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Addis Ababa, Ethiopia

Tadeg H.,Management science for Health MSH
East African journal of public health | Year: 2012

The objective of this review is to produce evidence on the prevalence and trends in the availability of substandard and counterfeit antimicrobials in the global market and its consequences on key public health interventions in developing countries Review of various literatures collected through the internet and other sources. Literature search using PubMed and Medline databases and Google search engine was conducted to identify related publications on the subject. Relevant published and unpublished literature was also consulted as additional source of information. During the past few decades, the trade of substandard and counterfeit medicines has increased substantially. Past experiences indicate that almost any kind of medicine can be counterfeited. In developing countries, primary targets are those antimicrobials that are commonly used in the treatment of life-threatening conditions including malaria, tuberculosis and HIV/AIDS. The findings in this review support the strong contention that substandard and counterfeit antimicrobials are available in the developing world in very high proportions. This is becoming one of the major causes of treatment failures leading to excessive mortality and morbidity. Moreover, it is implicated for contributing to the development of drug resistant organisms in many infectious diseases of public health significance such as malaria, tuberculosis and HIV/AIDS. If trends in the prevalence of counterfeit/substandard drugs continue at the current scale, there is a huge threat to interventions underway on major killer diseases in the developing world. So, public health interventions in developing countries should include quality control of antimicrobials as an integral part of program implementation. The national drug regulatory authorities in those countries should also be strengthened to enhance their capacity in enforcing regulations pertaining the registration, production, distribution and use of antimicrobial drugs. Source

Sileshi B.,Haramaya University | Deyessa N.,Addis Ababa Institute of Technology | Girma B.,Help Ethiopia Address Low TB HEAL TB Project | Melese M.,Help Ethiopia Address Low TB HEAL TB Project | Suarez P.,Management science for Health MSH
BMC Infectious Diseases | Year: 2013

Background: Tuberculosis (TB) is the leading cause of mortality in high HIV-prevalence populations. HIV is driving the TB epidemic in many countries, especially those in sub-Saharan Africa. The aim of this study was to assess predictors of mortality among TB-HIV co-infected patients being treated for TB in Northwest Ethiopia.Methods: An institution-based retrospective cohort study was conducted between April, 2009 and January, 2012. Based on TB, antiretroviral therapy (ART), and pre-ART registration records, TB-HIV co-infected patients were categorized into " On ART" and " Non-ART" cohorts. A Chi-square test and a T-test were used to compare categorical and continuous variables between the two groups, respectively. A Kaplan-Meier test was used to estimate the probability of death after TB diagnosis. A log-rank test was used to compare overall mortality between the two groups. A Cox proportional hazard model was used to determine factors associated with death after TB diagnosis.Results: A total of 422 TB-HIV co-infected patients (i.e., 272 On ART and 150 Non-ART patients) were included for a median of 197 days. The inter-quartile range (IQR) for On ART patients was 140 to 221 days and the IQR for Non-ART patients was 65.5 to 209.5 days. In the Non-ART cohort, more TB-HIV co-infected patients died during TB treatment: 44 (29.3%) Non-ART patients died, as compared to 49 (18%) On ART patients died. Independent predictors of mortality during TB treatment included: receiving ART (Adjusted Hazard Ratio (AHR) =0.35 [0.19-0.64]); not having initiated cotrimoxazole prophylactic therapy (CPT) (AHR = 3.03 [1.58-5.79]); being ambulatory (AHR = 2.10 [1.22-3.62]); CD4 counts category being 0-75cells/micro liter, 75-150cells/micro liter, or 150-250cells/micro liter (AHR = 4.83 [1.98-11.77], 3.57 [1.48-8.61], and 3.07 [1.33-7.07], respectively); and treatment in a hospital (AHR = 2.64 [1.51-4.62]).Conclusions: Despite the availability of free ART from health institutions in Northwest Ethiopia, mortality was high among TB-HIV co-infected patients, and strongly associated with the absence of ART during TB treatment. In addition cotrimoxazol prophylactic therapy remained important factor in reduction of mortality during TB treatment. The study also noted importance of early ART even at higher CD4 counts. © 2013 Sileshi et al.; licensee BioMed Central Ltd. Source

Talisuna A.O.,Medicines for Malaria Venture MMV | Talisuna A.O.,University of Nairobi | Daumerie P.G.,Medicines for Malaria Venture MMV | Balyeku A.,Medicines for Malaria Venture MMV | And 26 more authors.
Malaria Journal | Year: 2012

