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The natural product chemistry of South African Plocamium species

  • Authors: Knott, Michael George
  • Date: 2003
  • Subjects: Marine algae -- South Africa Red algae -- South Africa Green algae -- South Africa Halimeda -- South Africa
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:3820 , http://hdl.handle.net/10962/d1004920
  • Description: The brine shrimp lethality assay was used as a preliminary tool to screen eighteen seaweeds collected from the South African coast. Of the seaweeds tested, the red algae Plocamium corallorhiza and Hypnea rosea, and the green alga Halimeda sp., showed the most potent activity. The chemical investigation of P. corallorhiza resulted in the isolation and structural elucidation of five previously undescribed secondary metabolites, along with three known compounds and four possible artifacts of the extraction process. Standard spectroscopic methods and comparison with known compounds were used to determine the structures of the new metabolites. The new compounds included the linear halogenated monoterpenes 4,8-dibromo-1, 1-dichloro-3,7-dimethyl-2,6-octadiene (99), 4,6-dibromo-l, 1-dichloro-3,7-dimethyl-2,7-octadiene (100), 4,8-dibromo-l, 1,7-trichloro-3,7-dimethyl-2,5-octadiene (101) and 3,4,6,7-tetrachloro-3,7-dimethyl-l-octene (102) and the cyclic monoterpene 5-bromo-5-bromomethyl-I-chlorovinyl-2,4-dichloro-methylcyclohexane (103) while the known compounds were identified as 4-bromo-5-bromomethyl-1chlorovinyl-2,5-dichloro-methylcyclohexane (35), 1,4,8-tribromo-3, 7 -dichloro-3,7-dimethyl-1,5-octadiene (94) and 8-bromo-1,3,4,7-tetrachloro-3,7-dimethyl-1,5-octadiene (96). The four methoxylated compounds (104-107) were presumably formed via a standard substitution reaction between the halogenated monoterpenes 96 and 101 and MeOH, which was used as a component in the extraction solvent. With over 100 000 natural products having been reported, it has become necessary to employ an efficient dereplication strategy to quickly identify known compounds. A simple Gas Chromatography-Mass Spectrometry (GC-MS) method for the efficient physicochemical screening, identification and dereplication of Plocamium metabolites was developed. In this study the crude extracts of P. corallorhiza, P. cornutum and P. maxillosum were screened by GC-MS and the retention times and mass spectral fragmentation patterns of compounds 94, 96, 99 - 107 were used to quickly identify known and new compounds in the crude extracts of P. cornutum and P. maxillosum. This data indicated that compounds 99, 100, 103 were present in both P. corallorhiza and P.cornutum, while compound 102 was found to be present in P. corallorhiza, P. cornutum and P. maxillosum. These studies also indicated that ecotypes and chemotypes are not a significant feature of P. corallorhiza and P. cornutum. Different species of Plocamium (namely: P. corallorhiza, P. cornutum, and P. maxillosum) have very different chemical profiles, and GC may therefore have appreciable taxonomic application in the identification of the different Plocamium spp. which are endemic to South Africa.
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  • Date Issued: 2003

Competing interests and change within the pharmacy education system in South Africa

  • Authors: Allan, Lucie
  • Date: 2006
  • Subjects: Pharmacy -- South Africa Pharmacy -- Study and teaching -- South Africa Pharmacy -- Practice -- South Africa Community pharmacy services -- South Africa Community health services -- South Africa
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:3741 , http://hdl.handle.net/10962/d1003219
  • Description: This thesis provides a historical account of the emergence of the pharmacy education system in South Africa, and an analysis of the influence of competing interest groups over the pharmacy education curriculum. It provides a critical evaluation of structural-consensus and micro-interpretive approaches to medical and pharmacy education, and sets out a macrointerpretive account of pharmacy education in South Africa. Following Margaret Archer (1979) it analyzes three forms of negotiation between competing interest groups in their efforts to change the pharmacy curriculum; these are political manipulation, external transaction and internal initiation. The thesis argues that whilst the private sector interest group (comprising of retail, wholesale and manufacturing pharmacy) dominated the pharmacy education system until 1994, since then a newly emerged government interest group has begun to compete for educational control. The priorities pursued by this interest group have consistently reflected the objectives set out in the ANC National Health Plan of 1994. The thesis maintains that given its frustration over the non-implementation of the ANC’s health policy objectives, the government interest group is likely to resort to direct political manipulation by passing legislation to alter the content of the current pharmacy curriculum. Such changes would seek to ensure that the syllabus more accurately reflects the ANC Plan’s community health and primary health care objectives. The thesis asserts that such an outcome (of direct political manipulation of the curriculum) is not inevitable, and can be avoided through a process of internally initiated change. It presents the findings of an interpretive case study into how the Rhodes University Community Experience Programme (CEP) influenced final year pharmacy students’ perceptions of the role of the pharmacist. The students’ comments were collected by means of focus group interviews, participant observation and documentary analysis. Whilst the CEP did not successfully transform their concept of the pharmacist’s role, it did succeed in influencing students’ understanding of the notions of community pharmacy and primary health care in line with the government interest group’s health objectives. This thesis concludes that internally initiated change within the pharmacy education system, would be preferable to that imposed through external political manipulation, as such change would be more likely to preserve the independent professional interests of pharmacy academics.
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  • Date Issued: 2006

