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      Management of children’s acute diarrhea by community pharmacies in five towns of Ethiopia: simulated client case study

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          Abstract

          Background

          Acute diarrhea is the major cause of child morbidity and mortality in low-income nations. It is the second most common cause of death among children <5 years of age globally. The indispensable role of community pharmacists is clearly observed in the prevention and treatment of diarrhea. However, there is a paucity of data on how community pharmacies manage acute childhood diarrhea cases in Ethiopia. This study aimed to evaluate the experience of community pharmacies in the management of acute diarrhea in northern Ethiopia.

          Methods

          A simulated case-based cross-sectional study was conducted in community pharmacies from five towns of northern Ethiopia between April 2015 and September 2015. Convenience sampling technique was used to select sample towns. A structured questionnaire was organized to collect the information. Descriptive statistics, chi-squared test, one-way analysis of variance, and binary logistic regression were performed to describe, infer, and test for association between the variables. SPSS for Windows Version 21 was used to enter and analyze the data. A 95% confidence interval and P-value of 0.05 were set to test the level of significance.

          Results

          Approximately 113 community pharmacies were visited to collect the required data from five towns. Majority (78, 69%) of them were located away from hospitals and health care areas. Nine components of history taking were presented for dispensers. Regarding the patient history, “age” was frequently taken, (90.3%), whereas “chief complaint” was the least to be taken (23%), for patients presenting with diarrhea. Approximately 96 (85.0%) cases were provided with one or more medications. The remaining 17 (15%) cases did not receive any medication. A total of six pharmacologic groups of medications were given to alleviate acute diarrheal symptoms. Majority (66, 29.6%) of the medications were oral rehydration salts with zinc. The mean number of medications was 1.99 per visit. Components of advice, such as dose, frequency, duration, drug action, and adverse drug reactions, were found to vary among the five towns at a statistically significant level.

          Conclusion

          Community pharmacies provided inadequate treatment for acute childhood diarrhea. Inappropriate history taking and incorrect drug and food instructions have been frequently encountered during acute diarrhea management. Practitioners working in northern Ethiopia should receive proper training on the management of acute childhood diarrhea.

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          Most cited references 29

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          US pharmacists' effect as team members on patient care: systematic review and meta-analyses.

          One approach postulated to improve the provision of health care is effective utilization of team-based care including pharmacists. The objective of this study was to conduct a comprehensive systematic review with focused meta-analyses to examine the effects of pharmacist-provided direct patient care on therapeutic, safety, and humanistic outcomes. The following databases were searched from inception to January 2009: NLM PubMed; Ovid/MEDLINE; ABI/INFORM; Health Business Fulltext Elite; Academic Search Complete; International Pharmaceutical Abstracts; PsycINFO; Cochrane Database of Systematic Reviews; National Guideline Clearinghouse; Database of Abstracts of Reviews of Effects; ClinicalTrials.gov; LexisNexis Academic Universe; and Google Scholar. Studies selected included those reporting pharmacist-provided care, comparison groups, and patient-related outcomes. Of these, 56,573 citations were considered. Data were extracted by multidisciplinary study review teams. Variables examined included study characteristics, pharmacists' interventions/services, patient characteristics, and study outcomes. Data for meta-analyses were extracted from randomized controlled trials meeting meta-analysis criteria. A total of 298 studies were included. Favorable results were found in therapeutic and safety outcomes, and meta-analyses conducted for hemoglobin A1c, LDL cholesterol, blood pressure, and adverse drug events were significant (P < 0.05), favoring pharmacists' direct patient care over comparative services. Results for humanistic outcomes were favorable with variability. Medication adherence, patient knowledge, and quality of life-general health meta-analyses were significant (P < 0.05), favoring pharmacists' direct patient care. Pharmacist-provided direct patient care has favorable effects across various patient outcomes, health care settings, and disease states. Incorporating pharmacists as health care team members in direct patient care is a viable solution to help improve US health care.
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            Health and healthrelated indicators

            (2003)
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              Treatment of diarrhea in young children: results from surveys on the perception and use of oral rehydration solutions, antibiotics, and other therapies in India and Kenya

              Background Diarrheal disease is a leading cause of morbidity and mortality among children under five. Although oral rehydration solution (ORS) has tremendous therapeutic benefits, coverage of and demand for this product have remained low in many developing countries. This study surveyed caregivers and health care providers in India and Kenya to gather information about perceptions and use of various diarrhea treatments, assess reasons for low ORS use, and identify opportunities for expanding ORS use. Methods The project team conducted two rounds of semi–structured, quantitative surveys with more than 2000 caregivers in India and Kenya in 2012. A complementary survey covered more than 500 pharmacy staff and health care workers in both countries. In Kenya, the team also surveyed rural pharmacies to gather pricing and sales data. Results Although caregivers generally had very positive perceptions of ORS, they typically ranked antibiotics ahead of ORS as the strongest medicine for diarrhea (in India 62% ranked antibiotics first and 23% ranked ORS first, n = 404; in Kenya results were 55% and 29%, n = 401). Many caregivers had misconceptions about the purpose and effectiveness of various treatments. For example, most caregivers who gave ORS at last episode expected it to stop their child’s diarrhea (65% in India, n = 190; 73% in Kenya, n = 154). There were noteworthy differences between India and Kenya in the selection and sourcing of treatments. Much of the money spent by families during the last episode of diarrhea was for inappropriate treatments. This was especially true in India, where rural households typically spent US$ 2.29 (median for the 79% of rural households that paid for health care services or treatments, n = 199) with most of this going to pay fees of private health workers and/or for antibiotics. Conclusions Caregivers’ primary treatment goal is to stop diarrhea, and many believe that antibiotics or ORS will accomplish this goal. Inappropriate treatment – and especially overuse of antibiotics – is common. Satisfaction with ORS is high, but dosing is a challenge for caregivers. The results provide valuable insight into treatment behaviors and suggest significant opportunities to enhance use of ORS in developing countries.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2016
                05 April 2016
                : 12
                : 515-526
                Affiliations
                [1 ]Department of Clinical Pharmacy, School of Pharmacy, Gondar University, Gondar, Ethiopia
                [2 ]Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
                [3 ]Department of Hospital Pharmacy, Debremarkos Teaching and Referral Hospital, Debremarkos, Ethiopia
                Author notes
                Correspondence: Tadesse Melaku Abegaz, Department of Clinical Pharmacy, School of Pharmacy, Gondar University, 15 Bekafa street, PO Box 196, Gondar, Ethiopia, Tel +251 985 7975, Email melakutadesse98@ 123456gmail.com
                Article
                tcrm-12-515
                10.2147/TCRM.S98474
                4827418
                27103810
                © 2016 Abegaz et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                acute diarrhea, children, community pharmacies, simulated case, northern ethiopia

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