- A
study to investigate the rational use of antibiotics in ten district hospital
in Mashonaland provinces
Chikerema, L.
and Kasilo, O.
A study to investigate
the rational use antibiotics in in-patients in District hospitals in Mashonaland,
over a five month period, was carried out in a retrospective study. The
study also analysed the extent to which prescribers in these hospitals
follow treatment guidelines outlined in the Essential Drug List for Zimbabwe
EDLIZ and the effect of irrational antibiotic prescribing on treatment
costs. A total of 600 cases, randomly selected, were compiled from 10 randomly
selected District hospitals in Mashonaland. World Health Organisation (WHO)
drug use indicators were used to extract information from in-patients prescriptions
which had antibiotic(s) prescribed on them. Antibiotic treatment costs,
as supplied by Government Medical Stores (GMS), and statistical analysis
were also studied, for the drugs compiled. Benzylpenicillin was the most
prevalently occurring antibiotic appearing in 263 prescriptions (43,8%)
followed by co-trimoxazole which accounted for 28% representing 170 prescriptions.
In all, 99 prescriptions (16,5%) were irrationally prescribed and 85,86%
of these were irrationally indicated and the remainder irrational due to
incorrect dosing. Chloramphenicol was the most irrationally prescribed
antibiotic accounting for 29,3% (29 prescriptions). Of all the antibiotics
analysed, only, Amoxycillin-Potassium clavulanate does not appear in EDLIZ.
Total treatment costs of the cases studied amounted to $21 122.37 and proportion
irrationally prescribed was $2 660.10. There is need for health centres
to maintain high levels of record keeping and need for physicians to clearly
outline course of therapy and prognosis. Treatment guidelines outlined
in the EDLIZ are being followed at a highly commendable level. Some prescriptions
indicated that where the prescriber was not sure of the diagnosis (due
mainly to inadequate diagnostic tools), he would query several condition.
Antibiotics are being prescribed irrationally in District hospitals in
Mashonaland.
- Comparison
of compliance with medicines dispensed from clinics versus community pharmacies
Duve, B. and
Maponga, C.
The purpose of the
study was compare compliance with medicines dispensed from clinics versus
those dispensed from community pharmacies in Chitungwiza. The patients
used were those on chronic anti hypertensive therapy taking hydrochlorthiazide
(HCT) and methyldopa, following up of patients was done using addresses
form registers obtained from clinics or pharmacies where patients got their
medicines. Tablet counting was done on106 patients form clinics and 52
patients from pharmacies. The level of compliance was determined by matching
the amount of tablets the patients had on the day of counting to the amount
that should have actually remained. In the study 25 out of 106 patients
from the clinics were compliant and 15 of the 52 patients from pharmacies
were compliant . This represented 23.59% and 28.84% of the samples respectively.
On statistical analysis the difference in the levels of compliance was
no significant. From the study it was found that compliance with long term
therapy was low (25%). The sources of medicines to a small extend affected
compliance. The factors that affected compliance in the sample done were
counselling, cost, side effects and their attendance, level of expertise,
polypharmacy and quality of services. It was then concluded that the best
place where patients could get their medicine was the clinic on condition
that aspects like counselling, labelling and level of expertise were improved. - An
assessment of the prescribing habits of general practitioners in selected
geriatric homes in Harare
Gwatidzo, P.
and Chinyanganya, F.
Prescribing habits
at four geriatric homes B.S Leon, Dorothy Duncan Belvedere and Nightingale
were established using the WHO Indicators for Rational Drug Use. This was
to provide a baseline data for any future work. The average number of drugs
prescribed per encounter was 4.5, with 27% of prescribed drugs being antibiotics.
Of all the drugs prescribed only 64.9% appear on the Essential Drugs List
for Zimbabwe (EDLIZ) and 34.8% were prescribed using generics. The percentage
of drugs that were prescribed that were injectables were 16.1% and 65.9%
and 44.1% of the patients in the homes were on sedatives and antihypertensive
respectively. The results obtained were used to draw up recommendations
for future work for doing an audit and feedback intervention targeted at
the prescribers and nurses. This baseline survey can be used to create
intervention strategies for the promotion of rational drug use.
