for the indications of MXT to include Medical termination of pregnancy. More studies need to be done across the country to determine the overall financial impact the current regimen has and how much money could be saved from amending the guidelines to include the cost-effective regimen of MXT and misoprostol in combination. This study was not without limitations, it studied only the medicine required to bring about an abortion, for a more comprehensive budget impact analysis more variables will need to be considered.
Determining the prevalence and scope of polypharmacy in geriatric patients at a private hospital in Pietermaritzburg, KwaZulu-Natal.
(2015) Hemraj, Arti.; Suleman, Fatima.
Background: Polypharmacy can be defined as the use of multiple medicines by a single patient and includes inappropriate medicine use. This is common among the elderly, especially in patients 60 years and older. The use of multiple medicines has been shown to predispose patients to adverse medicine reactions. Objective: The goal of this study was to determine if polypharmacy is prevalent in geriatric patients in a private hospital in KwaZulu-Natal, Pietermaritzburg, and if so to determine the extent of the problem. Methods: A cross sectional descriptive study involving chart review of geriatric patients was carried out in a hospital. Prescriptions were reviewed for concomitant use of five or more medicines, adverse medicine reactions, therapeutic duplication, contraindications and inappropriate use of medicines. Demographic data e.g. age, sex, and medical aid membership were reviewed. Diagnosis, allergies and number of chronic disease states were also analysed. Results: The majority of the patients reviewed had between one to two chronic diseases. The youngest age group 60-69 years age had the most number of patients with between 1-2 chronic diseases. Females outnumbered males in all three age categories reviewed. The most common chronic disease was hypertension. The 120 study patients were prescribed a combined total of 859 medicines. The average number of medicines per patient was 7.2 (used to determine the degree of polypharmacy) ranging from two to twenty one. A total of 75 % (n=90) of the study patients received 5 and more medicines. Prescription medicine use was assessed according to gender of the study population. Polypharmacy was more prevalent in females when compared to the males. Polypharmacy was prevalent in each age category with the 60-69 years age group having the highest prevalence. Polypharmacy was evident from the results obtained. Conclusion: Prescribing trends in geriatric patients together with inappropriate medicine use were identified. The results of this study can be used by healthcare professionals to be aware of the prevalence of polypharmacy in their settings. Health care professionals can adopt an informed approach to address the needs of the geriatric population regarding polypharmacy. Strategies for pharmacists to manage polypharmacy can include medicine review, communication with the prescriber and patient, reduction in a geriatrics regimen to the fewest possible essential medicines. Prescribers and dispensers can utilize the information to decide whether the medicine is essential and if the geriatric can tolerate possible interactions or adverse effects.
Development of a pharmacoeconomic model to compare the cost-effectiveness of low versus high dose colistin in the treatment of nosocomial pneumonia caused by Multi-Drug Resistant (MDR) Gram negative bacteria in Saudi Arabia.
(2017) Cara, Abdul Karim Suleman.; Suleman, Fatima.; Zaidi, Syed Tabish Razi.
Introduction The emergence of multi-drug resistant bacteria has led to higher treatment failure and a subsequent increase in patient mortality. Limited treatment options are available for Gram-negative bacteria (GNB) that are resistant to carbapenam antibiotics. Colistin is considered as the last resort treatment options for the carbapenamase producing GNB, though occasional reports of colistin resistance has been noted in the literature. Available studies show efficacy with both doses and with variable levels of adverse effects. In the absence of consensus regarding a dosing strategy for colistin, a model comparing low and high dose colistin in the treatment of nosocomial pneumonia will serve as a useful tool in decision making. Methods A decision–analytic model using data obtained from a retrospective review of patients treated for nosocomial pneumonia at King Abdulaziz Hospital, Saudi Arabia, was developed to compare the costs and outcomes of low dose versus high dose colistin in the treatment of nosocomial pneumonia caused by colistin-only sensitive bacteria. Outcome measures used in the analysis were length of antibiotics use, length of hospital stay, cure and nephrotoxicity in order to calculate the mean total cost of treatment, incremental costs, cost effectiveness ratios and incremental cost effectiveness ratios. Results There was a total of 171 patients that received colistin during the study period of which 96 met the inclusion criteria. Of the remaining patients 33 received high dose and 63 received low dose colistin. Low dose colistin was associated with a non-significant 9% lower cure rate than high dose colistin (21% vs 30%, respectively; p=0.292). Low dose colistin was associated with a 22% lower incidence of nephrotoxicity than HDC (30% vs 8%, respectively) which was found to be significant (p=0.004), respectively. Low dose colistin was associated with similar cure rates and greater cost savings resulting from nephrotoxicity being avoided compared to high dose colistin (ICER = -SAR 13, 894.66 per nephrotoxicity avoided). Conclusion Low dose colistin was not inferior to high dose colistin in terms of clinical cure and had a lower incidence of nephrotoxicity resulting in significant cost avoidance. The cost–benefit profile suggests that low dose colistin could be considered a more cost-effective option than high dose colistin in the treatment of patients with pneumonia caused by MDR-GNB in Saudi Arabia. King Abdulaziz Hospital should adopt the low dose colistin strategy for treatment of nosocomial pneumonia caused by colistin-only sensitive gram negative bacteria while taking cognizance of local resistance patterns.
