Patients’Knowledge, Attitude and Practices on Disposal Methods of Expired and Unused Medicines: Implication for Creation of Drug Take-Back Program

Background: Handling of medicines is a day-to-day activity by patients and many health care providers. However, multiple studies have brought to light inappropriate disposal methods for expired and unused medication (EUM). Improper disposal of expired and unused medicines is hazardous both to humans and the environment. Objective: This sought to measure patients’ knowledge, attitude, and practices on disposal methods of EUM. Methods: A cross-sectional study was carried out among 384 patients at three outpatient pharmacies at the University Teaching Hospitals (UTHs). The structured questionnaire was used to collect data and STAT version 15.1 was used to analyse the data. Results: 384 respondents participated in this study and, at some point, had EUM. In this study, 356 (92.7%) of the participants reported that they had never heard of a drug take-back system. Most of the participants 285 (74.2%) and 239 (62.2%) kept and donated their unused medicine, respectively. Additionally, 244 (63.5%), 212 (55.2%), and 176 (44.8%) of the participants disposed of expired medicines in the bin or garbage, flushed them in toilets or sinks, or burned them, respectively. Occupation was significantly associated with unsafe disposal of unused medicine [P-value = 0.019]. Conclusion and Relevance: Knowledge of safe disposal methods for EUM was good amongst most participants. However, used unsafe disposal methods. The majority of the participants exhibited positive attitude concerning safe disposal methods. This study highlights the need for drug-take-back program creation in Zambia.

Roles of Community Pharmacists in Screening and Disseminating of Information about Non-Steroidal Anti-Inflammatory Drugs Risks: Implications for Drug Safety Assessment

Background: The increasing use of non-steroidal anti-inflammatory drugs (NSAIDs) both on prescription and over the counter raises a major global health concern because of the risks associated with their use if no proper guidance is given by the health care provider. This study assessed the roles of community pharmacists in screening and disseminating information about the risks associated with NSAID use in Zambia. Methodology: This was a national cross-sectional study in which a structured self-administered questionnaire was administered to 245 registered community pharmacists in Zambia. Stata/BE, version 15.1 (Stata Corporation, College Station, Texas, USA) and multivariate logistic regression model was used to determine factors associated with information dissemination about ADRs of NS-NSAIDs. Results: 231 of the 245 distributed questionnaires were returned giving a response rate of 94.3%. All (100%) participating community pharmacists claimed to have practiced dispensing NSAIDs. However, only 26 (11.0%) and 71 (30.8%) regularly screened for risk factor of selective COX-2 NSAIDS (SC2-NSAIDS) and non-selective NSAIDS (NS-NSAIDs) respectively. Information dissemination on adverse drug reactions (ADRs) of SC2-NSAIDS was regularly provided by only 22 (9.5%) of pharmacists while that of NS-NSAIDs was regularly provided by 49 (21.2%). In the multivariate logistic regression model, being the owner of a pharmacy (AOR: 5.4, CI: 1.84 - 16.4) was significantly associated with information dissemination about ADRs of NS-NSAIDs while an hour increase in the working hours per day (AOR: 0.9, CI: 0.64 - 0.95) was associated with less likelihood of information dissemination. Conclusion: Pharmacists working in community pharmacies in Zambia did not regularly screen and disseminate information about the risks associated with NSAID use. Therefore, pharmacists should be able to screen and monitor patients at risk and be aware of the majority of risk factors while dispensing NSAIDs to minimize the associated complications.

Global Strategies to Combat Antimicrobial Resistance: A One Health Perspective

Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies to reduce and combat AMR is critical. Purpose: This study aimed to highlight some global strategies that can be implemented to address AMR using a One Health approach. Methods: This study employed a narrative review design that included studies published from January 2002 to July 2023. The study searched for literature on AMR and antimicrobial stewardship (AMS) in PubMed and Google Scholar using the 2020 PRISMA guidelines. Results: This study reveals that AMR remains a significant global public health problem. Its severity has been markedly exacerbated by inappropriate use of antimicrobials in humans, animals, and the broader ecological environment. Several strategies have been developed to address AMR, including the Global Action Plan (GAP), National Action Plans (NAPs), AMS programs, and implementation of the AWaRe classification of antimicrobials. These strategies also involve strengthening surveillance of antimicrobial consumption and resistance, encouraging the development of new antimicrobials, and enhancing regulations around antimicrobial prescribing, dispensing, and usage. Additional measures include promoting global partnerships, combating substandard and falsified antimicrobials, advocating for vaccinations, sanitation, hygiene and biosecurity, as well as exploring alternatives to antimicrobials. However, the implementation of these strategies faces various challenges. These challenges include low awareness and knowledge of AMR, a shortage of human resources and capacity building for AMR and AMS, in adequate funding for AMR and AMS initiatives, limited laboratory capacities for surveillance, behavioural change issues, and ineffective leadership and multidisciplinary teams. Conclusion: In conclusion, this study established that AMR is prevalent among humans, animals, and the environment. Successfully addressing AMR calls for a collaborative, multifaceted One Health approach. Despite this, some gaps remain effectively implementing strategies currently recommended to combat AMR. As a result, it is essential to reinforce the strategies that are deployed to counter AMR across the human, animal, and environmental sectors.

