Evaluation of the intracellular lipid-lowering effect of polyphenols extract from highland barley in HepG2 cells

Active ingredients from highland barley have received considerable attention as natural products for developing treatments and dietary supplements against obesity.In practical application,the research of food combinations is more significant than a specific food component.This study investigated the lipid-lowering effect of highland barley polyphenols via lipase assay in vitro and HepG2 cells induced by oleic acid(OA).Five indexes,triglyceride(TG),total cholesterol(T-CHO),low density lipoprotein-cholesterol(LDL-C),aspartate aminotransferase(AST),and alanine aminotransferase(ALT),were used to evaluate the lipidlowering effect of highland barley extract.We also preliminary studied the lipid-lowering mechanism by Realtime fluorescent quantitative polymerase chain reaction(q PCR).The results indicated that highland barley extract contains many components with lipid-lowering effects,such as hyperoside and scoparone.In vitro,the lipase assay showed an 18.4%lipase inhibition rate when the additive contents of highland barley extract were 100μg/m L.The intracellular lipid-lowering effect of highland barley extract was examined using 0.25 mmol/L OA-induced HepG2 cells.The results showed that intracellular TG,LDL-C,and T-CHO content decreased by 34.4%,51.2%,and 18.4%,respectively.ALT and AST decreased by 51.6%and 20.7%compared with the untreated hyperlipidemic HepG2 cells.q PCR results showed that highland barley polyphenols could up-regulation the expression of lipid metabolism-related genes such as PPARγand Fabp4.

Model informed precision medicine of Chinese herbal medicines formulas-A multi-scale mechanistic intelligent model

Recent trends suggest that Chinese herbal medicine formulas(CHM formulas)are promising treatments for complex diseases.To characterize the precise syndromes,precise diseases and precise targets of the precise targets between complex diseases and CHM formulas,we developed an artificial intelligence-based quantitative predictive algorithm(DeepTCM).DeepTCM has gone through multilevel model calibration and validation against a comprehensive set of herb and disease data so that it accurately captures the complex cellular signaling,molecular and theoretical levels of traditional Chinese medicine(TCM).As an example,our model simulated the optimal CHM formulas for the treatment of coronary heart disease(CHD)with depression,and through model sensitivity analysis,we calculated the balanced scoring of the formulas.Furthermore,we constructed a biological knowledge graph representing interactions by associating herb-target and gene-disease interactions.Finally,we experimentally confirmed the therapeutic effect and pharmacological mechanism of a novel model-predicted intervention in humans and mice.This novel multiscale model opened up a new avenue to combine“disease syndrome”and“macro micro”system modeling to facilitate translational research in CHM formulas.

Study of the Management and Disposal Practices of Unused or Out-of-Date Medicines by Households in the Municipality of Ouagadougou, Burkina Faso

Introduction: Not all medicines that pass-through consumers’ hands are used, and some often expire in households. These health products can be sources of accidental risks and pollution when they are not properly disposed of. In Burkina Faso, there are as yet no guidelines for the disposal of unused medicines in households. The aim of this study was to estimate the extent of household possession of unused or expired medicines, and to describe attitudes and disposal practices. Methods: This was a descriptive cross-sectional study covering households in the Ouagadougou commune conducted from June to August 2021. Two-stage stratified sampling was used: selection of Enumeration Zones (EZs) and selection of households, with each EZ comprising several households. Data collection was based on direct interviews using a structured questionnaire. Data were processed using Epi Info software version 7.2.4.0. Results: In total, 417 household residents were surveyed out of the planned 423 households, corresponding to a completion rate of 98.58% compared with the initial sample. Among the respondents, 79.62% had unused and/or expired medicines in their household. A total of 2562 drug packaging units were counted, for a total weight of 121.90 kg. Nearly 75% were aware that improper disposal was a danger to the environment. Some respondents kept their unused medicines at home until they expired (43.41%), and disposed of them mainly by throwing them in the household garbage (75.58%). The majority (79%) were in favor of the government setting up a take-back program for these medicines. Conclusion: The introduction of a take-back program for unused or out-of-date medicines will ensure safer disposal of medicines, and better protection for households and the environment.