- Effectiveness
of various patient counselling techniques
Kurebwaseka,
F. and Maponga, C.
The effectiveness
of three different patient counselling techniques was assessed using patients
from Chitungwiza General Hospital, Seke North Clinic and Zengeza 2 Clinic
as the study population. The patients level of knowledge and understanding
about their medications was first assessed prior to counselling (Assessment
1) and then a few days after counselling (Assessment 2) when each patient
was visited at home. The average mark scored by patients prior to counselling
(Assessment 1) was found to be between 30% and 35% of what they could have
scored. The difference in marks scored by a patient between Assessment
2 and Assessment 1 calculated as a percentage was used to determine the
change in knowledge and understanding of the patient about his/her medication
hence providing a measure of the effectiveness of the counselling technique
used. Counselling Technique 1 in which fifty (50) patients were given information
leaflets but not counselled verbally produced an average 19.8% increase;
counselling Technique 2 in which fifty (50) patient were given information
leaflets and counselled verbally but individually produced a 39.5% increase;
and counselling Technique 3 in which 51 patients were given information
leaflets and counselled verbally in groups of 2 to 5 persons produced a
36.1% increase in the average mark scored by the patients. Although not
a measure, the mark scored by a patient was an indicator of the level of
understand and knowledge of the information concerned. All three techniques
satisfied the objective of improving patient knowledge and understanding
by at least 20% with Technique 2 and Technique 3 almost doubling this target
improvement. The ratio of knowledge the patients had after counselling
compared to the knowledge the patients had before counselling was 1.56
for Technique 1; 2.23 for Technique 2 and 2.08 for Technique 3. The most
remembered type of information was the name of the medication. Analysis
showed that although Technique 2 was not statistically superior to Technique
3, it appeared to be more effective in increasing the total number of patients
whose knowledge and understanding actually improved. It was concluded that
Technique 2 and Technique 3 were equally effective in improving patients
knowledge and understanding about their medications. Technique 1 was about
half as effective as the other two. The appropriateness of use of a given
technique depended on the particular circumstances confronting the pharmacist
or health worker involved. Technique 1 (individual non-verbal counselling)
was found to be suitable for very busy conditions where the pharmacist
has little time to spare and talk to patients. Technique 2 (individual
verbal counselling) would be good were the pharmacist could afford reasonable
amounts of time with each patient. Technique 3 (group counselling) would
be more appropriate for a relatively busy pharmacy with relatively large
numbers of patients receiving the same type of medication and who could
be gathered in reasonable groups.
- The
chemical and antimicrobial screening of Trichodesma physaloides
Madondo, G. and
Gundidza, M.
The plant extract
from the tubers of Trichodesma physaloides was extracted using the method
of Leven and her co-workers (19). Using the hole plate diffusion method
for antibacterial testing, the methanol extract exhibited significant activity
against Acinetobacter calcoaceticus, Aeromonas hydrophila, Bacillus subtilis,
Klebsiella pneumonia and Staphylococcus aureus. There was no antibacterial
activity against Lactobacillus plantarum and Serratia marcensesn. The dry
weight method was used to test for antifungal activity. The fungal species
Geotriclium candidum and Candida albicans showed significant sensitivity
to the methanol fraction of Trichodesma physaloides. Chemical Screening
was also done on the crude powdered plant material. This revealed that
the plant contains a lot of alkaloids, saponins and anthraquinones. The
plant also has some traces of tannins and flavonoids.
- Antibiotic
use in the treatment and management of sepsis in ICUs
Maduveko, P.
and Nyazema, N.
A prospective study
was carried out using 70 patients (30 males and 40 females) in two ICUs
at Parirenyatwa and Harare Central Hospitals to evaluate the pattern of
antibiotic use in the management and treatment of sepsis in ICU and to
justify the keeping of a septic patient in the ICU. Patients either admitted
into ICU with sepsis or those who became septic after admission into ICU
were studied with the aid of data-collection sheets. The majority of the
studied patients (55,7%) were in the age range of 21-40 years. The commonest
admitting diagnosis of septic patients were puerperal sepsis (21.4%), appendicitis
(12.9%), pelvic abscess (12.9%) and peritonitis (11.4%). Meningitis and
other CNS infections (45.7%), diarrhoea (38%) and pleural effusion (20%)
were the most prevalent complications among the septic patients. The most
utilised antibiotic categories were penicillins(87.1% utilisation), aminoglycosides
(61.4%), chloramphenicol (51.4%, cephalosporins(35,7%). Benzylpenicillin,
metronidazole, gentamicin, chloramphenicol, ceftriaxone and ampicillin
were the most utilised individual antibiotics with percentage utilisations
of 72,9, 72.9, 61.4, 51.4, 31.4 and 27.1 respectively. 8.5% of the antibiotics
were the only expensive, non-EDLIZ antibiotics used in the patients studied.