Zambia’s Response to the COVID-19 Pandemic: Exploring Lessons, Challenges and Implications for Future Policies and Strategies

The coronavirus disease 2019 (COVID-19) pandemic is a global public health problem that has affected the globe in different ways. There is little information published on the challenges and lessons learnt in responding to the COVID-19 epidemic in Zambia. Objective: To establish Zambia’s response, lessons and the challenges experienced in the fight against COVID-19. Results: Since the emergence of COVID-19, Zambia has experienced three waves, with the third wave being the most severe. The Zambian government responded positively and effectively to all three pandemics with the help of cooperating partners. Zambia adopted the World Health Organization (WHO) recommended prevention methods such as hand hygiene, masking up in public, physical distancing, avoiding crowded areas and staying at home to prevent the further spread of the disease. Additionally, surveillance of COVID-19 was strengthened, which led to the early detection of cases. Besides, there has been a strong call for all Zambian adults to receive the COVID-19 vaccine as a way of controlling the epidemic. However, since the launch of the COVID-19 vaccination programs, there has been a high level of vaccine hesitancy, causing Zambia to fall below the 10% of the adult population required to be vaccinated. Conclusion: The Zambian government put in place effective strategies in the fight against COVID-19. However, a lack of resources, misinformation, myths and vaccine hesitancy posed challenges in the fight against COVID-19 in Zambia. There is a need for continuous public education and sensitization on COVID-19 and the importance of vaccinations.

Phytochemical Analysis and Antibacterial Activity of <i>Azadirachta indica</i>Leaf Extracts against <i>Escherichia coli</i>

Background: Traditional medicine has employed Azadirachta indica to treat a variety of ailments. However, there is little information on the use of this plant in Zambia. Objective: To evaluate the phytochemicals and antibacterial activity of Azadirachta indica leaf extracts against Escherichia coli. Materials and Methods: This was a laboratory-based experimental study in which ethanol and water were used for extraction by maceration. Phytochemical analysis was then done on the leaf extract. Using the disc diffusion method, varying concentrations of A. indica aqueous and ethanolic extracts were used to test the antibacterial activity of A. indica against Escherichia coli. The sensitivity of the tested microorganisms to aqueous and ethanolic leaf extracts was shown by zones of inhibition after incubation. Results: The phytochemical screening of the A. indica leaves revealed the presence of phenolics and tannins in both the ethanol and aqueous extract. Saponins, flavonoids and alkaloids were only present in the aqueous extract. While steroids were only present in the ethanol extract. The antibacterial activity of A. indica leaves extract was determined by zones of inhibition which showed that both aqueous and ethanol extracts had activity against E. coli. The Minimum Inhibitory Concentration was determined at 10 mg/mL for the aqueous extract and 20 mg/mL for the ethanol extract. The zones of inhibition increased with concentration. Conclusion: The extracts of A. indica displayed antibacterial activity against E. coli in a dose-dependent manner. Comparatively, the aqueous extract produced better antibacterial properties against E. coli than the ethanolic extract.