Direct treatment costs of invasive candidiasis in Haematology patients at a South African private hospital.
(2019) Cruickshank, Rozlyn.; Suleman, Fatima.
ABSTRACT Background: Haematology patients are at a high risk of developing invasive candidiasis (IC). Fluconazole has been the mainstay of prophylaxis and treatment but recently a newer class of therapeutic options, the echinocandins, has seen a considerable improvement in treatment success. However, these agents are associated with substantial acquisition costs when compared to fluconazole. Objective: This study analysed the direct treatment costs of invasive candidiasis in haematology patients. Methods: This is a retrospective, single-centre economic analysis of haematology patients with IC, at a private hospital in Durban, KwaZulu-Natal province, South Africa.. The direct medical costs related to managing IC were analysed. These included antifungal administration costs, hospital ward costs, haematologist consultation costs and laboratory costs for blood cultures. Adult patients (≥18 years old) diagnosed with a haematology disorder and a positive blood culture for Candida who were prescribed fluconazole and/or an echinocandin as treatment were included in the study, patients in the three groups were analysed separately and compared. Results: There was a statistically significant difference for duration of antifungal treatment (p = 0.013) and antifungal administration costs (p = 0.003) between the three groups. Median overall direct treatment costs per patient were, ZAR110 365 for patients treated with fluconazole, ZAR219 915 for patients receiving an echinocandin and ZAR181 502 (for patients treated with both the antifungals. Overall hospital stay was the biggest cost contributor to the overall cost of treatment. Conclusion: The results of this cost analysis found that treatment with fluconazole only is considerably less expensive, almost half of the mean daily treatment cost, when compared to an echinocandin only and treatment using both agents is still less expensive than an echinocandin as first line therapy. 1
Drug utilization review of analgesics in the management of pain in accordance with the South African Standard Treatment Guidelines at a hospital level in Limpopo, South Africa.
(2022) Rikhotso, Muhluri Alvinah.; Bangalee, Varsha.; Suleman, Fatima.
Background One of the aims of the National Drug Policy (NDP) of South Africa was to promote the rational use of medicines and to achieve this goal, the Essential Medicines Programme (formerly EMP), which included an Essential Medicines List (EML) and Standard Treatment Guidelines (STGs), was developed. The STGs offer guidance on the rational use of medicines for the most common conditions including pain management. A perceived marked increase in the use of tramadol for pain management requires that research be undertaken to confirm if there is use of tramadol outside of prescribed guidelines, and to determine the contributing factors for this. Study aim The overall aim of the research was to review the use of analgesics in the management of pain in terms of compliance with STGs by prescribers and to determine the cost implication of failure to follow STGs in pain management for the district hospital. Prescriber awareness and use of the guidelines for pain management and the associated cost implications of nonadherence to guidelines was also assessed. Finally the study sought to ascertain prescriber experience on the misuse of tramadol when treating patients for pain. Methods This was a quantitative study in which the records of patients admitted and being treated for chronic mild to moderate pain at a district hospital in Limpopo from the 1st of April to the 30th of September 2021 were reviewed to determine whether the Hospital Level Adults STG/EML (2019) was followed when patients commenced with treatment. An Excel spreadsheet was used to record patient demographics; diagnosis; pain medication prescribed; dosage regimen; prescriber post and prescriber compliance with recommended STG. The treatment regimens for pain that were captured included paracetamol; ibuprofen; and tramadol as single prescribed therapies as well as combinations of paracetamol and ibuprofen; paracetamol and tramadol; and a combination of all three, viz. paracetamol, ibuprofen and tramadol. The recorded prescriptions were assessed for compliance in terms of the stepwise process of pain management as outlined in the Hospital Level Adults STG/EML (2019). Descriptive statistics and Excel were used for data analysis. The cost of analgesics was obtained from the Limpopo Province Pharmaceutical Depot (LPPD). A questionnaire was used to determine