Patient education : the effect on patient behaviour

  • Authors: Shiri, Clarris
  • Date: 2006
  • Subjects: Patient education -- South Africa -- Eastern Cape Patient compliance -- South Africa -- Eastern Cape Hypertension -- Treatment -- South Africa Health care services -- South Africa Community health services -- South Africa
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:3790 , http://hdl.handle.net/10962/d1003268
  • Description: Evidence suggests that the prevalence of certain non-communicable diseases, such as hypertension, is increasing rapidly, and that patients with these diseases are making significant demands on the health services of the nations in sub-Saharan Africa. However, these countries also face other health-related challenges such as communicable diseases and underdevelopmentrelated diseases. Developing countries like South Africa have limited resources, in terms of man power and financial capital, to address the challenges that they are facing. Non-communicable diseases cannot be ignored and since health care providers cannot meet the challenges, it is worthwhile to empower patients to be involved in the management of their conditions. Patient education is a tool that can be used to enable patients to manage their chronic conditions and thereby reduce the morbidity and mortality rates of these conditions. The aim of this study was to investigate the effect of a patient education intervention on participants’ levels of knowledge about hypertension and its therapy, beliefs about medicines and adherence to anti-hypertensive therapy. The intervention consisted of talks and discussions with all the participants as one group and as individuals. There was also written information given to the participants. Their levels of knowledge about hypertension and its therapy were measured using one-on-one interviews and self-administered questionnaires. Beliefs about medicines were measured using the Beliefs about Medicines Questionnaire (BMQ) whilst adherence levels were measured using pill counts, elf-reports and prescription refill records. The participants’ blood pressure readings and body mass indices were also recorded throughout the study. The parameters before and after the educational intervention were compared using statistical analyses. The participants’ levels of knowledge about hypertension and its therapy significantly increased whilst their beliefs about medicines were positively modified after the educational intervention. There were also increases, though not statistically significant, in the participants’ levels of adherence to anti-hypertensive therapy. Unexpectedly, the blood pressure readings and body mass indices increased significantly. The participants gave positive feedback regarding the educational intervention and indicated a desire for similar programmes to be run continuously. They also suggested that such programmes be implemented for other common chronic conditions such as asthma and diabetes. This study proved that patient education programmes can be implemented to modify patients’ levels of knowledge about their conditions and the therapy, beliefs about medicines and adherence to therapy. However, such programmes need to be conducted over a long period of time since changes involving behaviour take a long time.
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  • Date Issued: 2006

A drug utilisation review of Isotretinoin in the management of acne

  • Authors: Burger, Solé
  • Date: 2007
  • Subjects: Acne -- Treatment , Isotretinoin
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10147 , http://hdl.handle.net/10948/673 , Acne -- Treatment , Isotretinoin
  • Description: Acne is a common, chronic disorder that affects many adolescents. The most effective acne medication is systemic isotretinoin. It provides a permanent cure for many patients, but has various side effects. A South African Acne Treatment Guideline was introduced in 2005. Adherence to this guideline could lead to safer, more effective acne management. The primary aim of this study was to investigate the appropriateness of medications prescribed in the treatment of acne in South Africa, and to evaluate the safety and efficacy of systemic isotretinoin utilised by patients in the Nelson Mandela Metropole (NMM). A drug utilisation study (including 18 803 South African acne patients’ chronic prescription data between 2000 and 2005) and a patient questionnaire survey (including information from 57 patients in the NMM who used systemic isotretinoin) were conducted. Basic descriptive and interferential statistics were calculated. The drug utilisation study revealed that systemic antibiotics were the acne treatment prescribed to most (43.3 percent) patients, followed by 42.1 percent of patients on systemic isotretinoin, 33.2 percent on hormonal therapy and 18.9 percent on topical therapy. Topical retinoids were underused. The questionnaire survey indicated a lack of compliance by prescribers with guideline recommendations regarding the prescription (and accompanying counselling and monitoring) of isotretinoin. Incorrect cumulative doses were frequently prescribed, and a lack of proper implementation of pregnancy prevention measures was evident. The majority of isotretinoin patients reported a high efficacy of isotretinoin in clearing their acne.
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  • Date Issued: 2007

Development and in vitro evaluation of a clobetasol 17-propionate topical cream formulation