Knowledge, Attitudes, and Practices of Poultry Farmers on Antimicrobial Use and Resistance in Kitwe, Zambia: Implications on Antimicrobial Stewardship

Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding the knowledge, attitude, and practices of poultry farmers on AMU and AMR. Therefore, this study assessed the knowledge, attitude and practices regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Methods: This was a cross-sectional study conducted among 106 poultry farmers from November to December 2021 using a structured questionnaire. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: Overall, of the 106 participants, 90.6% knew what antimicrobials were, but only 29.2% were aware of AMR. The study showed that 46.2% of the participants had low knowledge, 71.7% had negative attitudes, and 61.3% had poor practices regarding AMR. The prevalence of antibiotic use in poultry production was 83%. The most used antimicrobials were tetracycline (84%) and gentamicin (35.2%). The commonly reported reason for the use of antimicrobials was for the treatment (93.2%) and prevention (89.8%) of diseases. Further, 76.9% of the administered antimicrobials were usually done without veterinarian consultation or prescription. Conclusion: The study shows that there was high AMU in poultry farms in Kitwe. However, there was low knowledge, negative attitude, and poor practices towards AMU and AMR. Therefore, there is a need for educational and sensitisation programmes regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Alongside this, antimicrobial stewardship and surveillance systems should be strengthened in the livestock production sector. This will ensure food safety and public health.

Psychological Impact of COVID-19 on Healthcare Workers in Africa, Associated Factors and Coping Mechanisms: A Systematic Review

Background: The coronavirus disease 2019 (COVID-19) is a public health problem that has caused harm to the mental health of healthcare workers. In Africa, the COVID-19 pandemic has led healthcare workers to experience mental health disorders such as anxiety, depression, stress, insomnia and burnout. This study aimed to review published studies on the effect of COVID-19 on the mental health of healthcare workers, associated factors and coping strategies that have been employed in Africa. Methods: This was a systematic review that was conducted through searching databases including;PubMed/Medline and Google Scholar. The study included published literature from January 2020 to May 2022 that met the inclusion criteria. The selection of articles was conducted following the 2020 PRISMA guidelines. Results: A total of 39 articles were retrieved, of which only 18 met the inclusion criteria and were used in this study. Our review revealed that healthcare workers experienced mental health disorders such as anxiety, depression, insomnia, stress and burnout that were associated with the COVID-19 pandemic. Coping strategies such as religious practices, support from family members and colleagues and avoiding listening to social media about COVID-19 were used to minimize mental health problems. Conclusion: The COVID-19 pandemic has caused increased mental health disorders among healthcare workers in Africa. Identification of factors associated with mental health problems is cardinal in developing coping mechanisms against the psychological impact of COVID-19. Therefore, there is a need for governments to develop and implement strategies for protecting the mental health of healthcare workers during crises such as the COVID-19 pandemic.

Challenges Affecting African Countries in the Fight against the COVID-19 Pandemic: Implications for Interventional Strategies in Low- and Middle-Income Countries

The coronavirus disease 2019 (COVID-19) has caused many global challenges, especially in resource-constrained countries. Africa, a continent with a large number of low-and middle-income countries (LMICs), shares this burden disproportionately compared to developed countries. Here we review some of the major challenges African countries face in the fight against COVID-19 and propose some mitigation measures. Studies have reported low adherence to COVID-19 prevention measures in most African countries. Additionally, there has been a shortage of healthcare workers, inadequate surveillance and diagnostic tools, unavailability of drugs in healthcare facilities, increased wrong beliefs, myths, misinformation and misconceptions about COVID-19 and vaccinations, and an already existing burden of infectious and non-infectious diseases across the African continent. Despite being very challenging to implement across African countries, telehealth is a critical solution to offer healthcare services during disease outbreaks. Many African countries have faced challenges in the fight against COVID-19. The training of healthcare workers (HCWs) must be strengthened to help address the shortage. In addition, African countries should strive to invest in research and capacity-building to be self-reliant regarding diagnostic tests. Thus, there is an urgent need to address the challenges faced by African countries in this fight, which may even include increased collaborations with other countries.

Familiarity, Knowledge and Practices of Healthcare Professionals Regarding the Pharmacovigilance of Biological Medicines in Lusaka, Zambia: A Multi-Facility Cross-Sectional Study