prescribers’ awareness of STGs, compliance with guidelines for the management of chronic mild to moderate pain, and awareness of the cost implications of non-compliance among prescribers assigned to the general ward for the period of data collection. Full ethical approval was obtained before commencement with the study. Results A total of 224 prescriptions were recorded for the 6-month period. Patients initiated on paracetamol as first-line treatment for pain were 129 (57.5 %). Nineteen patients (8.5%) were initiated on tramadol and 54 patients (24 %) on paracetamol and tramadol. Patients initiated on paracetamol and ibuprofen were 12 (5.4%); those on ibuprofen were 3 (1.3%) and 7 (3%) were switched between pain regimens. The prescription compliance rate in terms of the stepwise process of pain management as outlined in the STGs/EML was 90.6% and 9.4% were noncompliant. The total cost for both compliant and non-compliant prescriptions was R1128,10. Compliance to STGs when prescribing analgesics as reported by prescribers was 33%. Half of the prescribers (50%) stated that they only follow guidelines occasionally. Only 33% followed STGs when prescribing tramadol although 83% stated that they prescribe paracetamol for pain. All prescribers had encountered tramadol misuse by patients but only 50% monitored patients after the medicine was prescribed. The study found that 67% of prescribers had poor knowledge of the cost implication associated with non-compliance to STG. Conclusion This study has identified that there is a prescription compliance rate of 90.6% among prescribers in prescribing analgesics according to the STG/EML. There is however still room for improvement because non-compliance to guidelines has cost implications. In the South African setting where there are resource constraints, compliance is critical for the purpose of efficient use of health care resources. There is also a need for educating prescribers on the importance of compliance to guidelines.
Evaluating the impact of Single Exit Pricing (SEP) on medicine product withdrawal from the private health care market in South Africa.
(2019) Naidoo, Kasturie.; Suleman, Fatima.
ABSTRACT / SUMMARY Introduction The introduction of medicine pricing policies in South Africa in the form of Single Exit Pricing (SEP), provided a mechanism to improve medicine price transparency and reduce both medicine price and inflation. However regulating medicine prices may have had further unforeseen effects on the availability of medicine. This research presents the impact of medicine price controls in the form of SEP on medicine product discontinuations from the private health care market in South Africa Aim The aim of this study is to evaluate the impact of SEP legislation on the availability of medicines in the private health sector market in South Africa, in terms of withdrawal of medicines from the market and rationale for withdrawal. Methods A descriptive, quantitative analysis of all registered medicines on the South African market by Stock Keeping Units (SKUs) to establish medicine products withdrawn from the market by SKU during a 14 year period from 2001 to 2014. Results A total number of 152 manufacturers discontinued 3691 SKUs between 2001 and 2014. The mean number of discontinuations per generic manufacturer was 22.34 (sd= 58.11), while innovator manufacturers discontinued a mean of 27.61 (sd= 41.89). The 2002 saw the largest number of SKUs being commercially withdrawn n=603, ` 2 followed by 2003 (n=463) and 2004 (n=407). There was a negative correlation between number of discontinued SKUs per year and SEP increase; with a Pearson’s correlation coefficient (r) = -0.414 (p=0.14). Discussion Medicine pricing policies may have a dual impact in the market. Policies are typically aimed to make medicines more affordable to the patient; however pricing policies may have a negative effect on medicine availability. The results show that the SEP and transparent pricing policy may have had an impact on SKU withdrawal from the market. Lower prices and control of annual increases on medicines may have led to SKUs exiting the market. Conclusion The result of reduced product availability in the market and its impact to the cost and quality of healthcare to the patient needs to be regularly monitored and evaluated to ascertain if direct price regulations are achieving the intended outcomes as well as evaluate other intended or unintended effects in pharmaceutical market dynamics.
Evaluating the impact of the change in regulations related to medicine pricing and pharmacy ownership in the private pharmaceutical sector of South Africa.
(2020) Moodley, Rajatheran.; Suleman, Fatima.
