Martha Susanna Lubbe

Objectives: The study aimed to determine the types of pharmacy services lawfully permitted to be offered and provided in the different categories of pharmacies in South Africa. Methods: A cross-sectional survey was conducted using an online self-administered questionnaire sent to all responsible pharmacists (N = 4334) of pharmacies registered in the different categories under the Pharmacy Act 53 of 1974. Key findings: A total of 217 responses were received, yielding a response rate of 5.0%. Although the participating pharmacies offer a broad spectrum of services, they do not provide all the public health-oriented services for which they are legally permitted to offer. Consequently, they (>80%) focus on more conventional pharmacy services and services related to patients’ pharmaceutical care needs. Furthermore, a larger proportion of community (independent and corporate) (>90%) than private institutional pharmacies (<75%) offered services supporting pharmaceutical care (P = .0001), such as assessing patient compliance (Cramér’s V = 0.4), patient follow-up (Cramér’s V = 0.4), and providing pharmacist-initiated therapy (Cramér’s V = 0.7). Overall, the findings confirmed that the participating pharmacies did not provide the full range of legally permitted services. More specifically, there was limited delivery of public health services in institutional pharmacies, whereas independent and corporate community pharmacies provided few primary care drug therapy services. Conclusions: The study highlights an opportunity for pharmacies in South Africa to offer more public health-related services that they are legally permitted to provide. Consequently, the apparently limited provision of these services should be investigated further.

Introduction: Middle-aged adults (45–64 years), who constitute a large proportion of the population, are at risk of potentially inappropriate medicine (PIM) prescribing due to their high prevalence of multimorbidity. Drug class duplication, the concurrent prescription of two or more medicines from the same pharmacological class, is a commonly reported PIM criterion in studies using the PRescribing Optimally in Middle-aged People’s Treatments (PROMPT) criteria. Aim: To determine the prevalence of drug class duplication, stratified by sex and age group, and its associated factors among middle-aged adults using a South African pharmaceutical benefit management (PBM) company’s medicine claims database. Method: A cross-sectional study was conducted using data from 1 January 2023–31 December 2023. Drug class duplication was assessed across 14 pharmacological drug classes. Prevalence of drug class duplications was analysed by sex and age group, with associations tested using Pearson’s chi-square test. Spearman’s correlation coefficient ( r _s ) was used to assess the correlation between drug class duplication and potential associated factors. Results: Of the 195,446 patients analysed (51.9% female; mean age 53.69 years [standard deviation (SD) 5.41, 95% confidence interval (CI) 53.665–53.713]), 48.8% experienced one or more drug class duplication. Duplication was similar between sexes ( p = 0.1685) and higher in older age groups ( p < 0.0001, Cramér’s V = 0.2). The most prevalent drug class duplications were 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) (n = 36,887, 18.9%); non-steroidal anti-inflammatory drugs (NSAIDs) (n = 30,829, 15.8%); angiotensin-converting enzyme (ACE) inhibitors (n = 25,646, 13.1%); angiotensin II receptor blockers (ARBs) (n = 22,411, 11.5%); calcium-channel blockers (CCBs) (n = 15,716, 8.0%); selective serotonin reuptake inhibitors (SSRIs) (n = 12,139, 6.2%); and beta-receptor blockers (β-blockers) (n = 11,577, 5.9%). Strong correlations were observed between drug class duplication and the number of Chronic Disease List (CDL) conditions per patient ( r _s = 0.680, 95% CI 0.678–0.683), and number of prescriptions per patient ( r _s = 0.638, 95% CI 0.636–0.641). Correlation with the number of medicine items per prescription per patient was moderate ( r _s = 0.391, 95% CI 0.388–0.400), and weak with age ( r _s = 0.232, 95% CI 0.227–0.236) (all p < 0.0001). Conclusion: Drug class duplication was common, highlighting that targeted interventions may be useful to improve patient safety.