  • Authors: Wa Kasongo, Kasongo
  • Date: 2007
  • Subjects: Adrenocortical hormones , Adrenocortical hormones -- Physiological effect , Drugs -- Testing , Drug development , Dermatopharmacology
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:3799 , http://hdl.handle.net/10962/d1003277 , Adrenocortical hormones , Adrenocortical hormones -- Physiological effect , Drugs -- Testing , Drug development , Dermatopharmacology
  • Description: One of the primary contributing factors to the escalating costs of health care is the high cost of innovator pharmaceutical products. As a consequence, health authorities in various countries and in particular in the developing world have identified generic prescribing and generic substitution as possible strategies to contain the escalating costs of health care provision. There is therefore a need for formulation scientists in developing countries to invest more time in the research and development of generic formulations. Clobetasol 17-propionate (CP) generic cream formulations containing 0.05% w/w of the drug were manufactured and characterized using in vitro testing. Formulation development studies were preceded by the development and validation of an RP-HPLC with UV detection for the quantitation and characterization of CP in innovator and generic cream formulations during formulation development and assessment studies. Furthermore the in vitro release ates of CP release from innovator and generic cream formulations were monitored using a validated in vitro release test method developed in these studies. The formulation of CP cream products was accomplished using a variety of commercially available mixed primary emulsifiers, such as Estol® 1474, Ritapro® 200, Emulcire® 61 WL and Gelot® 64. Successful formulations were selected based on their ability to remain physically stable immediately after manufacture and for 24 hours after storage at room temperature (22°C). Estol® 1474 was found to produce an unstable cream and was therefore not investigated further. The other three emulgents produced stable creams, but only the in vitro release profile of CP from a cream manufactured to contain Gelot® 64 was found to be statistically similar to that of the innovator formulation. Therefore the cream containing Gelot® 64 was selected as the most appropriate prototype generic cream formulation and was characterized in vitro in terms of CP content, viscosity, pH and in vitro release rate. Data generated from these studies were compared to those of the innovator product, Dermovate® cream, using statistical methods. The CP content, pH and in vitro release rate data of the CP formulation were similar to those of the innovator product, however the intrinsic viscosity of Dermovate® cream was almost three (3) times greater than the intrinsic viscosity of the test formulation developed using Gelot® 64. The CP cream formulation developed in these studies was stored for 4 weeks at 40 ± 2°C and 25 ± 5% RH in an incubator and the formulation was found to be stable. A formulation has been developed and assessed and found to be suitable for use as a topical semi-solid dosage form for CP.
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  • Date Issued: 2007

Influence of pharmaceutical advertising on consumers: an exploratory descriptive study

  • Authors: Knoesen, Brent Claud
  • Date: 2007
  • Subjects: Pharmaceutical industry -- Moral and ethical aspects , Pharmaceutical industry -- Marketing , Pharmaceutical industry -- ethics -- South Africa -- Port Elizabeth , Pharmaceutical policy -- Developing countries , Advertising -- Medicine -- Moral and ethical aspects , Advertising -- Drugs -- Moral and ethical aspects
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10149 , http://hdl.handle.net/10948/658 , Pharmaceutical industry -- Moral and ethical aspects , Pharmaceutical industry -- Marketing , Pharmaceutical industry -- ethics -- South Africa -- Port Elizabeth , Pharmaceutical policy -- Developing countries , Advertising -- Medicine -- Moral and ethical aspects , Advertising -- Drugs -- Moral and ethical aspects
  • Description: Pharmaceutical advertising involves the advertising of medicines, medical devices, and healthcare services. A review of available international literature indicates the belief that pharmaceutical advertisements negatively affect healthcare decisions made by consumers. Very little research has been conducted to determine how consumers in South Africa (SA) are affected by pharmaceutical advertisements. This study aimed to determine how consumers in the Nelson Mandela Metropole (NMM) perceive pharmaceutical advertisements. More specific objectives included the investigation of legislation in SA employed in pharmaceutical advertisements, the interpretation and misinterpretation of the advertisements, and the identification of problematic areas in this form of advertising. South African legislation applied to pharmaceutical advertisements was investigated by means of a literature review. A qualitative research design was also used to achieve the aim and objectives. This included a focus group consisting of six randomly selected participants in the NMM. A consumer survey, consisting of a 100 consumers obtained from 10 randomly selected community pharmacies within the NMM, supported the findings of the qualitative techniques. The themes identified in the focus group were incorporated into a questionnaire used in the consumer survey. Three randomly selected pharmaceutical advertisements were also decoded to interpret the components employed in each. The results determined that pharmaceutical advertising is a marketing tool that incorporates various emotional and psychological techniques to persuade consumers. It was also evident that consumers can misinterpret pharmaceutical advertisements. Various legal and ethical problems were identified in pharmaceutical advertisements. These results showed that pharmaceutical advertisements have the possibility of negatively affecting consumers’ healthcare decisions and warrants further investigation.
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  • Date Issued: 2007

Optimisation of pharmacological management of diabetes mellitus in a primary health care setting