One of the imperatives of the post-1994 government was to improve access to medicines and related pharmaceutical services to previously disadvantaged areas. The government implemented multiple strategies to achieve this goal. The first was to ensure the availability of quality affordable medicines to all its citizens. In the public sector, the government controlled the purchases through a tender system and ensured the availability and affordability of medicines to the majority of the population free at the point of service. In 2004 the government introduced the Single Exit Price (SEP), a transparent pricing system in the private sector for all prescription medicines comprising of a fixed exfactory price with a logistics fee component (and value-added tax) for medicines sold to all purchasers other than the State. This study presents two papers that evaluated a basket of 50 originator medicines and its available generics using the WHO/HAI methodology. Data were obtained from community pharmacy and pharmacy software vendors and subjected to an Interrupted Time Series (ITS) evaluation, where the changes in slope and levels of the medicines before and after regulations were obtained. A second strategy was to look at opening up ownership of pharmacies with the goal of improving access to medicines and services. On 23 October 1997, Minister Zuma introduced the amendment to the Pharmacy Bill that intended removing the restriction that ‘only people registered as pharmacists may own a pharmacy.’ The objective of the open ownership policy change was to increase public access to pharmaceutical services by increasing the number of pharmacies, especially in outlying areas. This amendment came into effect in 2003. While no extensive studies have been performed in South Africa to examine this change in ownership impact, research has suggested that open ownership has contributed to the demise of community pharmacy in rural areas (Blignault, 2010; Lowe, 2009). However, a comprehensive longitudinal evaluation has not been undertaken to date. It is unclear whether South Africa benefited from this policy or repeated the same mistakes as other countries, that have deregulated ownership, have demonstrated. The third paper examines the opening, transfer, and closing of all pharmaceutical licenses as per the South African Pharmacy Council register prior to the changes in regulation and postregulations up to 2014. Each license was tracked over time and mapped at a municipal and district level. The investigation further allowed for a population overlay to determine changes in access, ownership categories, and urban-rural access over time, and in this way, examined the impact of the change in policy and whether its intended outcomes were achieved. It addressed the gap in research and evidence in terms of the policy on the deregulation of pharmacy ownership. The research contributed to lessons for low- and middle-income (LMIC) countries, especially those on the African continent. Conclusions: Using interrupted time series methodology, the research confirmed that substantial price reductions were achieved through the Single Exit Price regulations. This was true in both the originator and generic medicine where possible savings were experienced in the private sector. While the liberalisation of the ownership laws in South Africa may have increased the number of pharmacies in the country it did not result in increased access in previously disadvantaged and rural areas to any marked degree.
Evaluation of extemporaneous compounding in tetriary hospital pharmacy in the Polokwane Municipality : a pilot study.
(2015) Masupye, Euphenia Mathebule.; Suleman, Fatima.; Govender, Thirumala.
Background: Some medicines are available in doses that are not suitable for a specific population group and therefore manipulation of the existing medication is undertaken in order to obtain the required concentration of that medication. The groups affected by this include paediatrics, adults who are unable to swallow (such as, geriatric patients); those who are fed using naso-gastric tubes; and the terminally ill. Studies on the practices, frequency and extent of extemporaneous compounding have been undertaken in other countries such as New Zealand, Australia, United Kingdom, United States of America, the Netherlands and Mexico. No published data currently exists for South Africa. Extemporaneous compounding studies are essential for improving the care of patients particularly in South Africa with its complex and unique challenges. Aim: The aim of this pilot study was to explore the extemporaneous compounding practices in a South African public sector setting. Methods: This was a pilot study using a cross-sectional descriptive design. Purposive sampling was used to sample both the hospitals and the pharmacists. A self-administered close-ended and open-ended questionnaire was designed to collect information from willing pharmacists for exploring the compounding practice processes. All the batch records from April 2008 to March 2009 were purposively sampled for frequency and extent of compounding to obtain information on dosage form, medicine classification and route of administration. The descriptive analysis was done using Statistics Package for Social Sciences (SPSS Version 20, 2011). Results: Fifty-nine questionnaires were distributed to tertiary hospital pharmacy personnel, of which 25 were returned (a 42.37% response rate). The main findings were that almost all of the pharmacists (96%) reported receiving compounding skills training and 60% of the respondents confirmed that the expiry date was personally developed. There was no proof of records being kept on the regular calibration of electronic weighing balances (76%) and maintenance (72%) despite the fact that documentation for compounding comprising of manufacturing batch records (80%), as well as compounding formula and procedures (72%) are mostly kept. The maintenance of electronic weighing balances was in the most instances, not carried out (64%). A logbook of all compounded medicines was commonly not kept (64%). A key finding was that there was limited training in aseptic technique (3%), which, if not applied correctly, could result in contamination of compounded products. About 691 batch records were reviewed for the study period. The most compounded medicines were dermatologicals (46.60%), with, creams and ointments totalling 33.0% and 13.60%, respectively. The most compounded product was Betamethasone cream (27.9%) . Conclusion: The findings suggest that there seem to be insufficient skills within the tertiary hospital pharmacy staff for small scale compounding. Documentation on equipment calibration and maintenance was not available in most cases. The findings of this pilot study highlight the need for further such studies across South Africa to identify and improve extemporaneous compounding training and practice in the country.
An evaluation of knowledge, attitude and behaviour amongst patients regarding antibiotic use and misuse in South Africa.
(2020) Ballaram, Sholene.; Suleman, Fatima.
