Promising Practices in Capacity Development for Health Supply Chains in Resource-Constrained Countries.

Performance gaps in health supply chains in low- and middle-income countries contribute significantly to inefficiencies and underperformance of their health systems. Some significant factors hindering the performance of supply chains in low and middle-income countries include low human resource capacity and capability, weak structures for monitoring supply chain performance, weak in-service and pre-service training programs, chronic underfunding, lack of transparency and an overdependence on obsolete methods, like manual data gathering, record-keeping, and analyses. Although proven health supply chain strengthening techniques exist, the level of adoption of these practices has varied across countries, resulting in multiple capacity gaps and underperforming supply chains.

An assessment of dispensing practices in private pharmacies in Dar-es-Salaam, Tanzania.

Objectives: To assess medicine dispensing practices in private pharmacies in Dar-es-Salaam, Tanzania and recommend interventions to improve practice.

Methods: A cross-sectional survey and observational study of dispensing practices among 70 pharmacies in metropolitan Dar-es-Salaam, Tanzania.

Key Findings: There were 1479 dispensing encounters recorded across the 70 pharmacies.

The quest for universal access to effective malaria treatment: how can the AMFm contribute?

Access to quality assured artemisinin-based combination therapy (ACT) has remained very low in most malaria endemic countries. A number of reasons, including unaffordable prices, have contributed to the low accessibility to these life-saving medicines. The Affordable Medicines Facility-Malaria (AMFm) is a mechanism to increase access to quality assured ACT.

Knowledge of medicine outlets' staff and their practices for prevention and management of malaria in Ghana.

Objective: To obtain information about the staff resources available in licensed medicine outlets, assess their knowledge about malaria illness, current policy initiatives for malaria control, and the practices for prevention and management of malaria.

Setting: Hospitals/clinics and retail medicine outlets (community pharmacies and licensed chemical shops) from urban and rural areas in Southern and Northern Ghana.

Method: A cross section of medicine outlets (n = 121) in the two geographic and socio-economically diverse settings in Ghana were sampled.

Existing capacity to manage pharmaceuticals and related commodities in East Africa: an assessment with specific reference to antiretroviral therapy.

Background: East African countries have in the recent past experienced a tremendous increase in the volume of antiretroviral drugs. Capacity to manage these medicines in the region remains limited. Makerere University, with technical assistance from the USAID supported Rational Pharmaceutical Management Plus (RPM Plus) Program of Management Sciences for Health (MSH) established a network of academic institutions to build capacity for pharmaceutical management in the East African region.

A strategy to improve skills in pharmaceutical supply management in East Africa: the regional technical resource collaboration for pharmaceutical management.

Background: International initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief and the President's Malaria Initiative have significantly increased availability and access to medicines in some parts of the developing world. Despite this, however, skills remain limited on quantifying needs for medications and ordering, receiving and storing medications appropriately; recording medications inventories accurately; distributing medications for use appropriately; and advising patients on how to use medications appropriately. The Regional Technical Resource Collaboration for Pharmaceutical Management (RTRC) has been established to help address the problem of skills shortage in pharmaceutical management in East Africa.

Availability and choice of antimalarials at medicine outlets in Ghana: the question of access to effective medicines for malaria control.

Although national and international efforts to combat malaria have intensified over the years, problems with availability, distribution, and choice of antimalarials at medicine outlets in Africa continue to exist. This article presents the results of an indicator-based assessment of availability and choice of antimalarials at 130 licensed medicine outlets in Ghana. We also discuss how the choice of an antimalarial to dispense conforms to recommendations of the national policy for malaria therapy.

Self-reported use of anti-malarial drugs and health facility management of malaria in Ghana.

Objective: To assess the appropriateness of self-reported use of anti-malarial drugs prior to health facility attendance, and the management of malaria in two health facilities in Ghana.

Method: A structured questionnaire was used to collect data from 500 respondents who were diagnosed clinically and/or parasitologically for malaria at Agogo Presbyterian Hospital and Suntreso Polyclinic, both in the Ashanti Region of Ghana. Collected information included previous use of anti-malarial drugs prior to attending the health facilities, types of drugs used, how the drugs were used, and the sources of the drugs.

Medical doctors' perceptions and expectations of the role of hospital pharmacists in Sudan.

Aims: To investigate medical practitioners' perceptions, expectations and experience with the role of hospital-based pharmacists in Sudan.

Setting: Teaching hospitals in Khartoum State, Sudan.

Methods: A self-administered, pre-tested, structured questionnaire was distributed to 300 randomly chosen medical practitioners of different grades and specialities in four teaching hospitals in Khartoum State.