  • Authors: Dickason, Beverley Janine
  • Date: 2007
  • Subjects: Diabetes , Diabetes -- Treatment
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10161 , http://hdl.handle.net/10948/846 , http://hdl.handle.net/10948/d1012902 , Diabetes , Diabetes -- Treatment
  • Description: Levels of diabetic care in primary health care settings in South Africa have been found to be sub-optimal. Knowledge deficits and inadequate practices have been implicated in the poor quality of local diabetes care. Type 2 diabetes and hypertension are commonly associated chronic conditions hence to optimise diabetic care, tight control of blood pressure is essential. Although guidelines for the overall management of diabetes in a primary health care setting have been published (Working Group of the National Diabetes Advisory Board, 1997; Society for Endocrinology, Metabolism and Diabetes of South Africa, 2002a), adherence to these guidelines has not yet been optimised in the primary health care setting. The objectives of the study were: to design and implement an educational intervention aimed at nursing staff, based on the South African guidelines for type 2 diabetes and hypertension, at a public sector primary health care clinic; to determine the impact of the educational intervention on the level of knowledge and attitudes of the nursing staff, and on the level of diabetic and blood pressure control achieved in the patient population, and to determine the impact of the educational intervention on pharmacological management of patients. A questionnaire was used to quantitatively assess the nursing staffs’ knowledge of the management of type 2 diabetes and hypertension at a primary health care level. A qualitative evaluation of the nursing staff attitudes was obtained using focus group interviews. The educational intervention, in the form of lectures and based on national diabetes and hypertension guidelines (Working Group of the National Diabetes Advisory Board, 1997; Society for Endocrinology, Metabolism and Diabetes of South Africa, 2002a; Milne et al., 2003), was then implemented and directed at the nursing staff at a primary health care clinic. A post-intervention evaluation was performed after four months by repeating the questionnaire and focus group interviews. Comparisons between the pre- and post-intervention questionnaire and focus group interviews evaluated the impact of the educational intervention on the knowledge and attitudes of nursing staff towards the management of type 2 diabetes. Pre- and post-intervention patient data was collected from patient medical files and compared to determine if the management of diabetes and hypertension improved in the patient population after the implementation of the educational intervention. The patient population consisted of 103 patients. The educational intervention resulted in an extremely significant improvement in the level of knowledge of the nursing staff [93 correct responses (28.3 percent; n = 329 (pre-intervention)) vs 223 correct responses (67.8 percent; n = 329 (post-intervention)); p < 0.0001, Fisher’s Exact test]. The educational intervention resulted in improved attitudes of nursing staff towards the management of diabetes. Ideal random blood glucose concentrations improved significantly [16 percent; n = 100 (pre-intervention) vs 22 percent; n = 100 (post-intervention); p = 0.0003; Student t test]. The number of patients with a compromised HbA1c level (> 8 percent) decreased by 2 [51; 49.5 percent, n = 103 (pre-intervention) vs 49, 47.5 percent, n = 103 (post-intervention)] which was not a significant improvement. Ideal blood pressure control improved by one from 38 patients [36.9 percent; n = 103 (pre-intervention)] to 39 patients [37.9 percent; n = 103 (post-intervention)] which was not significant. Optimal change of pharmacological management following the referral of an uncontrolled diabetic patient was only noted for 18 patients (20.2 percent, n = 89) referred in the post-intervention phase. Clinical inertia was identified as a major limitation to the optimisation of diabetes care. Implementation of an educational intervention based on the South African diabetes and hypertension guidelines at a public sector primary health care clinic was successful in improving the knowledge levels and attitudes of nursing staff
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  • Date Issued: 2007

The impact of pharmaceutical care services on the management of asthma patients in a primary health care clinic

  • Authors: Mostert, Zhan
  • Date: 2007
  • Subjects: Asthma -- Treatment -- South Africa -- Eastern Cape , Pharmacist and patient -- South Africa -- Eastern Cape
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10154 , http://hdl.handle.net/10948/574 , http://hdl.handle.net/10948/d1011711 , Asthma -- Treatment -- South Africa -- Eastern Cape , Pharmacist and patient -- South Africa -- Eastern Cape
  • Description: Optimal management of a chronic disease, like asthma, requires the active participation of patients. To achieve this, patients require education about asthma. Many of the recommended components of asthma care and management might not be effective without adequate patient education. Pharmacists in community, hospital and clinic practice are well placed to provide continued information and reinforcement of key messages, in order to improve compliance with medication and the outcomes of asthma management plans. Pharmacists may be able to increase medication adherence with patient counselling and monitoring systems and by facilitating communication with physicians. However, regardless of this, it remains uncertain whether pharmacist-patient interactions improve patient outcomes, and in spite of recommendations for teamwork and a multidisciplinary approach in the education of asthma patients, medical doctors and nurses are still largely responsible for carrying out the greatest part of patient education. The objectives of this study were therefore to determine the impact of pharmaceutical care services at a primary health care level on the management and well-being of asthmatic patients; to determine the effect of complex or multi-faceted pharmaceutical interventions, in patients with asthma, on lung function, asthma knowledge, attitudes and perceived self-management efficacy, asthma related quality of life and asthma control; and to determine the extent to which pharmacotherapeutic interventions, with regards to medication changes and dosage changes, are accepted and implemented by doctors. A randomised-control study was conducted at a primary health care clinic in the Eastern Cape. A total of 120 patients were allocated to two groups of sixty patients each (a Control Group and an Intervention Group). Baseline values were measured and follow-up interviews and post-intervention data collection were conducted three months afterwards for each group. Patients in the Control Group were attended to by the clinic staff as usual. Patients in the Intervention Group were educated on their disease by a pharmacist. The use of a customised 500ml plastic bottle as a spacer was suggested and each patient’s medication was evaluated against the Standard Treatment Guidelines for the management of asthma in adults at the primary health care level and where necessary, prescribing recommendations were made. Following assessment of the medication regimens of the patients in the Intervention Group, a total of 49 prescribing recommendations were made, of which 73 percent were accepted by both the doctor and patient. After educating the patients in the Intervention Group on inhaler technique, a significant improvement in technique was observed at the 3-month follow-up assessment (p<0.05). Using a short form of the Asthma Quality of Life Questionnaire (AQLQ(S)), a significant improvement post-intervention in mean total quality of life score (p<0.05) and mean average quality of life score (p<0.05) in the Intervention Group, were demonstrated. An improvement in mean activity limitation score in the Intervention Group post-intervention was also recorded for the activity limitation subscale of the AQLQ(S) (p<0.05). On measuring changes in asthma related knowledge, attitudes and self-efficacy, using a questionnaire (KASE-AQ), a significant improvement in mean knowledge score in the Intervention Group after the intervention (p<0.05) was also shown. With regards to lung function, both vital capacity (percent FVC) and expiratory flow volumes (percent FEV1) improved significantly in the Intervention Group (p<0.05). This study therefore demonstrated that multi-faceted pharmacist interventions, including medication assessment, asthma education, education on inhaler technique and the provision of medication aids in the form of spacers, can significantly improve the management of asthma patients and improve their well-being and quality of life.
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  • Date Issued: 2007