Background: Antibiotic misuse is a global problem that presents a threat to public health. Antibiotic misuse and overuse are responsible for the increase and spread of antibiotic resistance. The community plays a fundamental role in the appropriate antibiotic use and the increase and spread of antibiotic resistance. Hence, public knowledge and attitude regarding antibiotic use are imperative in treatment success. Method: A quantitative approach was performed using a descriptive cross-sectional design. The data were collected by a self-administered questionnaire completed by patients accessing the pharmacy. The data was analysed using descriptive statistics, namely Microsoft Excel and the Statistical Package for the Social Sciences (SPSS). Results: From a total of 135 respondents, the majority (n = 108; 80%) of the respondents were aware that different antibiotics were needed to treat different diseases. However, over two-thirds (n = 98; 73%) of the respondents agreed that antibiotics are effective against viruses. More than half of the respondents (n = 82; 61%) considered that antibiotic resistance is a global problem. The vast majority of the sample population (n = 104; 77%) agreed that the pharmacists often tell them how to use their antibiotics during the dispensing process. However, a high number of respondents (n = 97; 72%) agreed that doctors take time to inform them during the consultation on using the antibiotics that s/he prescribed, but this number is lower (n = 104; 77%) when compared to the pharmacists. Conclusion: The results demonstrate that the community frequently uses antibiotics. These findings indicate misunderstanding related to the antibiotics' role and their cause of the disease (bacterial or viral). The multifaceted educational interventions and patient-healthcare provider communication tools should focus on the specific socio-demographic factors and misconceptions of antibiotics to promote rational antibiotic use. Community-based interventions will help prevent the development of antibiotic resistance, cross-resistance and anticipated future events of treatment failure.
Exploring pharmacists views, knowledge and perceptions regarding generic medicines in the Western Cape.
Shaikh, Naseema.; Suleman, Fatima.; Bangalee, Varsha.
BACKROUND In 1996, South Africa adopted a National Drugs Policy. An important objective of this policy focused on promoting the use of generic medicines in the country to ensure that medicines are accessible to the majority of South Africans. Pharmacists play a vital role in influencing patients’ choice of medication, thus highlighting the importance of gaining all health professionals’ support for the quality and utilization of generic medicines. OBJECTIVES This study sought to assess and evaluate the perceptions, views, knowledge and willingness to recommend generic medicines by pharmacists that are located within the Western Cape, as well as to explore pharmacists’ perceptions towards the safety, quality, and efficacy of generic medicines. In addition, the study assessed pharmacists’ views on current policy with respect to substitution of generic medicines as well as to determine if these views vary in the different practice settings. Finally the study assessed pharmacists’ views on the pricing system of generics as well as their opinion on promotion of these medications. METHOD A cross-sectional online survey, which targeted 1730 pharmacists living in the Western Cape, was conducted, using SurveyMonkey, from 7 September to 7 October 2014. Data collected included participant demographics, qualification, experience, education, knowledge and perceptions of generic medication. Survey Monkey was used to produce graphical representations of the data and data was exported onto Microsoft excel in order to make analytical comparisons. RESULTS A total of 321 pharmacists responded to the questionnaire (a response rate of 18,6%). 82% of pharmacists stated there is no difference in safety between original brand and generic medicines. Majority of respondents (74%) believed that generic medicines are therapeutically equivalent to the original medicines. However, 39% of pharmacists stated that original medicines are of a better quality than their generic counterparts. A large number (more than 60%) of pharmacists reported concerns of bioequivalence as their main problem when switching to a generic medicine. CONCLUSION Majority of Pharmacists in the Western Cape had a positive outlook on generic medication and supported and encouraged its use. Concerns were raised however, regarding quality, safety, and effectiveness of generic medicines as well as doubts in the reliability of certain generic manufacturing companies. Pharmacists’ opinions could negatively impact generic usage in South Africa, therefore continuing education and awareness campaigns should be implemented in order to re-confirm pharmacists’ knowledge of generic medicines being bioequivalent and of equal quality to branded medicines. Furthermore, pharmacists should be encouraged to report Adverse Drug Reactions in order to resolve any quality issues.
Exploring trends in antibiotic use and resistance in a district, regional and tertiary hospital in the uMgungundlovu District.
(2017) Desai, Ayesha.; Essack, Sabiha Yusuf.; Suleman, Fatima.