Introduction of Western Medicines into China and Improvement on Decoctions during Modern China

During the late Qing dynasty(1840 A.D.-1912 A.D.),a large quantity of Western medicines entered China,which continuously impacted the traditional Chinese medicine(TCM)market and revealed the shortcomings of Chinese medicines.Some personages in the TCM community followed the trend of learning from the West,and attempted to reform TCM,with the improvement on decoction becoming an important aspect of this effort.Through debates and trials,the improvement on decoction underwent three stages of conceptual evolution:“taking Chinese medicines as the foundation and referring to the dosage forms of Western medicines”,“introducing Western techniques to serve the preparation of decoctions”and“integrating the theories of TCM and Western medicine to improve decoctions”.The study highlights the effective complementarity between modern TCM and Western medicine in the field of pharmacy,and provides valuable experience and support for the reevaluation of the value of TCM in contemporary society.

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.

Comparative efficacy and safety of Chinese patent medicines of iron deficiency anemia during pregnancy:A network meta-analysis

BACKGROUND Iron deficiency anemia(IDA)is a prevalent nutritional disorder during pregnancy.Clinical studies indicate that incorporating Chinese patent medicines(CPMs)with oral iron(OI)in treating IDA in pregnancy can reduce adverse effects and improve clinical outcomes.Nonetheless,the comparative efficacy of different CPMs remains unclear.AIM To assess the safety and effectiveness of different CPMs for treating IDA during pregnancy using network meta-analysis.METHODS We conducted a search for randomized controlled trials(RCTs)that combined CPM and OI for IDA treatment in pregnancy,spanning from 2013 to the present.Data analysis was performed using Rev Man 5.3 and Stata 14.0 on literature that satisfied the quality criteria.RESULTS The analysis included 45 RCTs,encompassing 4422 pregnant patients with IDA.Six CPMs were examined,including Shengxuebao Mixture,Shengxuening Tablets(SXN),Yiqi Weixue CPMs(YQWX),Jianpi Shengxue CPMs(JPSX),Yiqi Buxue Tablets,and Compound Hongyi Buxue Oral Liquid(FFHY).Findings indicated that FFHY+OI significantly improved the clinical effective rate.SXN+OI was most effective in boosting red blood cells counts and hemoglobin levels.YQWX+OI showed superior results in improving serum ferritin,and SXN+OI was most effective in increasing serum iron levels.JPSX+OI was optimal in reducing adverse pregnancy outcomes,while YQBX+OI effectively minimized adverse events.A cluster analysis suggested that SXN+OI could be the potentially optimal therapeutic regimen for IDA in pregnancy.CONCLUSION This study demonstrates that the combination of OI with CPMs offers better outcomes than OI alone.Based on clinical efficacy and other measured outcomes,SXN+OI emerges as the most effective treatment modality for improving the health of pregnant patients with IDA.

The potential of Chinese herbal medicines in treating anxiety disorders

In recent years,there has not been much progress in developing anxiolytic drugs.Amongst the barriers are the lack of clarity on the pathogenesis of anxiety disorders,low product conversion rates for developing drugs targeting the receptors,and species variability.Some scientists have focused on natural medicines,especially herbal medicines in traditional Chinese medicine.New drugs with excellent anxiolytic activity are hoped to be found in herbal medicines with anxiolytic effects.This mini-review summarised three Chinese herbal medicines with anxiolytic effects and anxiolytic herbal formulas used in the traditional Chinese medicine clinic.Several key issues that block the development of new anxiolytic drugs are also discussed.We hope to provide some ideas for researching and developing new anxiolytic drugs and studying anxiolytic components in traditional Chinese medicine.

Use of Topical Complementary and Alternative Medicines (CAM) in Diabetic Septic Foot Disease in Makkah Region, Western of Saudi Arabia, an Exploratory Study