Background: Artemisinin-based combination therapy (ACT), the treatment of choice for uncomplicated falciparum malaria, is unaffordable and generally inaccessible in the private sector, the first port of call for most malaria treatment across rural Africa. Between August 2007 and May 2010, the Uganda Ministry of Health and the Medicines for Malaria Venture conducted the Consortium for ACT Private Sector Subsidy (CAPSS) pilot study to test whether access to ACT in the private sector could be improved through the provision of a high level supply chain subsidy. Methods. Four intervention districts were purposefully selected to receive branded subsidized medicines - "ACT with a leaf", while the fifth district acted as the control. Baseline and evaluation outlet exit surveys and retail audits were conducted at licensed and unlicensed drug outlets in the intervention and control districts. A survey-adjusted, multivariate logistic regression model was used to analyse the intervention's impact on: ACT uptake and price; purchase of ACT within 24 hours of symptom onset; ACT availability and displacement of sub-optimal anti-malarial. Results: At baseline, ACT accounted for less than 1% of anti-malarials purchased from licensed drug shops for children less than five years old. However, at evaluation, "ACT with a leaf" accounted for 69% of anti-malarial purchased in the interventions districts. Purchase of ACT within 24 hours of symptom onset for children under five years rose from 0.8% at baseline to 26.2% (95% CI: 23.2-29.2%) at evaluation in the intervention districts. In the control district, it rose modestly from 1.8% to 5.6% (95% CI: 4.0-7.3%). The odds of purchasing ACT within 24 hours in the intervention districts compared to the control was 0.46 (95% CI: 0.08-2.68, p=0.4) at baseline and significant increased to 6.11 (95% CI: 4.32-8.62, p<0.0001) at evaluation. Children less than five years of age had "ACT with a leaf" purchased for them more often than those aged above five years. There was no evidence of price gouging. Conclusions: These data demonstrate that a supply-side subsidy and an intensive communications campaign significantly increased the uptake and use of ACT in the private sector in Uganda. © 2012 Talisuna et al.; licensee BioMed Central Ltd. Source

Berhan Z.,Management science for Health MSH | Abebe F.,Education and Training Officer for PSE of health cadres | Tesfa M.,Health Science University | Assefa M.,Debretabor Health Science College | Tafere Y.,Bahir Dar Health science College
BMC Research Notes | Year: 2015

Background: The estimated HIV prevalence among pregnant women in Ethiopia is 1.2 percent and unfortunately one of every 3 children born to these women gets infected with HIV. Elimination of these mother-to-child transmissions (MTCT) of HIV is possible through HIV testing during pregnancy and taking antiretroviral medications. However, only 24 percent of the pregnant women living with HIV have yet received the medication needed to prevent the transmission of HIV. Hence, there exists a concern that the rate of HIV infection among infants born to HIV positive mothers is increasing. This study assessed the prevalence of HIV infection and associated factors among infants born to women living with HIV, in South Gondar zone, Amhara region, Ethiopia. Methods: Facility based document review was conducted upon 434 charts. The study participants were HIV exposed infants enrolled from January to December 2012. The data were reviewed from all the 17 health facilities which were providing PMTCT services in the zone. The study included 434 HIV exposed infants having an HIV Deoxyribonucleic Acid (DNA) Polymerase Chain Reaction (PCR) test result. The data were collected using structured data extraction tool. Binary logistic regression analysis was employed to assess the putative association of independent variables with the outcome variable. Significance was taken at a P value <0.05 and 95% confidence level. Result: The prevalence of HIV among HIV exposed infants was 10.1% (95% CI = 7.3 - 13%). Delayed diagnosis (AOR = 2.7, 95% CI = 1.3, 29.4), mixed infant feeding (AOR = 8.8, 95% CI = 4.5, 22.8), failure to receive either antiretroviral therapy or prophylaxis during pregnancy or breast feeding (AOR = 21.6, 95% CI = 14.5, 39.8) and shorter duration of HIV treatment (AOR = 12, 95% CI = (4.2, 45.0) were the factors that increase the risk of mother- to- child transmission of HIV. Conclusion: The prevalence of HIV infection among HIV exposed infants is strikingly high. Inadequate use of antiretroviral therapy and skilled delivery care were the factors that enhance mother-to-child transmission of HIV. Integrated and audience specific education and promotion for seeking obstetric care and HIV services is instrumental to curb the devastating consequences of HIV on pregnant women and their newborns © 2014 Berhan et al.; licensee BioMed Central Ltd. Source

Ndiaye P.,University Gaston Berger | Niang K.,Cheikh Anta Diop University | Diallo I.,Management science for Health MSH
Comptes Rendus - Biologies | Year: 2013

As a way to prevent maternal mortality and stillbirth, the dystocia risk score includes three components: a left column provides a list of eight characteristics to check for in the woman; an upper horizontal section provides a checklist of possible outcomes of the pregnancy itself: and a rectangular grid indicates the prognosis in three zones: a large red (dangerous), a medium-sized grey (doubtful) and a small blue (hopeful). The DRS is positive if there is at least one cross in the dangerous zone and/or two crosses in the doubtful zone (it indicates that the woman should be referred to a center specialized in obstetric emergency care); elsewhere, the DRS is negative. The validation test gives good results (sensitivity = 83.61%, specificity = 90.05%, positive predictive value = 72.34%, and negative predictive value = 94.04%). Its large-scale use would accelerate the identification of pregnant women with a high risk of dystocia. Their timely referral to specialized emergency obstetrics centers would increase the efficacy of care and reduce the levels of maternal mortality and stillbirth. © 2013 Académie des sciences. Source

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