The role of the community pharmacist in cardiovascular disease management

  • Authors: Venter, Ignatius Johannes Erhardt
  • Date: 2007
  • Subjects: Pharmacist and patient -- South Africa -- Port Elizabeth , Phamaceutical services -- Patients , Cardiovascular system -- Diseases
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10150 , http://hdl.handle.net/10948/652 , Pharmacist and patient -- South Africa -- Port Elizabeth , Phamaceutical services -- Patients , Cardiovascular system -- Diseases
  • Description: Cardiovascular disease contributes to mortality and morbidity statistics worldwide and in South Africa. The current focus in health care revolves around activities aimed at preventing the development of cardiovascular disease, rather than the treatment of disease. The identification of risk factors that can predispose a patient to the development of cardiovascular disease is an essential component of any cardiovascular disease management programme. It is necessary that in the management of these risk factors, they are not considered to be isolated, but inter-related. Through the provision of point-of-care cardiovascular risk screening and monitoring services as well as disease-related counselling, the community pharmacist, as a readily accessible source of healthcare, can play an essential role in the cardiovascular disease management process. The aim of this study was to describe the nature of the services provided by community pharmacists with respect to cardiovascular risk and disease management in the Nelson Mandela Metropole. The research design was a non-experimental, descriptive study using a crosssectional survey method. Data was obtained through the utilisation of a questionnaire. The questionnaire consisted of three sections and was administered to community pharmacies in the Nelson Mandela Metropole, that provided cardiovascular point-of-care screening services. The community pharmacists correctly identified cardiovascular risk factors such as obesity (76.6 percent; 36, n=47) and smoking (27.7 percent; 13, n=47). Other cardiovascular risk factors such as abdominal obesity (4.2 percent; 2, n=47), gender (2.1 percent; 1, n=47) and family history (4.2 percent; 2, n=47) were largely ignored by the pharmacists. Point-of-care testing services were readily available in the pharmacies, with all of the pharmacies providing blood glucose and blood pressure measurements. Blood cholesterol measurements were only provided in 87.8 percent (36, n=41) of the pharmacies. The services were generally provided in a clinic facility, with 90.2 percent (37, n=41) of the pharmacies having a clinic facility available. Pharmacists were involved in the provision of point-of-care services, with 85.4 percent (35, n=41) of the pharmacies indicating that the pharmacists participated. Pharmacists readily provided counselling prior (70.7 percent; 29, n=41) to and after (80.5 percent; 33, n=41) the conduction of the screening services on areas such as lifestyle modification and treatment options. Only 15 percent (7, n=47) of the pharmacists indicated that they were aware of Cardiovascular Risk Calculator Tools and none of the pharmacists indicated that they had utilised such a tool. Pharmacists recommended frequent monitoring (60.5 percent; 26, n=43) and lifestyle modification (67.4 percent; 29, n=43) to patients, if the result of their screening service was within normal limits. However, the majority of the pharmacists indicated that they would refer patients, if the results obtained were out of the normal range. Conclusions based on the findings indicated that the pharmacists are readily providing cardiovascular risk screening services. The pharmacists were also able to identify the presence of any risk factors that can lead to the development of cardiovascular disease in the patients. However, active pharmaceutical involvement in further cardiovascular disease monitoring seemed to be lacking. Recommendations were made on areas such as reimbursement for pharmaceutical care services, increased utilisation of support staff and Continuing Professional Development events that could assist in improving the role of the community pharmacist in cardiovascular disease management.
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  • Date Issued: 2007

Availability of pharmacoeconomic data and its use in the development of drug formularies in South Africa