Diabetes is a chronic condition that is significantly impacted daily by environment. At least one in five Saudis, suffer from diabetes. “Diabetes is a pandemic of unprecedented magnitude spiraling out of control” (Boulton). Saudi Arabia ranks the second highest in the Middle East, and is the seventh in the world for the prevalence of diabetes (WHO). Diabetes mellitus (DM) has been found to be related to high mortality, morbidity accompanied by poor general health and lower quality of life. Current Saudi diabetes patients’ behaviors, practices, and beliefs regarding foot health problems such as ulcers, are not well investigated. Diabetic patients frequently utilize natural remedies and Herbs for self-medication as a part of complementary and alternative Medicine. Aim of study: To explore the widespread use of the alternative remedies in the local communities of the Western Saudi Arabia, the drives behind using and to focus on the potential adverse effects following their usage. Method: A descriptive, cross-sectional study of 386 diabetic patients with feet problems in Makkah Region, West of Saudi Arabia during the period April - June 2023. Results: Out of the 531 participants, only 386 participants reported diabetic foot disorder (DFD). Most of the participant were above 65 years of age group (24.61 %). Male (52.08%) more than female (47.92%) in the research group. All of the participants had diabetic foot disorders at least once. The prevalence of complementary and alternative medicines (CAM) use among them was 67.88%, as solitary or in combination with hospital medicines. Honey headed the list followed by myrrh and black seeds. Acquaintances advice (59.54%) was the most reason for using the alternative medicine. 60.30% of Diabetic foot patient complained of adverse effects during CAM remedies use. Conclusion: Consumption of CAM remedies among diabetic patients for Diabetic Foot Disorder (DFD) is common. Honey headed the list followed by myrrh and black seeds. Additional wide-scale research is required to establish their actual efficacy, safety and potential adverse out-comes and to generalize the outcomes.

Lipids,lipid-lowering drug and sepsis:a Mendelian randomization study

lipid-lowering interventions on the disease.Methods:Two-sample Mendelian randomization analyses were conducted to evaluate the associations of high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,triglycerides,apolipoprotein B and apolipoprotein A-I levels with risks for sepsis,and those of low-density lipoprotein cholesterol(HMGCR,PCSK9,NPC1L1),triglycerides(LPL,ANGPTL3,APOC3)and high-density lipoprotein cholesterol(CETP),apolipoprotein A-I(CETP),apolipoprotein B(HMGCR,PCSK9,NPC1L1,LPL,APOC3)with sepsis.Results:HMGCR-mediated low-density lipoprotein cholesterol and apolipoprotein B were associated with an increased risk of sepsis,with an odds ratio value of 1.4(95%confidence interval(CI):1.06-1.84,P=0.017)and 1.41(95%CI:1.01-1.98,P=0.046).CETP-mediated high-density lipoprotein cholesterol and apolipoprotein A-I were associated with a reduced risk of sepsis,with an odds ratio of 0.87(95%CI:0.82-0.92,P<0.01)respectively and 0.84(95%CI:0.78-0.9,P<0.01).Sensitivity analysis showed that the results were robust.Conclusion:HMG-CoA reductase inhibitors and CETP inhibitors may contribute to the prevention and treatment of sepsis.

Advances in Research Methods of Pharmacodynamic Substances in Traditional Chinese Medicines and Their Application in the Teaching of Traditional Chinese Medicine Analysi

With the continuous progress of science and technology,the research methods of pharmacodynamic substances in traditional Chinese medicine are developing,and the application of these methods in teaching is becoming more and more extensive.By introducing these research methods into the classroom,teachers can help students to deeply understand the nature and mechanism of action of pharmacodynamic substances in traditional Chinese medicine,and improve their interest in and knowledge of traditional Chinese medicine.This paper introduces the definition of pharmacodynamic substances in traditional Chinese medicine,research methods,and their application in the teaching of traditional Chinese medicine analysis.

Improving the Selection Model of Essential Medicines in China by Evidence-based Thinking

Objective To sort out the problems in the selection model of essential medicines in China,and to put forward some suggestions to optimize the selection model to ensure the rationality of the medicines in the essential medicines list.Methods The domestic and foreign literature on the selection of essential medicines was reviewed.Then,the opinions on the selection methods and results of essential medicines from foreign literature were investigated to make a comparison with the selection of essential medicines in China.Finally,the general and special laws of the selection process of the essential medicines were explored.Results and Conclusion It is recommended that the selection model of essential medicines in China should be further optimized,and the evidence-based thinking and methods should be utilized to enhance the scientific nature of the selection process.