Pharmacy education in Jordan, Saudi Arabia, and Kuwait.

The practice of pharmacy, as well as pharmacy education, varies significantly throughout the world. In Jordan, Kuwait, and Saudi Arabia, the profession of pharmacy appears to be on the ascendance. This is demonstrated by an increase in the number of pharmacy schools and the number of pharmacy graduates from pharmacy programs.

Physicians' perceptions and expectations of pharmacists' professional duties in government hospitals in Kuwait.

Objective: The objectives of this study were to evaluate the perceptions, expectations and experience of physicians with hospital-based pharmacists in Kuwait.

Materials And Methods: A piloted self-administered questionnaire was hand delivered to 200 physicians practicing in four government hospitals in Kuwait. Main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists.

Changing the prescribing patterns of sexually transmitted infections in the White Nile Region of Sudan.

Background: The number of inappropriate prescriptions for sexually transmitted infections (STIs) in Sudan is suspected to be high. Simple multifaceted interventions directed at prescribers may improve prescribing patterns in the Sudan.

Objective: To evaluate the effect of multifaceted interventions on prescribing for STIs in the White Nile State, Sudan.

Self-medication with antibiotics and antimalarials in the community of Khartoum State, Sudan.

Purpose: To estimate the prevalence of self medication with antibiotics and antimalarials in Khartoum State, Sudan and evaluate factors associated with self medication.

Methods: A pre-tested questionnaire was used to collect data from a sample of 600 households, (1750 adult persons), selected from three cities in Khartoum State, Sudan, using a multistage stratified clustered sampling.

Results: One thousand two hundred and ninety three (73.

Self-reported medication use among adolescents in Kuwait.

Objective: The objectives of this study were to describe and examine the pattern of medication use, including age and gender differences among adolescents in Kuwait, and to establish the sources of information on medicines in this age group.

Subjects And Methods: A cross-sectional survey of 1,110 male and female students (14-21 years) from 10 randomly selected public schools in Kuwait was conducted. The prevalence of self-medication was estimated.

Unaffordable drug prices: the major cause of non-compliance with hypertension medication in Ghana.

Purpose: The prevalence of hypertension is increasing in Ghana. In addition hypertension has been identified as the most common cause of heart failure, stroke, chronic renal disease and spontaneous sudden deaths in Ghana. A major concern arising from this increasing hypertension prevalence is that many patients in this relatively poor country find it difficult to afford the standard hypertension medications.

Interrupted time series designs in health technology assessment: lessons from two systematic reviews of behavior change strategies.

Objectives: In an interrupted time series (ITS) design, data are collected at multiple instances over time before and after an intervention to detect whether the intervention has an effect significantly greater than the underlying secular trend. We critically reviewed the methodological quality of ITS designs using studies included in two systematic reviews (a review of mass media interventions and a review of guideline dissemination and implementation strategies).

Methods: Quality criteria were developed, and data were abstracted from each study.

Effectiveness and efficiency of guideline dissemination and implementation strategies.

Objectives: To undertake a systematic review of the effectiveness and costs of different guideline development, dissemination and implementation strategies. To estimate the resource implications of these strategies. To develop a framework for deciding when it is efficient to develop and introduce clinical guidelines.

How to synthesize evidence for imaging guidelines.

Aim: To provide guidance on how to gather and evaluate evidence from the literature on the efficacy of imaging, using as an example the assessment of the role of magnetic resonance imaging (MRI) in the diagnosis of osteomyelitis. This method was adopted for evaluating evidence for the musculoskeletal section of the 5th edition of the Royal College of Radiologists' (RCR) guidelines.

Materials And Methods: A systematic review of the literature published between 1966 and July 2001 was carried out.

Interrupted time series analysis in clinical research.

Objective: To demonstrate the usefulness of interrupted time series analysis in clinical trial design.

Methods: A safety data set of electrocardiographic (ECG) information was simulated from actual data that had been collected in a Phase I study. Simulated data on 18 healthy volunteers based on a study performed in a contract research facility were collected based on single doses of an experimental medication that may affect ECG parameters.

Effects of mailed dissemination of the Royal College of Radiologists' guidelines on general practitioner referrals for radiography: a time series analysis.

Aim: To evaluate the effect of postal dissemination of the third edition of the Royal College of Radiologists' (RCR) guidelines on general practitioner referrals for radiography.

Materials And Methods: An interrupted time series using monthly data for 34 months before and 14 months after dissemination of the guidelines was employed. Data were abstracted for the period April 1994 to March 1998 from the computerized administrative systems of open access radiological services provided by two teaching hospitals in one region of Scotland.