  • Authors: Keele, Mothobi Godfrey
  • Date: 2008
  • Subjects: Drugs -- Cost effectiveness , Pharmacy -- Economic aspects
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10146 , http://hdl.handle.net/10948/685 , Drugs -- Cost effectiveness , Pharmacy -- Economic aspects
  • Description: In an attempt to manage scarce health care resources and keep drug expenditure low, health care administrators worldwide have to make careful considerations regarding the choice of drugs to be provided to patients within their systems. One of the key strategies that is being employed to achieve this goal is the use of formularies. A major challenge in the formulary development process is to use pharmacoeconomics and outcomes research effectively to arrive at formularies that simultaneously provide patients with effective pharmacotherapy whilst maintaining financial stability. The extent to which this can be successfully achieved depends to a large extent on the availability of appropriate pharmacoeconomic data. The primary objectives of this study were to describe the availability and quality of literature pertaining to South African based pharmacoeconomic research, and to establish the manner in and extent to which pharmacoeconomic data is used in drug formulary decision-making processes, in both the private and public health care sectors in South Africa. A structured bibliographic search for South African pharmacoeconomic studies was conducted and a qualitative assessment of the identified studies which met the predetermined inclusion criteria was completed, using a pre-validated quality evaluation tool. In order to determine the use of pharmacoeconomic data in the formulary decisionmaking processes, by various stake holders in both the public and private of health care sectors in South Africa, a cross-sectional, descriptive study using a self-administered questionnaire was conducted. The results suggest that there is a limited availability of pharmacoeconomic research data in South Africa. Only 16 full pharmacoeconomic studies could be identified as having been published between 01 January 1995 and 30 June 2007. The quality of 3 of these studies was considered to be ‘dubious’, one study was found to be of high standard whilst the other 12 (74.95%) were of acceptable quality and thus could be considered as suitable to be used in formulary decision-making. The results of the national survey indicated that pharmacoeconomics is considered to be of importance and is used in formulary decision-making processes in both the public and private sectors. The primary source of pharmacoeconomic data used in formulary decisions appears to be international peer-reviewed publications. Of concern however, is the finding that this data, mostly from studies conducted outside of South Africa, is applied directly without sensitivity analysis or modelling. The results of the literature search and the subsequent quality appraisal suggest that pharmacoeconomic research and the use of pharmacoeconomic data in formulary decisions is at its infancy in South Africa. Thus efforts are needed to develop and grow the discipline of pharmacoeconomics in South Africa.
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  • Date Issued: 2008

Evaluation of the pharmaceutical availability of erythromycin from topical formulations

  • Authors: Mandimika, Nyaradzo
  • Date: 2008
  • Subjects: Pharmacy -- Research Chromatographic analysis Gel permeation chromatography Gels (Pharmacy) Chemistry, analytic Acne -- Treatment Sebaceous glands -- Diseases -- Treatment Drugs -- Testing Erythromycin -- Bioavailability
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:3771 , http://hdl.handle.net/10962/d1003249
  • Description: Erythromycin (ERY) is a macrolide antibiotic which is used in the treatment of acne vulgaris.Acne is a common skin condition that occurs when the sebaceous glands and hair shafts become infected by the bacteria Propionibacterium acnes. Acne is a chronic condition that may last for years and the severity of the effects of the disease on patients is often undermined especially in third world countries where more emphasis is placed on other more life-threatening diseases. It may cause considerable physical and emotional distress to sufferers along with the possibility of permanent scarring. Although use of topical ERY formulations is not the first line of treatment it has proven to be effective in treating inflammation of skin and skin structures cause by the responsible bacteria. To-date there are a variety of vehicles which are used in preparing topical ERY formulations namely ointment and gel bases, alcoholic solutions and pledgets. All the gel formulations on the market contain hydroxypropyl cellulose, alcohol and water along with the active ingredient(s). However, some gel formulations contain propylene glycol in addition to these excipients an example being Emgel®. Propylene glycol has been shown to affect the penetration of topically applied drugs through the skin suggesting that it would be highly likely that those formulations which contain propylene glycol may release more ERY into the skin following application. With this in mind, two ERY gel formulations were produced which contained different percentages of propylene glycol. According to the FDA guidelines, pharmacokinetic measurements in blood, plasma and/or urine of topical dermatological drug products are not feasible to document bioequivalence since the active ingredient(s) in topical formulations is/are not intended to be absorbed into the systemic circulation and in addition, concentrations in extracutaneous biological tissues would generally not be measurable. This limits determination of bioavailability and assessment of bioequivalence of such products to pharmacodynamic measurements, clinical trials and dermatopharmacokinetic (DPK) measurements such as tape stripping (TS) and microdialysis (MD).TS is a sampling technique which involves sequential removal of layers of the stratum corneum using strips of adhesive tape. This technique has found increasing use in DPK studies for investigation of drug kinetics in the skin following the application of a topical formulation. The technique has also been used as a diagnostic tool in assessing the quality of the stratum corneum in diseased skin. In the current research study, the tape stripping technique was used to investigate the pharmaceutical/biological availability of topical gel formulations containing ERY. MD is another DPK sampling technique which has been used to determine the amount of a topically applied drug that penetrates through the stratum corneum to reach deeper tissues of the skin. The in vivo sampling technique involves the insertion of microdialysis probes beneath the skin surface in the dermal tissue and allows for real-time sampling of the analyte at its target site. Recently in vitro MD has also been successfully used to assess the pharmaceutical availability of a topical corticosteroid, mometesone furoate, from topical formulations. Based on this work, microdialysis was used to determine the pharmaceutical availability of ERY from gel formulations which were developed for use in this research. The results of the pharmaceutical availability of ERY from in vivo tape stripping studies and the in vitro microdialysis studies were compared to establish correlation between the data. Pharmaceutical equivalence and bioequivalence data obtained from the respective studies on the gel formulations were investigated by statistical analysis of the data generated from both the in vitro and in vivo experiments. In summary the objectives of this research were: 1. To develop and validate a high performance liquid chromatography method suitable to analyse ERY concentrations obtained from in vitro microdialysis studies and in vivo tape stripping studies. 2. To prepare two different ERY gel formulations with different percentage content of propylene glycol. 3. To determine the pharmaceutical availability of ERY from two different gel formulations using in vitro microdialysis. 4. To develop and validate a tape stripping technique which could be used to determine percutaneous penetration and bioequivalence of the gel formulations. 5. To compare in vitro microdialysis and in vivo tape stripping data and attempt to establish a correlation between the two different approaches.
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  • Date Issued: 2008