Antibiotics play an important role in overcoming life-threatening bacterial infections. However, the increasing rate of antibiotic resistance is a serious threat to public health. Undoubtedly the indiscriminate use of antibiotics plays a role in the emergence of resistance. The objective of this study was to identify the trends in antibiotic use and resistance at three public sector hospitals at three different levels of healthcare in the uMgungundlovu district, i.e., a district hospital, a regional hospital and a tertiary hospital. The antibiotics indicated for the treatment of infections caused by Escherichia coli (Gram-negative bacteria) and Staphylococcus aureus (Gram-positive bacteria) were investigated. Yearly antibiotic consumption data was calculated as Defined Daily Dose (DDD) per 1 000 inhabitants and percentage susceptibility was analysed based on susceptible and non-susceptible isolates for each antibiotic. There was a general trend of reduced antibiotic susceptibility as the levels of healthcare increased attributed to the fact that more severe and complex infections are treated at the higher levels of healthcare and require greater quantities of and/or broader spectrum antibiotics. For treatment of infections caused by S. aureus antibiotic use generally increased as the level of healthcare increased. Azithromycin was the most frequently used while linezolid was the least used antibiotic and showed the highest levels of susceptibility across all levels of healthcare. S. aureus showed the lowest level of susceptibility to cloxacillin across all the levels of healthcare and was indicative of the prevalence of methicillin-resistant S. aureus (MRSA). When antibiotic use was correlated with resistance, cloxacillin displayed a downward trend in use from 2014 to 2016 while cloxacillin resistance increased from 2014 to 2015 followed by a decrease in resistance in 2016 indicating that resistance is a function of time and use and that the lag time between the decrease in use and a corresponding decrease in resistance is not predictable and varies for different antibiotics in different healthcare settings. In contrast, azithromycin showed a steady decline in resistance although use increased over the three years (2014-2016). In the case of the treatment of infections caused by E. coli there was a general trend of the greater use of narrow spectrum antibiotics at the lower district and regional levels while the broad-spectrum antibiotics were used more frequently at a tertiary level. Trimethoprim-sulphamethoxazole was used the most, whereas colistin was used the least. Contrary to expectations, there were higher susceptibility levels to third and fourth generation cephalosporins and meropenem at a tertiary level than regional level. E. coli showed lowest levels of susceptibility to ampicillin and highest level of susceptibility to levofloxacin across all levels of healthcare. When antibiotic use was correlated with resistance, antibiotics that were used frequently however resistance remained high. The same trend was observed with amoxicillin clavulanic acid and ampicillin use and resistance indicating possible co-selection of resistance by the use of other classes of antibiotics. This study added to the body of knowledge that there exists a link between the use of antibiotics and resistance, albeit not a direct causal one. Quantifying antibiotic use and identifying trends in resistance associated with antibiotic consumption assists prescribers and policy makers to improve antibiotic use, guide antibiotic stewardship programmes and optimise antibiotic policies and guidelines.(sulphamethoxazole-trimethoprim, amoxicillin clavulanic acid and ampicillin) displayed high levels of resistance over the three years. Trimethoprim-sulphamethoxazole use decreased slightly over the years however resistance remained high. The same trend was observed with amoxicillin clavulanic acid and ampicillin use and resistance indicating possible co-selection of resistance by the use of other classes of antibiotics. This study added to the body of knowledge that there exists a link between the use of antibiotics and resistance, albeit not a direct causal one. Quantifying antibiotic use and identifying trends in resistance associated with antibiotic consumption assists prescribers and policy makers to improve antibiotic use, guide antibiotic stewardship programmes and optimise antibiotic policies and guidelines.
The impact of the introduction of generics and generic references pricing and candesartan and rosuvastatin utilisation, price and expenditure in South Africa.
(2017) De Jager, Hendrik Petrus.; Suleman, Fatima.
Rationale for the study The growth of pharmaceutical expenditure as a percentage of total health care expenditure has stagnated, both locally and globally, despite increasing consumption. Two factors that contributed to the stagnation are the introduction of generic medicines after patent expiry, and the introduction of cost-containment policies, like generic reference pricing. The introduction of generic medicines offer the opportunity to reduce medicine expenditure because of a switch in utilisation from expensive brand-name originator products to more cost-effective generic alternatives. Reference pricing is a policy where therapeutically similar medicines are grouped together, and a maximum reimbursement rate is set for the group. If a patient chooses to use a product more expensive than the reference price, they have to pay the difference in price. In the South African context, generically similar products are grouped together and the reimbursement rate is set at the average price of the generically equivalent products. Aims and objectives The aim of the study is to determine the impact of the introduction of generics and generic reference pricing on two active ingredients, candesartan and rosuvastatin, which recently lost their patent protection, in the South African private health care sector, for the period January 2012 to December 2015. To achieve this aim, three objectives were identified: 1. To measure the impact on medicine utilisation after the introduction of generics and generic reference pricing on candesartan and rosuvastatin. 2. To measure the impact on the average medicine price after the introduction of generics and generic reference pricing on candesartan and rosuvastatin. 3. To measure the impact on medicine expenditure after the introduction of generics and generic reference pricing on candesartan and rosuvastatin. Method Medicine claims for candesartan and rosuvastatin was obtained from a Pharmacy Benefit Manager in South Africa. The claims covered a 48-month period from January 2012 to December 2015 and provided a pre- and post-reference price period for analysis. Medicine utilisation was measured as the number of Defined Daily Doses dispensed per 100 000 beneficiaries. Medicine price and expenditure was calculated as the average per Defined Daily Dose. Results Candesartan experienced an average 7.0% year-on-year decline in utilisation and rosuvastatin a 5.0% increase. Utilisation of generic medicines was 59.3% of the total volume in the final year of the study for candesartan and 76.4% for rosuvastatin. The introduction of generic alternatives resulted in a 31.0% reduction in the average price per Defined Daily Dose for candesartan and a 13.9% reduction for rosuvastatin. Medicine expenditure reduced by an additional 34.6% and 20.9% for candesartan and rosuvastatin respectively, because of the introduction of generic reference pricing. The total saving because of the introduction of generics and generic reference pricing was 54.8% for candesartan and 31.9% for rosuvastatin. Conclusion The introduction of generics and generic reference pricing did not have an impact on overall medicine utilisation, but reduced the price and expenditure of both candesartan and rosuvastatin.