Background: Pharmacovigilance of biological medicines is crucial because it ensures that medicines meet the World Health Organization (WHO) standards. In Zambia, there is little information on healthcare professionals’ familiarity, knowledge and practices on the pharmacovigilance of biological and biosimilar medicines. Therefore, this study investigated the familiarity, knowledge, and practices related to the pharmacovigilance (PV) of biological and biosimilar medicines at selected hospitals in Lusaka, Zambia. Methods: The study was an analytical questionnaire-based cross-sectional study conducted among healthcare professionals (HCPs) at the Adult hospital, Cancer Diseases hospital, Paediatrics hospital and Women and New Born Hospital in Lusaka. Data were collected over four weeks in May and June 2021 and subsequently analysed using IBM SPSS version 21. The statistical significance was set at a 95% confidence interval. Results: Of 245 participants, only 115 (48.9%) of the HCPs were familiar with biological medicines to a basic understanding. Regarding the term biosimilars, most of the HCPs (40.9%) never heard of this word. The mean score for knowledge regarding the PV considerations of biological medicines was 4.1 out of 8 questions. Most HCPs used non-proprietary names (44.2%) when prescribing, dispensing, or administering biological medicines. Additionally, more than half (57.3%) of HCPs did not record batch numbers when dispensing or administering biological medicines. Conclusion: Healthcare professionals were more familiar with the term biological medicines than biosimilars. Healthcare professionals generally scored poorly when their knowledge regarding the PV considerations of biological medicines was assessed. Thus, there is a need to provide adequate training and continuous professional development among healthcare professionals on the pharmacovigilance of biological and biosimilar medicines.

Availability of Antimalarial Medicines in Community Pharmacies of Lusaka District, Zambia: Implications on Compliance to Malaria Treatment Guidelines

Background: Malaria remains a major cause of morbidity and mortality in Zambia, affecting all levels of society, with children under the age of five and pregnant women being most at risk of serious illness. The availability of antimalarial medicines is one of the key interventions of malaria management. This study assessed the availability of antimalarial medicines in community pharmacies in Lusaka district, Zambia. Materials and Methods: This was a cross-sectional study that was conducted among 210 community pharmacies from September to November 2022 using a well-structured checklist in selected areas of Lusaka district. The availability was verified by a physical check of the product. The checklist contained the medicines listed both in the guidelines for diagnosis and treatment of malaria in Zambia as well as in the World Health Organization (WHO) malaria treatment guidelines. Results: This study found that all antimalarials listed in the local treatment guidelines for malaria were available in community pharmacies, though with the varying distribution. Of the 210 community pharmacies, 209 (99.5%) had artemether/lumefantrine in stock. The lowest available antimalarial was quinine/clindamycin, which was only available in 3 (1.4%) of the outlets. Conversely, 3 out of 16 (18.8%) antimalarials that were available in community pharmacies were not listed in the local treatment guidelines of malaria in Zambia, despite being listed in the WHO malaria treatment guidelines. This translated into a compliance level of 81.2% based on the local malaria treatment guidelines. Conclusion: This study concluded that antimalarials were available for all categories of malaria management in community pharmacies, though with a varying distribution. The presence of antimalarials not listed in the Zambian treatment guidelines is of public health concern which may have an impact on antimicrobial resistance in the future.

Assessment of Knowledge, Attitude and Practices towards the Disposal of Unused and Expired Medications among Students of Private Medical Universities in Lusaka, Zambia

Background: The disposal of unused and expired medications has been a concern in many countries in that, the pharmaceutical waste enters the ecosystem and eventually causes a negative impact on human health and environment. Aim: To assess the knowledge, attitude and disposal practices of unused and expired medicines by students in the private medical universities in Lusaka of Zambia. Method: A cross-sectional survey was conducted over a period of 8 weeks among 391 respondents from three private universities in Lusaka. Respondents were polled using semi structured questions that focused on their knowledge, attitudes, and disposal practices for unused and expired drugs. In order to analyze data, the statistical package for social sciences (SPSS) version 20 was utilized. Results: The mean age of the participants was 23 years (SD: ±3). Out of the 391 participants, 320 (81.8%) knew about medicine waste and 391 (100.0%) responded that unsafe disposal of unused and expired medicine poses a threat to human health and can harm the environment. The drug-take-back system was unknown to a vast percentage of the respondent 371 (94.9%). The majority 274 (70.1%) of respondents had unused medicine stored at home, with antibiotics 215 (56.0%) and analgesia 111 (28.4%) being the most prevalent types of drugs kept in the households. The most commonly used disposal practice for unused 126 (32.2%) and expired medicines 274 (70.1%) was throwing them in household garbage. Only 27 (6.9%) and 30 (7.7%) reported returning unused and expired medicines to the nearest pharmacy respectively. The majority of respondents believed the risk stemmed from the presence of an undesired drug in the home, the potential for harm to children, a lack of proper information on safe disposal practices, and the necessity for a take-back program. Conclusions: The majority of the study participants used unsafe methods to dispose of unused and expired medicine. However, most of the participants acknowledged that unsafe disposal of unused and expired medicines is a public health problem and proposed the need to introduce drug take-back programs in the communities.