Current scenario of traditional medicines in management of diabetic foot ulcers:A review

Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy making the foot prone to injuries from trivial trauma,and local tissue hyperglycaemia favouring infection and delaying the wound healing.DFU have been the leading cause for non-traumatic amputations of part or whole of the limb.Western medicines focus mainly on euglycaemia,antimicrobials,debridement and wound cover with grafts,and off-loading techniques.Advances in euglycaemic control,foot care and footwear,systemic antimicrobial therapy,and overall health care access and delivery,have resulted in an overall decrease in amputations.However,the process of wound care after adequate debridement remains a major cost burden globally,especially in developing nations.This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence.Wound modulation with various dressings and techniques are often a costly affair.Some aspects of the topical therapy with modern/Western medicines are frequently not addressed.Cost of and compliance to these therapies are important as both the wounds and their treatment are“chronic.”Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations,though without adequate clinical base/relevance.Traditional Chinese medicine involves restoring yin-yang balance,regulating the‘chi’,and promoting local blood circulation.Traditional medicines from India have been emphasizing on‘naturally’available products to control wound infection and promote all the aspects of wound healing.There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns.Various natural and plant derived products(e.g.,honey,aloe vera,oils,and calendula)and maggots are also used for wound healing purposes.We believe that patients with a chronic wound are so tired physically,emotionally,and financially that they usually accept native traditional medicine which has the same cultural base,belief,and faith.Many of these products have never been tested in accordance to“evidence-based medicine.”There are usually case reports and experience-based reports about these products.Recently,there have been some trials(in vitro and in vivo)to verify the claims of usage of traditional medicines in management of DFU.Such studies show that these natural products enhance the healing process by controlling infection,stimulating granulation tissue,antimicrobial action,promoting fibroblastic activity and collagen deposition,etc.In this review,we attempt to study and analyse the available literature on results of topical traditional medicines,which are usually advocated in the management of DFU.An integrated and‘holistic’approach of both modern and traditional medicine may be more acceptable to the patient,cost effective,and easy to administer and monitor.This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.

Rapid metabolic fingerprinting with the aid of chemometric models to identify authenticity of natural medicines: Turmeric, Ocimum, and Withania somnifera study

Herbal medicines are popular natural medicines that have been used for decades.The use of alternative medicines continues to expand rapidly across the world.The World Health Organization suggests that quality assessment of natural medicines is essential for any therapeutic or health care applications,as their therapeutic potential varies between different geographic origins,plant species,and varieties.Classification of herbal medicines based on a limited number of secondary metabolites is not an ideal approach.Their quality should be considered based on a complete metabolic profile,as their pharmacological activity is not due to a few specific secondary metabolites but rather a larger group of bioactive compounds.A holistic and integrative approach using rapid and nondestructive analytical strategies for the screening of herbal medicines is required for robust characterization.In this study,a rapid and effective quality assessment system for geographical traceability,species,and variety-specific authenticity of the widely used natural medicines turmeric,Ocimum,and Withania somnifera was investigated using Fourier transform near-infrared(FT-NIR)spectroscopy-based metabolic fingerprinting.Four different geographical origins of turmeric,five different Ocimum species,and three different varieties of roots and leaves of Withania somnifera were studied with the aid of machine learning approaches.Extremely good discrimination(R^(2)>0.98,Q^(2)>0.97,and accuracy=1.0)with sensitivity and specificity of 100%was achieved using this metabolic fingerprinting strategy.Our study demonstrated that FT-NIR-based rapid metabolic fingerprinting can be used as a robust analytical method to authenticate several important medicinal herbs.

Food and Medicine:Qualities and Efficacies in Chinese Ethnic Medicines

Drawing on our research in China’s southern mountains about ethnic medicines,and intrigued by the proverbial Chinese view that Yao Shi Tong Yuan(food and medicine have the same source),this article traces the eventfulness and powers at play in healing and eating when they are seen as closely related forms of life.Ancient and modern traditional Chinese medicine understandings of flavor are here shown to be a common basis for the healing and harming powers of both food and medicine.The term Wu Wei,or five flavors is explored as both experiences of eating and cooking,and some patterns of qi movement that animate and invigorate the body.Following Vivienne Lo’s term“potent flavors,”practices of harmonizing(He,Tiao He)flavors in Chinese medicine,as in cooking,express a world of natural powers and expert embodiment that goes far beyond mere taste.