Background: Spontaneous reporting is the most frequently used method to collect data on adverse drug events (ADEs). To promote ADE reporting and enhance medicine safety, it is important to understand enablers and barriers to ADE reporting. This study described medicine users’ practices and previous experiences with reporting ADEs, including barriers and enablers to reporting ADEs in South Africa. Methods: This was a cross-sectional, analytical study in which adults residing in South Africa were requested to complete an online questionnaire. Results: The majority of participants (70.5%, n = 203; N = 288) indicated that they experienced ADEs in the past and 77.0% ( n = 181; N = 235) of these events occurred after the use of medication. Only 59.1% ( n = 120; N = 203) of participants who experienced ADEs, reported them. There was no difference in reporting frequency between healthcare professionals (HCP) and non-HCPs ( p > 0.9). Furthermore, 78.3% ( n = 94; N = 120) of participants reported ADEs to their doctor. The main enabler for reporting ADEs indicated by both HCP and non-HCPs was that reporting could help to keep others safe. The most cited barrier to ADE reporting for both HCP and non-HCPs was the assumption that the side effects would go away once the medication was stopped. Conclusions: A large proportion of participants who experienced ADEs reported them to their doctors, and reporting of ADEs was similar between HCPs and non-HCPs. The barriers and enablers to reporting ADEs were similar for HCPs and non-HCPs. These results could help in planning awareness-raising campaigns aimed at improving ADE reporting in South Africa.

Background: Reporting of adverse drug events (ADEs), by consumers enhances medication-related risk surveillance, public awareness, and understanding of medicine safety. The aim of this study was to explore adults’ awareness of ADEs, attitudes towards reporting and perceptions of their role in reporting ADEs in South Africa. Method: We conducted a cross-sectional, analytical study in which adults residing in South Africa completed an online questionnaire. The data collected was analysed using both descriptive and inferential statistics. Results: We received responses from 350 participants. Most participants (86.2%, n = 302; N = 350) reported having heard about ADEs and the majority of participants (94.4%, n = 301; N = 319) indicated that reporting of ADEs was important. The Med Safety App was not widely known (17.3%, n = 58; N = 336) while the South African Health Products Regulatory Authority (SAHPRA) was relatively well known (77.4%, n = 260; N = 336). Healthcare providers only educated 55.7% (n = 180; N = 323) of the participants about ADEs and only 50.5% (n = 163; N = 323) of the participants asked their healthcare providers about ADEs. Awareness regarding ADEs was significantly higher (p < 0.001) among healthcare professionals (HCPs) compared to non-healthcare professionals (non-HCP). Conclusion: Most participants were aware of ADEs and agreed it was important to report ADEs although reporting tools, such as the Med Safety App, were not well known. We recommend awareness campaigns on reporting processes because this could improve consumer reporting of ADEs in South Africa.

Due to the COVID-19 pandemic, many children missed their routine vaccinations globally. There is insufficient evidence on the trends in vaccination coverage in the private healthcare sector in South Africa. This study explored the changes in childhood vaccination patterns (non-COVID vaccines) in the private healthcare sector in South Africa using medicine claim data. Using the information on medication claims from a South African pharmaceutical benefit management (PBM) company, we performed a quantitative cross-sectional analysis comparing the period before (2018–2019) and during the COVID-19 pandemic (2020–2021). All patients who made claims within the study period were included. This study included 67,830 children aged two years and younger. In particular, from 2018 to 2021, boys (52%) outnumbered girls (48%). Pharmacists consistently held the predominant prescriber role before and during the COVID-19 pandemic. The proportion of children receiving non-COVID-19 vaccines was higher before the pandemic (60%) than during the pandemic (55%). Furthermore, there was a notable decline of 5% in measles vaccination rates during the children’s first year of life, while a notable increase was observed for measles (5%), hepatitis A (7.7%), and the pentavalent vaccine (5%) during the second year of life. Governments and private healthcare providers must take action to enhance vaccination coverage rates for children in their first year of life to prevent a resurgence of vaccine-preventable diseases. The results obtained in this study underscore the significance of implementing vaccine catch-up campaigns to address missed vaccination opportunities arising from the impact of the COVID-19 pandemic. Moreover, pharmacists emerged as the predominant healthcare providers responsible for administering vaccinations within the private healthcare sector in South Africa, both prior and during the COVID-19 pandemic. Their pivotal role in the vaccination process warrants due recognition and should not be underestimated.