Investigating medicines availability for selected non-communicable diseases at Raleigh Fitkin Memorial Hospital, Manzini, Swaziland and the impact on patient out-of-pocket payments.
Shabangu, Kholiwe.; Suleman, Fatima.
Background: The burden of non- communicable diseases (NCDs) in low and middle -income countries is greatly increasing and posing both financial and public health concerns. Increased morbidity has significantly reduced quality of life in these populations and Swaziland is no exception. Patients with NCD’s often have to pay for their medicines out-of-pocket. The extent of this practice is not known. Methods: The study was conducted at a regional hospital in Manzini that serves majority of NCD patients in the central part of the country. Exit interviews were conducted with 300 patients diagnosed with diabetes, hypertension and asthma. Patients were asked how often they experienced stock-outs of essential medicines at the facility and how much they paid at private pharmacies to access the medicines. Responses were triangulated with Central Medical Stores’ (CMS) 2012 annual stock records to ascertain availability of the selected medicines and their turnaround time which was the time taken for medicines to be issued to the facility on receipt after they had been out of stock at CMS. Results were analyzed using the Statistical Package for Social Sciences (SPSS). Results: Majority of patients (n=213; 71%) confirmed not receiving the complete package of their prescribed medicines at each visit to the hospital in the past six months. On average patients spent 10-50 times more for their medicines in private pharmacies than they would when accessing them from the health facility. Stock-outs at CMS ranged from minimum of 30 days to over 217 days in the course of the assessment period (12 months) were recorded and found to be the cause of stock-outs in the health facility. The turnaround time of medicines from CMS to the facility was not found to have influence on shortages recorded in facility. Conclusion: Out-of-pocket expenditure is very common for patients with NCDs using this health facility which increases of the possibility of default on treatment because they cannot afford the commercial fees charged at private pharmacies. Patients were paying 10 to 50 times more to access medicines for their conditions in private pharmacies than when accessing them from the health facility in the event they were out-of-stock.
Investigating the administration of medication in a private healthcare facility: identifying the most common medication administration error.
(2015) Selagan, Nirvana.; Suleman, Fatima.; Ojewole, Elizabeth Bolanle.
Background: Medication errors are an ongoing global problem for which there is limited South African data. Most medication errors have been shown to occur during the prescribing and administration of medication, with medication administration errors being the type of medication error least likely to be caught before reaching the patient. A study was conducted in one ward in a South African private healthcare facility to investigate the administration of medication in order to identify the most common medication administration error. The potentially serious effects of medication administration errors for the patient, as well as limited South African data on the topic show the significance of this study. Aim: Identification of the most common medication administration error in the selected ward. Method: Medication administration was observed over 16 consecutive days in one ward in a private healthcare facility in KwaZulu-Natal, South Africa. Allowing medication errors to occur for observation was considered unethical. Observer intervened in cases of potential errors before the error reached the patient. These potential errors were counted as near-misses. Nurses who administered medication in the ward also filled out a questionnaire to obtain their views on medication administration errors. Sampling was by convenience for both elements of the study. Results: A near-miss rate of 10.65% (n=56) including wrong time near-misses. The most common type of near-miss was wrong dose (33.93%, n=20). Discussion/Conclusion: The most common type of near-miss was wrong dose mainly due to ineffective communication between members of the healthcare team, which provides direction for educational efforts to improve system safety and thereby reduce near-miss rate. Recommendations: A bigger study involving more sites is required. Improved communication is required especially between pharmacists and nurses administering medication by communicating changes on prescriptions to nurses and providing medication information.