“Three medicines and three formulas”in COVID-19:from bench to bedside

Chinese guideline has proven effective in the fight against coronavirus disease 2019(COVID-19)during the global spread of the epidemic.Traditional Chinese medicine(TCM)is widely recognized for its effectiveness in alleviating symptoms,inhibiting disease progress,reducing mortality,and improving the cure rate of patients with COVID-19.During the pandemic,“three medicines and three formulas”(TMTFs)stood out from hundreds of others in registered clinical studies,which became highly recommended as TCM for COVID-19 treatment.The TMTFs not only effectively relieve the clinical symptoms of fever,cough,fatigue,and phlegm,but also substantially shorten the time of nucleic acid negative conversion,improve lung computed tomography imaging features and inflammation,ameliorate clinical biochemical indicators,and reduce sequelae.Their potential pharmacological mechanisms are mainly related to the crosstalk between viral toxicity,endothelial damage,cytokine storm,immune response,and microthrombus.In brief,the clinical effects and the potential mechanisms of TMTFs on COVID-19 were systematically analyzed and summarized covering the entirety of disease development,including virus invasion and replication,immune response and cytokine storm,and acute respiratory distress syndrome and multiple organ dysfunction syndrome.This review provides a theoretical basis and reference for the in-depth understanding of the positive role of TMTFs in COVID-19 treatment.

Why pharmacovigilance of traditional medicines used as analgesics is important?

Traditional remedies have gained recognition for their effectiveness in treating various conditions such as diabetes,arthritic pain,liver disease,cough and cold,memory enhancement,and immunological stimulation.Their perceived safety has led to the increasing use of herbs by people without prescriptions.These therapies remain significant in areas with limited access to modern drugs or cultural preferences for traditional treatments.With a long history of use,traditional medicines have been the primary method of pain management.This review article explores natural and herb-based analgesics,their origins,and potential benefits,along with the growing scientific evidence supporting their effectiveness.Studies have examined their efficacy in treating musculoskeletal pain,neuropathic pain,and migraines.Rather than being seen as separate therapies,traditional medicines should be considered supplementary or alternative options that can be integrated into comprehensive pain management regimens.However,some studies have reported adverse drug reactions associated with herbal formulations and plants.Therefore,there is a need for pharmacovigilance in traditional medicine to ensure patient safety and promote evidence-based practices.Although pharmacovigilance in this field is still developing,it faces challenges due to the wide availability of herbal medicines without on-site medical supervision.This paper discusses the complex challenges of herbal pharmacovigilance,provides insights on recent advancements,and offers recommendations for improving the safety monitoring of traditional medications in the future.

Use of Non-Formulary Medicines at a Kenyan Private Hospital

Background: Hospital formularies are used to encourage the use of safe, ef-fective and most affordable medications. Institutions need to make provi-sions for non-formulary medicines (NFM) due to the dynamic nature of dis-eases and their management. The aim of this study was to describe the pat-terns of non-formulary medicine prescriptions at the Nairobi Hospital, the reasons for their purchase as well as the duration taken to avail them. Methods: A descriptive review of all the non-formulary medicine prescrip-tions from January 2021 to June 2022. The medicines were listed and catego-rized according to the WHO Anatomical Therapeutic Chemical (ATC) classi-fication system. Correspondence between pharmacy and procurement was reviewed to understand the reason for the requests and the duration it took to avail the medicines. Results: A total of 183 NFM were purchased, with a general increase in the number from January 2021 to June 2022. Vitamins, Mineral supplements and General nutrients accounted for 41 (22.4%) of the NFM. Dermatologicals 27 (14.6%), Genito-urinary system drugs and sex hormones 20 (10.9%), Ophthalmologicals 14 (7.6%) and Antineoplastic and Immuno-modulating agents 12 (6.6%) were also frequently purchased out of formulary. The main reasons for NFM purchases were: having no therapeutic equivalents in the hospital formulary 72 (39.3%) and prescriber or patient preference 69 (37.7%). It took a median (IQR) of 4 (2 - 7) days for the phar-macy to avail these drugs;with 18.6% being availed in 1 day and 55.2% tak-ing more than 3 days. For the NFM where no alternative was available in the hospital formulary, sales amounted to USD 63,362 which was 79.1% of the value of all the NFM sales. Conclusion: There’s a need to regularly update the hospital formulary and to emphasize to the prescribers the importance of adhering to it, as much as possible.