Neuroprotective mechanisms of nevirapine and efavirenz in a model of neurodegeneration

  • Authors: Zheve, Georgina Teurai
  • Date: 2008
  • Subjects: HIV infections -- Treatment AIDS (Disease) -- Treatment AIDS dementia complex -- Treatment Nervous system -- Degeneration -- Treatment Melatonin Neurotoxic agents Quinolinic acid
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:3807 , http://hdl.handle.net/10962/d1003285
  • Description: AIDS Dementia Complex (ADC) is a neurodegenerative disorder implicated in HIV-1 infection that is associated with elevated levels of the neurotoxin, quinolinic acid (QA) which causes a cascade of events to occur, leading to the production of reactive oxygen species (ROS), these being ultimately responsible for oxidative neurotoxicity. In clinical studies, Non-nucleoside reverse transcriptase inhibitors (NNRTIs), efavirenz (EFV) and nevirapine (NVP) have been shown to potentially delay the progressive degeneration of neurons, thus reducing the frequency and neurological deficits associated with ADC. Despite these neuroprotective implications, there is still no biochemical data to demonstrate the mechanisms through which these agents offer neuroprotection. The present study aims to elucidate and further characterize the possible antioxidant and neuroprotective mechanisms of NVP and EFV in vitro and in vivo, using QA-induced neurotoxicity as a model. Research has demonstrated that antioxidants and metal chelators have the ability to offer neuroprotection against free radical induced injury and may be beneficial in the prevention or treatment of neurodegeneration. Hence the antioxidant and metal binding properties of these agents were investigated respectively. Inorganic studies, including the 1, 1-diphenyl-2 picrylhydrazyl (DPPH) assay, show that these agents readily scavenge free radicals in vitro, thus postulating the antioxidant property of these agents. The enhancement of superoxide radical generation and iron mediated Fenton reaction by QA is related to lipid peroxidation in biological systems, the extent of which was assayed using the nitroblue tetrazolium and thiobarbituric acid method respectively. Both agents significantly curtail QA-induced lipid peroxidation and potentially scavenge superoxide anions generated by cyanide in vitro. Furthermore, in vivo results demonstrate the ability of NVP and EFV to protect hippocampal neurons against lipid peroxidation induced by QA and superoxide radicals generated as a consequence thereof. The alleviation of QA-induced oxidative stress in vitro possibly occurs through the binding of iron (II) and / or iron (III), and this argument is further strengthened by the ability of EFV and not NVP to reduce iron (II)-induced lipid peroxidation in vitro directly. In addition the ferrozine and electrochemistry assay were used to measure the extent of iron (II) Fe[superscript 2+] and iron (III) Fe[superscript 3+] chelation activity. Both assays demonstrate that these agents bind iron (II) and iron (III), and prevent redox recycling of iron and subsequent complexation of Fe[superscript 2+] with QA which enhances neuronal damage. Both NNRTIs inhibit the endogenous biosynthesis of QA by inhibiting liver tryptophan 2, 3-dioxygenase activity in vivo and subsequently increasing hippocampal serotonin levels. Furthermore, these agents reduce the turnover of hippocampal serotonin to 5-hydroxyindole acetic acid. NVP and not EFV increase 5-hydroxyindole acetic acid and norepinephrine levels in the hippocampus. The results of the pineal indole metabolism study show that NVP increases the synthesis of melatonin, but decreases N-acetylserotonin, 5-hydroxyindole acetic acid and 5-hydroxytryptophol levels. Furthermore, it shows that EFV decreases 5-hydroxyindole acetic acid and melatonin synthesis. Behavioural studies using a Morris water maze show that the post-treatment of rats with NVP and EFV significantly improves QA-induced spatial memory deficits in the hippocampus. This study therefore provides novel information regarding the neuroprotective mechanisms of NVP and EFV. These findings strengthen the argument that these NNRTIs not only have antiviral effects but possess potential neuroprotective properties, which may contribute to the effectiveness of these drugs in the treatment of ADC.
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  • Date Issued: 2008

An illustrated information leaflet for low-literate HIV/AIDS patients on antiretroviral therapy : design, development and evaluation

