Afghanistan, a low-income landlocked country, is continuously suffering from domestic war and conflicts; the country struggles to provide quality healthcare services, including affordable medicinal products in the required quantity. Moreover, the quality standards of domestic pharmaceutical companies have not been established yet. One of the internationally recognized guidelines for monitoring manufacturing processes in pharmaceutical companies is Good Manufacturing Practice (GMP), recommended by World Health Organization (WHO). Therefore, this study aimed to assess whether a pharmaceutical company in Kabul, Afghanistan adheres to the GMP standards established by WHO.A descriptive cross-sectional study was conducted to assess the WHO-delineated GMP compliance of 25 pharmaceutical companies in Kabul, Afghanistan. The inspection checklist was developed by Afghanistan's National Medicine and Healthcare Products Regulatory Authority (NMHRA) using the WHO-delineated GMP guidelines. In addition, direct observation, interviews with respective delegates, and documentation reviews were conducted to collect research data.Only 38.33% (1.14 ± 1.08) of GMP contents were complied. Personnel 66.67% (2 ± 1.15) and materials 58.67% (1.76 ± 1.11) were the most commonly complied components, whereas the product recall 12.98% (0.39 ± 0.85), quality assurance 16.44% (0.49 ± 0.81) and quality control laboratory 28.35% (0.85 ± 1.12) were the least complied ones.None of the GMP components was fully adhered to by the pharmaceutical companies in Kabul, Afghanistan. Quality control and assurance should be implemented immediately, including validation and qualification practices.
Abstract Background: The outbreak of coronavirus posits deleterious consequences on global healthcare system while affecting human life in every aspect. Despite various measures undertaken to limit the socio-economic effect of coronavirus, various challenges remain pervasive, and one such challenge is mental health, particularly sleep disorders. Therefore, this study examines the prevalence and determinants of sleep disorders among Malaysian adults. Methods: An online survey was conducted from 11 January to May 2021. Structured questionnaire link using Google form was sent to the adults through E-mail in Malaysia. The study utilized Holland Sleep Disorder Questionnaire (HSDQ) to screen out the various sleep disorders, namely; Insomnia, Parasomnia, Circadian Rhythm Sleep Disorder (CRSD), Hypersomnia, Restless Legs Syndrome (RLS/PLMD), and Sleep-disordered Breathing (SDB). Percentage distribution and logistic regression analysis were used as study tools. Results: Around 70% of the surveyed population had one or another sleep disorder. One-third reported RLS/PLMD (34.8%) and CRSD (33.9%). More than one-fourth of the adults reported Insomnia (29.7%) and Hypersomnia (25.8%). Increased risk of sleep disorders was found to be associated with being unemployed (OR=2.4, C.I.=1.17-4.89). The risk of insomnia and hypersomnia was higher among female adults (OR=1.6, C.I.=1.11-2.3) and unemployed adults (OR=2.4, C.I.=1.23-5.04), respectively. Conclusion: Immediate interventions to prevent aggravation of sleep disorders should be promoted. It is recommended to bring forth psychiatric and psychological support to those suffering from various sleep disorders in the ongoing coronavirus pandemic. Government shall impart counselling through various online channels consisting of psychologists and sleep experts to improve the quality of sleep.
Abstract Background The impact of COVID-19 pandemic on the provision of Drug and Alcohol (D&A) services and associated outcomes have been under-researched. Aim This study aimed to understand the experiences of service providers in relation to how drug and alcohol (D&A) services were affected during COVID-19 pandemic, including the adaptations made and lessons learnt for the future. Method Focus groups and semi-structured interviews were conducted with participants from various D&A service organisations across the UK. Data was audio recorded followed by transcription and thematic analysis. Results A total of 46 participants representing various service providers were recruited between October and January 2022. The thematic analysis identified ten themes. COVID-19 required significant changes to how the treatment was provided and prioritised. Expansion of telehealth and digital services were described, which reduced service wait times and increased opportunities for peer network. However, they described missed opportunities for disease screening, and some users risked facing digital exclusion. Participants who provided opiate substitution therapy service spoke of improving service provider/user trust following the shift from daily supervised treatment consumption to weekly dispensing. At the same time, they feared fatal overdoses and non-adherence to treatment. Conclusion This study demonstrates the multifaceted impact of the COVID-19 pandemic on UK-based D&A service provisions. The long-term impact of reduced supervision on Substance Use Disorder treatment and outcomes and any effect of virtual communications on service efficiency, patient-provider relationships and treatment retention and successes are unknown, suggesting the need for further study to assess their utility.