Investigating the availability of antimicrobials at Kamuzu Central Hospital in Malawi.
(2017) Hamisi, Tadala.; Suleman, Fatima.; Småbrekke, Lars.; Khuluza, Felix.
Stock-outs of medicines in Malawian public hospitals affect the majority of the population, and may have serious public health consequences. Aim The aim of this study was to identify stock-outs of selected antimicrobials in the years 2014 and 2015 at Kamuzu Central Hospital (KCH), and investigate whether there were alternative treatments available. Methods This was a retrospective, cross-sectional observational study. The sample list of 70 medicines represented antimicrobial agents on the Malawi Essential List of Medicines. Data was collected from Pharmacy stockkeeping records and analysed in Microsoft Excel. The following calculations were made; total number of days out of stock per year, total number of episodes out of stock and stock-out duration. Results The most available group were antituberculosis at stock-out median number of days of 10 and 62, in 2014 and 2015 respectively. Most stocked-out was the antiretroviral medicines group with a median stock-out days of 175 and 170 in 2014 and 2015 respectively. Antibiotic agents had median number of days of 65 and 96. Specifically penicillins had median stock-out days of 86 in 2014 and 119 in 2015 whereas cephalosporins had 67 in 2014 and 80 in 2015. Macrolides had 36 and 87 median stock-out days in 2014 and 2015. Antimalarial medicines had median number of stock-out days of 55 in 2014 and 32 in 2015. Alternative first line treatments for malaria and TB were available; however, HIV, STD and pneumonia alternatives were not always available. Recommendations Stock-outs of antimicrobials occurred at KCH in both 2014 and 2015. In some cases, alternative therapy was unavailable, and patients probably received inadequate treatment. This negatively affects patient outcome in addition to the possible negative public health effects due to development of antimicrobial resistance.
An investigation into the relationship between the number of available generics within a therapeutic class and prices of medicines in South Africa.
(2013) Bangalee, Varsha.; Suleman, Fatima.
Abstract available in PDF file.
Profile of sickness absenteeism at the Consul Glass factory, Clayville, Midrand, 2004.
(2008) Suleman, Fatima.; Naidoo, Saloshni.
INTRODUCTION Sick leave absenteeism is a recognized problem in all work sectors. The financial impact of sick leave has been well-documented. A profile of sick leave records can establish the extent of the sick leave problem in a workplace, the associated and predisposing factors for sick leave and the patterns of sick leave amongst workers. A baseline profile of the sick leave patterns in a workplace should be a preliminary step toward developing a programme aimed at the improvement of workers' health and attendance at work. AIM OF THE STUDY The aim of this study was to profile recorded sick leave for 2004 amongst permanent workers at the Consul Factory in Olifantsfontein, Midrand, Johannesburg in order to make recommendations to management. METHODS This was a cross-sectional study using a retrospective review of sick leave records of permanent workers at the Consul Glass factory for 2004. Information gathered included the demographic profile of workers who recorded sick leave, the frequency of sick leave, associated factors for sick leave, health care choices of workers with sick leave and the reasons for sick leave. Descriptive and analytic statistics have been presented. RESULTS • Workers over the age of fifty years had sick leave of longer duration compared to those younger than 50 years old (p<0.05). The median hours taken off for sick leave was higher in the male subgroup compared to the female subgroup of workers in the study population (p<0.05); • Workers from the production areas had more sick leave episodes for the year than workers from the non-production areas (p<0.05). Workers with bronchitis working in the production areas of the factory, had longer duration of sick leave compared to workers with bronchitis working in the nonproduction areas of the factory (p<0.05); • Workers on a variable shift schedule took more sick leave on days of the week that were unlinked to weekends and public holidays (p<0.05).A longer duration of sick leave occurred with certified sick leave compared with self reported sick leave (p<0.05); • In the study population, the majority were not medical aid members. Medical aid members had a longer duration of sick leave per episode compared to non-medical aid members (P<0.05); • Respiratory tract infection was the most common reason for sick leave. Of the ten most common reasons for sick leave, there was a significant difference in the mean number of hours of sick leave taken per episode for dental treatment and backache (p<0.05); • There was a significant difference in the mean number of hours of sick leave recommended by the four different sources of sick notes (p<0.05); • There was a significant association for worker interviews/counselling by the Human Resources' Department official and the worker having had four or more episodes of sick leave for the year (p<0.05). CONCLUSION The profile of sick leave at this company identified important associations with sick leave patterns. These significant findings provide management with baseline information, which can be used for the development of workplace interventions to address the taking of sick leave at the Consul Glass factory.