Household Survey on Access to Medicines Used for the Treatment of Diarrhoea in Musoma Municipal Council, Tanzania

Background: Access to medicines is part of the human right to health. According to WHO, access to medicine is measured by how easily households obtain medicines for acute and chronic conditions including diarrhoea through household surveys. Diarrhoea is among the top ten leading causes of death. Anti-diarrhoea medicines save lives but, should be available and obtainable to do so. The objectives of this study were to determine anti-diarrhoea medicines used by households, their sources and factors affecting their accessibility in Musoma Municipal. Methods: A cross-section survey was conducted in Musoma Municipal Council, Mara, Tanzania. The lottery method of simple random sampling was used to select three wards and pick three streets from each ward. The study population was 255 household heads from households selected by systematic random sampling from each street. A structured questionnaire was used to obtain information from household heads. Results and Discussion: Males (51.8%) had more diarrhoea illnesses than females (48.2%). Distinctive household heads (52.6%) had primary education. The majority, (79.1%) of all diarrhoea patients were recommended/prescribed anti-diarrhoea medicines. Of those whom anti-diarrhoea medicines were prescribed/recommended, 63.5% adhered to the prescriber’s/dispenser’s instructions and obtained and used anti-diarrhoea medicines. The most frequent source of anti-diarrhoea medicines was ADDO (38%). Widely used anti-diarrhoea medicines were antimicrobials (77.5%) followed by ORS (17.5%). Reasons not to seek or obtain anti-diarrhoea medicines were;Patient started feeling better (56.3%), Alternative treatment (26%), Financial reasons (10%), Decided medicines weren’t needed (3.5%), Distance from source (2.2%), Reactions to medicine (1%). Utilization of primary health care services was only 21.5%. Under-fives were mostly prescribed with antimicrobials (62.5%) than ORS (31.2%) and Zinc (6.3%) in mild to moderate dehydration contrary to Standard treatment guidelines (STG) in Tanzania. Conclusion: Anti-diarrhoea medicines are moderately easily obtainable in Musoma Municipal (50% of all diarrhoea patients obtained medicines). Alternative treatment (26%) and financial reasons (10%) were vivid factors hindering access. Treatment of diarrhoea in under-five years old is not adhered to in Musoma Municipal (use of 62.5% of antimicrobials and only 31.2% of ORS in mild diarrhoea cases).

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.

Routine Supportive Supervision and Management of Medicines and Other Health Products and Technologies in Vihiga County, Kenya

Health Products and Technologies (HPTs) are pivotal for an efficient health system. Availability and accessibility to affordable health products are critical indicators towards achieving universal health coverage. Routine supportive supervision, performance monitoring, recognition of efforts and client feedback are vital activities toward health supply chain system strengthening. This is a descriptive paper that describes a model of integrated commodity supportive supervision, and mentorship and its impact on various outcomes of health commodity management. Data were abstracted from the standardized scored checklists used during integrated commodity supportive supervision and supply chain audit in public health facilities in Vihiga County. Scores for the period 2020 to 2022 were analyzed on the eight key areas of interest. The analysis was done using Statistical Package for Social Sciences (SPSS version 26). Results are interpreted at 95% Confidence interval. This paper also shares findings from both quantitative and qualitative data from client exit and facility managers’ interviews. Six complete rounds of supervisions, three clients and service providers’ interviews, and three annual award events have been conducted. We observed trends across six data collections points and compared the results at first point or baseline (January-June 2020) to the results at the last point or end line (April-June 2022). Findings show significant improvements on the eight parameters in terms of mean scores as follows: resolution of issues from previous visits by 35.06% (46.75% - 81.81%);storage of HPTs by 17.41% (68.72% - 86.13%);inventory management by 28.16% (42.67% - 70.83%);availability and use of commodity data management information systems (MIS) tools by 22.39% (74.40% - 96.79%);verification of commodity data by 25.61% (65.56% - 91.17%);availability of guidelines and job aids for commodity management by 46.28% (36.65% - 82.93%). There was an improvement on the mean score on accountability by 20.22% (58.58% - 83.51%). The composite (final) score improved by 28.33% (56.19% - 84.52%). There was progressive narrowing of the standard deviations on all the indicators across the study period. This demonstrates that there is standardization of practices and positive competition among all the public health facilities. There were significant improvements on all the eight indicators. Routine integrated commodity supportive supervision has proven to be an effective high impact intervention in improving management of health products and technologies in Vihiga County, Kenya.