The General Medication Adherence Scale (GMAS) evaluates intentional and unintentional behaviour of patients, disease and medication burden and cost-related burden associated with non-adherence. GMAS was developed and validated among Urdu-speaking patients with chronic diseases. However, validated tool in Nepalese language to measure medication adherence among chronic illness patients currently does not exist.To translate, culturally adapt, and validate the English version of GMAS into the Nepalese language to measure medication adherence among chronic illness patients.The study was conducted among patients with chronic diseases in both hospital and community pharmacies of Nepal. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Practice Guideline for linguistic translation and cultural adaptation was used to translate and culturally adapt the English version of GMAS into the Nepalese version. The translated version was validated amongst patients with chronic diseases in Nepal. Exploratory factor analysis was carried out using principal component analysis with varimax rotation. Test-retest reliability and internal consistency were analysed.A total of 220 (53.6% females, and 51.4% of 51 to 70 aged patients) patients with chronic diseases participated in the study. The majority of patients took two medications (27.3%) from six months to five and half years (68.2%). Kaiser Meyer Olkin was found to be 0.83. A principal axis factor analysis was conducted on the 3 items of GMAS without and with orthogonal rotation (varimax). The scree plot showed an inflexion on the third item that meant three components were present. The overall Cronbach's alpha value of the full-phase study was 0.82.The General Medication Adherence Scale was successfully translated into the Nepalese language, culturally adapted, and validated amongst chronic diseases patients of Nepal. Therefore, the GMAS-Nepalese version can be used to evaluate medication adherence among Nepalese-speaking patients with chronic disease.
Objective: To study the profile of the patient, the pattern of their illness and their drug use patterns attending to general ward of quaternary care hospital.Methods: Prospective observational study of 2 mo was performed at neurology unit of the quaternary care private hospital, India. Patients aged above 20 y with at least one neurological drug in prescription were included to observe their demographic profile, illness pattern and drug use. The data was analysed and summarised as frequency and percentage using microsoft excel and presented as tables.Results: Among 60 patient that were enrolled, more were males (N=33, 55%) than females (N=27, 45%) and within the age group of 60-70 y (N=22, 36.67%). The majority of patients were diagnosed with strokes (N= 48, 80%) where the cerebrovascular accident was most common (N=16, 26.66%). Males (N=29, 60.4%) were more prone to get stroke than females (N=19,39.6%). An average number of drugs per prescription was 5.7, the percentage of antibiotics, generic drugs and injections were 36.6%, 0.05% and 44.14% respectively. A total of 28 different drug classes with 61 different drugs was utilised. Fourteen drug classes had been accounted for 90% of drugs utilisation. Clopidegrol+Aspirin have frequently used the drug.Conclusion: Most people attending neurology unit were elderly. Stroke occupies 1st list for the burden. Average drugs for neurology visit remain high. Wide types of drug classes are utilised in neurological wards
Restricted and repetitive behaviors, and a pronounced preference for behavioral and environmental consistency, are distinctive characteristics of autism spectrum disorders (ASD). Whether these clinical features of ASD are related to fundamental neuropsychological impairments in behavioral flexibility remains to be clarified.Forty-one individuals with ASD and 37 matched controls performed a probabilistic reversal learning task to assess behavioral flexibility. Participants learned to choose the correct stimulus location from a pair of locations to win points (acquisition). After making the correct choice over multiple trials, the rewarded stimulus location changed without warning (reversal). Feedback was provided on an 80:20 probabilistic schedule, with 80% of correct choices and 20% of incorrect choices randomly reinforced.ASD and control participants performed comparably during acquisition. At reversal, ASD participants initially chose the new correct location as quickly as controls, but then more frequently reverted back to the previously preferred response. The ASD group also more frequently shifted back to the previous response choice immediately following intermittent non-reinforcement of the new correct response. The number of regressive errors was positively correlated with independently ascertained clinical ratings of restricted and repetitive behaviors, but not other core features of ASD.Restricted and repetitive behaviors in ASD are associated with neurocognitive deficits in flexible choice behavior. Preclinical research has established that frontostriatal circuitry supports flexibility on reversal learning tasks. Thus, alterations in this circuitry may contribute to behavioral rigidity in ASD and represent a target for therapeutic intervention.