The mean duration of treatment with antibiotics was 7,7 days per antibiotic.
75,4% of the antibiotic administration was by parenteral routes whilst
the oral and rectal routes accounted for 24.6%. The average number of antibiotics
was found to be 3.41 per patient. The mean duration of stay in ICU was
18,4 days and was prolonged in HIV infected patients. 37,1% of the studied
patients died in the ICU. The daily minimum monetary cost maintaining a
septic patient in ICU was five-hundred dollars in the studied group. Keeping
of a septic patient in ICU was justified with priority considered on the
basis HIV or HB status. Antibiotics use for sepsis treatment correlated
well with both the observed and known causative organisms of sepsis. The
study showed that there is generally rational use of antibiotics in the
treatment and management of sepsis in the ICUs studied, though complete
cost-effective use of antibiotics is yet to be achieved. - Herbal
remedies and HIV infection/AIDS
Madyiwa, R. and
Nyazema, N.
A study was carried
out to find out the toxic effects of herbal remedies which are used in
HIV infections/AIDS. Healthy male and female Calb C mice, weighing between
24-44g and aged between 6-8 weeks were used in the study. Herbal remedies
obtained from one traditional healer were orally administered to the mice.
In all the test carried out, no significant toxicity was observed. Minimal
hepatomegaly and kidney hypertrophy were observed in the mice after subchronically
and chronically exposing them to the herbal remedies. In another study
in which 8 AIDS patients were interviewed, 4 said that most of their symptoms
had be alleviated. 1 reported only a slight improvement and 3 said they
had not improved at all. Since 50% had most of their alleviated then we
can conclude that herbal remedies are effective in alleviating the symptoms
of AIDS.
- Antimicrobial
and chemical screening of the fruit extract of Solanum incanum and its
incorporation into a lotion
Mahmood, S. and
Gundidza, M.
The fruit extract
of Solanum incanum was screened for its chemical and antimicrobial properties.
The citric acid fraction was tested for its in vitro antimicrobial activity
against 25 bacteria, 9 fungi and a yeast. Biological test methods for screening
the plant extract consisted of the agar overlay technique for antibacterial
testing and the filtration method for antifungal testing. Significant antimicrobial
activity, against all the fungi and almost all the bacteria species, was
exhibited by the extract. Amongst the bacteria the most susceptible organisms
were Klebsiella pneumoniae, Lactobacillus plantarum, Leuconostoc cremoris,
Proteus vulgaris and Pseudomonas aeruginosa. The extract, however, did
not show any activity Salmonella pullorum and showed minimal activity against
Clostridium sporogenes. Antifungal results indicated the most susceptible
fungi to be Aspergillus ochraceus and the most resistant, Alternaria alternata.
Results obtained from general chemical screening indicated the presence
of alkaloids, saponins and polyphenols, which have been reported to show
antimicrobial activity in other plant species as well. The I.C.P. (inductively
Coupled Plasma) method used to investigate the mineral content of the extract,
showed it to contain a significant amount potassium, magnesium, iron, sulphur
and phosphorus. Incorporation of the extract into a lotion for topical
application caused a reduction in the antimicrobial activity exhibited
by the extract. This could be due to possible interactions between the
plant extract constituents and lotion ingredients. Solancum lotion was
found to be stable for two weeks at room temperature and for one week when
incubated at 35-40oC.
- Effect
of cantharidin on DNA synthesis in vitro
Mahuni, C. and
Nyazema, N.
The effect of cantharidin
on DNA synthesis in vitro was investigated using PCR (polymerase chain
reaction). The hepatitis B virus DNA plasmid was used. Different concentration
of cantharidin dissolved in acetonitrile-water were with 2ul plasmid DNA
at 37oC at different times. In other words 5ul or 10ul (concentration 5uglul)
cantharidin solution in a buffer with 2ul plasmid DNA for 340 minutes,
1 hour and 2 hours. After the specified times 10ul of each were added to
the PCR reaction, which was then viewed under UV to check for amplification.
In another reaction 2ul cantharidin solution was added to a PCR reaction
in which there was no plasmid DNA incubation. The results obtained showed
tat no amplification occurred if incubation was done for more than 30 minutes.
In addition amplification occurred when there was no incubation. Therefore
from this it can be ascertained that cantharidin may inhibit DNA synthesis
in vitro if there is longer contact time between DNA plasmid and cantharidin.
[ii]
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