Background: Lack of harmonization in pharmacovigilance (PV) practice in resource‐limited states in Africa has led to differentiation and marginalization, thus creating an environment where weak or absent PV systems may benefit from regional guidelines.Purpose: To compare the PV guidelines of Southern African Development Community (SADC) member states to international guidelines and identify areas for improvement for aligning PV practice within the SADC region.Methods: We utilized a 73‐item checklist to assess the PV guidelines of the SADC member states. Checklist parameters were rated using binary scoring.Results: Only seven (Botswana, Mauritius, Namibia, South Africa, Tanzania, Zambia, and Zimbabwe) of the 16 SADC member states had guidelines to assess. Of these, only four had supporting legislation. All seven national medicines regulatory authorities (NMRA)'s guidelines required reporting of local serious adverse drug reactions (ADRs). Four NMRAs implemented device vigilance; none specified submission timelines for ADRs associated with substandard or falsified medicines. Only three NMRAs required electronic transmission of individual case safety reports in the E2B format. Five NMRAs mandated safety monitoring during interventional clinical trials. Five NMRAs required aggregate reporting through periodic safety update reports. Only two NMRAs required submission of the development safety update report. Regarding risk management, four NMRAs required notification of actions taken by foreign NMRAs and four NMRAs expected to review Dear Healthcare Professional Letters before distribution by the marketing authorization holder.Conclusions: Areas for improvement of guidelines to establish common process standards and allow for synchronized submissions of comparable data to SADC NMRAs are provided.

Background: Hospital pharmacists are important in antibiotic stewardship programs (ASP), a global strategy to combat antibiotic resistance (ABR). South African public hospitals have limited ASP implementation. This study describes Limpopo Provincial Hospital pharmacists’ knowledge, attitudes, and practice toward ASP implementation. Method: A questionnaire to explore pharmacists’ knowledge, attitudes and practices regarding ASP implementation comprised 43 questions hosted online. A link was sent by invitation e-mail to eligible respondents in November 2021. Five questions on respondents’ demographics, 15 questions on ASP knowledge, 10 Likert scale questions on attitude, and 13 on ASP practices were included. Mean (standard deviation (SD)) knowledge and attitude scores and a median (interquartile range (IQR)) practice score was calculated. Associations between categorical variables were assessed using chi-square/Fisher’s exact analysis (p < 0.05), with Cramér’s V as effect size. Results: The survey yielded 35 responses (13.1%). Twenty (57.1%) respondents were female. Seventeen (48.6%) respondents were between the ages of 31 and 40 years. The mean knowledge score of respondents was 9.8 (2.6) (N = 34), with knowledge gaps on One Health and socioeconomic determinates of ABR. Ten (29.6%) respondents thought One Health discouraged multi-sector collaboration, and nineteen (55.9%) respondents thought ASP was the only strategic response to ABR. Sixteen (47.1%) respondents did not know that poor access to clean water accelerates ABR and seventeen (50.0%) did not know that poverty could be a determinant for antibiotic use. The mean respondent attitude score was 8.0 (1.7) (N = 28). Twenty-seven (96.4%) respondents agreed that ASP was necessary and agreed to participate in ASP respectively. All 28 (100.0%) respondents agreed to lead an ASP. The median (IQR) respondents’ practice score was − 2.0 (IQR: -6.0–5.8) (N = 16). Respondents were inconsistently (never, sometimes, every time) participating in multi-disciplinary forums (6/16, 37.5%) and expressed a desire for training (11/13, 84.6%) on ASP through in-service (7/27, 25.9%). Respondents thought ASP training should include medical officers (12/29, 41.4%) and nurses (9/29, 31.8%). Knowledge score was associated with gender (p = 0.048; V = 0.416) and attitude score (p = 0.013; V = 0.556). Conclusion: Our study found pharmacists had good knowledge and a positive attitude toward ASP implementation but poor ASP practices. A multi-disciplinary in-service training could address identified knowledge and practice gaps.