Abstract Background Unintended pregnancies, the primary cause of abortion, can consequence in severe negative effects such as infertility and maternal death. Adequate knowledge of emergency contraceptive pills (ECPs) and a positive attitude among the dispensers in community pharmacy is a prerequisite for timely access to ECP thus ultimately abating the incidence of unintended pregnancies. This study intended to explore the knowledge, attitude and practice of dispensers of community pharmacy toward ECPs in Kathmandu valley. Methods A cross-sectional study was conducted in community pharmacies located in three districts of Kathmandu valley. A convenient sampling method was employed to interview dispensers in 227 community pharmacies using a validated questionnaire. The questionnaire assessed the demographic characteristics, knowledge, attitude and dispensing practice of the dispensers. The data were subjected to descriptive and inferential analysis using SPSS 18 (SPSS Inc., Chicago, IL, USA). Results Respondents’ knowledge was statistically significant with dispensing practice and had a positive relation [AOR= 11.86, 95% CI (5.821-24.190)]. Approximately (74.9%) of respondents had a good practice and about 65.6% had a good knowledge on dispensing ECP. Majority (93.4%) had a positive attitude towards ECP yet some of the respondents (54.2%) had conservative belief about the Over the Counter (OTC) availability of ECP. ECP related knowledge was higher among the age group 40-49 years, Bphamacy degree holders with experience above 10 years and pharmacies located inside the city and in the Kathmandu district. After adjusting the possible confounder variables, age, degree and district of pharmacy were significantly associated with knowledge. Similarly, respondents’s practice towards ECP was higher among the age group 40-49 years with experience above 10 years and pharmacies located inside the city and in the Kathmandu district. Adjusted for other variables, only pharmacies located at Kathmandu district was significantly associated with practice. Conclusion The dispensers lacked specific significant information on ECP and posed a conservative perception of its’ OTC availability, despite good overall knowledge and positive attitude. Hence, training on proper counseling strategies should be afoot to refine service delivery.
BackgroundThe COVID-19 pandemic has led to system-wide disruption of health services globally.We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal. MethodsWe conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020).We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care.We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women's residence in a COVID-19 hotspot area. ResultsThe mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% (P < 0.0001) in comparison to the same time-period in 2019.The institutional birth in high-medium volume hospitals declined on average by 20.8% (P < 0.0001) during the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% (P = 0.001).Maternity services halted for a mean of 4.3 days during the pandemic and there was a redeployment staff to COVID-19 dedicated care.Respectful provision of care was better in hospitals with low-volume birth (β = 0.446, P < 0.0001) in comparison to high-medium-volume hospitals.There was a positive association between women's residence in a COVID-19 hotspot area and respectful experience of care (β = 0.076, P = 0.001). ConclusionsThe COVID-19 pandemic has had differential effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better.More research is needed to investigate the effects of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform a "building-back-better" approach in post-pandemic period.
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