Background: There is a paucity of research on the incidence and antimicrobial resistance (AMR) of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE) pathogens in Africa because of the inadequate establishment of AMR surveillance systems. Objective: This study reports on the incidence and AMR of bloodstream ESKAPE pathogens at a referral hospital in northern South Africa. Methods: This retrospective descriptive study used routinely collected bloodstream isolates (pathogen identification and antimicrobial susceptibility testing performed using automated systems) from the South African National Health Laboratory Service, from January 2014 to December 2019. Resistant phenotypes analysed included methicillin-resistant S. aureus and carbapenem-resistant A. baumannii. Results: The ESKAPE pathogen incidence rate was stable from 2014 to 2019 (p = 0.133). The most isolated pathogens were S. aureus (268/746; 35.9%) and A. baumannii (200/746; 26.8%). Staphylococcus aureus increased from 39 isolates in 2014 to 75 in 2019 (p = 0.132). The incidence rate of A. baumannii increased from 11.9% (16/134) in 2015 to 37.8% (68/180) in 2019 (p = 0.009). Most isolates (417/746; 55.9%) were from the neonatal ward. Carbapenem-resistant A. baumannii increased from 68.8% (11/16) in 2014 to 75.0% (51/68) in 2019 (p = 0.009). Methicillin-resistant S. aureus decreased from 56.0% (14/25) in 2016 to 17.3% (13/75) in 2019 (p = 0.260). Conclusion: Routine data provide essential information on the incidence of ESKAPE pathogens and AMR phenotypes, serving as a basis for an antibiogram, a surveillance tool in antibiotic stewardship programmes. What this study adds: The study provided local information on the incidence and AMR pattern of ESKAPE pathogens, which is essential when developing empiric treatment protocols for appropriate antibiotic prescribing and infection prevention and control practices.

Background: Electronic continuous surveillance databases are ideal for monitoring antibiotic use (ABU) in hospitalised patients for antibiotic stewardship programmes (ASP). However, such databases are scarce in low-resource settings. Point prevalence surveys (PPS) are viable alternatives. This report describes ABU and identifies ASP implementation improvement areas in Limpopo Province, South Africa. Methods: This cross-sectional descriptive study extracted patient-level ABU data from patients’ files using a modified global PPS tool. Data were collected between September and November 2021 at five regional hospitals in Limpopo Province, South Africa. All patients in the wards before 8 a.m. on study days with an antibiotic prescription were included. Antibiotic use was stratified by Anatomic Therapeutic Chemical and Access, Watch, Reserve classifications and presented as frequencies and proportions with 95% confidence intervals (CI). Associations between categorical variables were assessed using the chi-square test. Cramér’s V was used to assess the strength of these associations. Results: Of 804 inpatients surveyed, 261 (32.5%) (95% CI 29.2–35.7) were prescribed 416 antibiotics, 137 were female (52.5%) and 198 adults (75.9%). One hundred and twenty-two (46.7%) patients received one antibiotic, 47.5% (124/261) received two, and 5.7% (15/261) received three or more antibiotics. The intensive care units had a higher ABU (68.6%, 35/51) compared to medical (31.3%, 120/384) and surgical (28.5%, 105/369) wards (p = 0.005, Cramér’s V = 0.2). Lower respiratory tract infection (27.4%, 104/379), skin and soft tissue infections (SST) (23.5%, 89/379), and obstetrics and gynaecology prophylaxis (14.0%, 53/379) were the common diagnoses for antibiotic prescriptions. The three most prescribed antibiotic classes were imidazoles (21.9%, 91/416), third-generation cephalosporins (20.7%, 86/416) and combination penicillin (18.5%, 79/416). Access antibiotics accounted for 70.2% (292/416) of prescriptions and Watch antibiotics for 29.6% (123/416) (p = 0.110, Cramér’s V = 0.1). Reasons for prescribing and treatment plans were documented in 64.9% (270/416) (95% CI 60.3–69.5) and 21.4% (89/416) (95% CI 17.3–25.3) of prescriptions, respectively. Conclusions: The study serves as a baseline for ABU surveillance at the five regional hospitals in Limpopo Province. Lack of documentation indicates poor prescribing practices; ASP should address gaps by deploying evidence-based, multifaceted and stepwise interventions.

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.