  • Authors: Ramela, Thato
  • Date: 2009
  • Subjects: Antiretroviral agents -- South Africa HIV-positive persons -- Care -- South Africa AIDS (Disease) -- Study and teaching -- South Africa HIV infections -- Treatment -- South Africa AIDS (Disease) -- Treatment -- South Africa AIDS (Disease) -- Africa, Sub-Saharan -- Statistics Communication in medicine -- South Africa Communication in public health -- South Africa
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:3834 , http://hdl.handle.net/10962/d1007563
  • Description: South Africa's HIV prevalence rate is estimated to be 5.7 million and at the end of2007 a total of 45845 HIV/AIDS adult patients were taking antiretroviral therapy (ART). The global incidence of HIV/AIDS has been slowly decreasing over the years but is still widespread. This disease is still more prevalent in sub-Saharan Africa than in other parts of the world, with more than 60% people living with HIV/AIDS. Highly active antiretroviral therapy (HAART), the treatment of choice, slows the progression of the human immunovirus but demands a high adherence rate in excess of 95%. Patients who are poorly informed about antiretrovirals (ARVs) and misunderstand medicine-taking instructions or experience unexpected side effects may interrupt therapy, predisposing them to the development of resistance. Such patients need information but, given the poor literacy skills prevalent in South Africa, written information is often not fully comprehended and is often written at too high a reading level. The objectives of this research project were to design, modify and evaluate HIV / AIDS patient education materials for low-literate isiXhosa speaking adults residing in Grahamstown and to examine their impact on the understanding of various aspects of the disease and its treatment. Pictograms illustrating common side effects of ARVs (e.g. stavudine, efavirenz, lamivudine), as well as various sources 'for purchasing nonprescription medicines, storage and medicine-taking instructions were designed and evaluated both qualitatively, using group discussions, and quantitatively through individual interviews where interpretation of the pictograms was assessed. These pictograms were incorporated in a patient information leaflet (PIL) which had been specifically designed for people with limited reading skills and was a simple document containing the minimum of essential text. A previously developed PIL was modified in collaboration with the target population and two versions were produced, one incorporating pictograms illustrating side effects, the other with none. Pictograms were used in both to illustrate other medicine-taking instructions. The PILs were tested objectively to assess the readability, format, content, and general design. They were translated into isiXhosa prior to being qualitatively and quantitatively evaluated in a low-literate isiXhosa speaking population. Understanding of the PILs was assessed by asking a series of questions about the PIL content. Participant opinion of the readability and appearance of the PIL was recorded. The relationship between PIL understanding and selected demographic variables was investigated. Findings from this study illustrated that well designed pictograms assist in the location of information in written leaflets and they may enhance understanding of the information. It was further demonstrated that education influences total understanding of PIL content thus emphasizing the need for tailor-written information in accordance with the education level of the target population. A desire to receive PILs incorporating pictograms was expressed by the majority of participants. Collaboration with the intended target population is essential to design culturally acceptable, easily interpreted pictograms and to produce user-friendly, easy-to-read, comprehensible patient education materials. The rigorous, iterative design, modification and testing process described in this study is one that should be adopted in producing all health-related education materials.
  • Full Text:
  • Date Issued: 2009

Disclosure of HIV status and adherence to antiretroviral therapy

  • Authors: Kubashe, Nomachina Theopatra
  • Date: 2009
  • Subjects: HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10142 , http://hdl.handle.net/10948/1174 , HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
  • Description: The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.
  • Full Text:
  • Date Issued: 2009

Identifying, recording and monitoring adverse effects associated with antriretroviral treatment

  • Authors: Mulinge, Florence Muthoni
  • Date: 2010
  • Subjects: Highly active antiretroviral therapy , Antiretroviral agents -- South Africa -- Uitenhage , HIV infections -- Treatment -- South Africa -- Uitenhage , AIDS (Disease) -- Treatment -- South Africa -- Uitenhage
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10131 , http://hdl.handle.net/10948/1491 , Highly active antiretroviral therapy , Antiretroviral agents -- South Africa -- Uitenhage , HIV infections -- Treatment -- South Africa -- Uitenhage , AIDS (Disease) -- Treatment -- South Africa -- Uitenhage
  • Description: South Africa, with an estimated 5.7 million people living with HIV, continues to have one of the largest epidemics in the world. The introduction of HAART resulted in prolonged and improved quality of life of many infected patients. However, adverse effects caused by these drugs have become a major concern as they affect the adherence of patients and in some cases even result in the death of patients. Although much research has been and is still being conducted in the area of understanding, preventing and management of ARV adverse effects, there is still a need for patients to be actively involved in self-monitoring for adverse effects. This will assist health care professionals in early identification of serious or potentially serious ARV effects. This study aimed at evaluating the usefulness of strategies developed and employed in the identification, recording and monitoring of adverse effects. The study was conducted with patients receiving HAART from a private HIV and AIDS clinic in Uitenhage, Eastern Cape, South Africa. The research project was approved by the Nelson Mandela Metropolitan University Research and Ethics Committee and the research site. This was an experimental, randomized controlled study carried out over a period of three months (August to October 2009), with a sample size of 160 patients divided into four study groups of 40 patients each. Two monitoring strategies, namely an ARV adverse effect monitoring tool and a patient self-monitoring diary were developed and used for the identification and recording of adverse effects. The four study groups included a Control group, a Tool group, a Diary group and a Tool-Diary group. Willing patients, after signing an informed consent form, were randomly assigned to one of the four groups by participating health care workers at the study site. Data was retrieved from the patient files by the researcher. Descriptive statistical analysis of the findings of the study was conducted using SPSS®. One hundred and forty nine patients were included in the final data analysis. Of the 80 diaries handed out to patients, only 33 were returned and due to errors only 31 were suitable for analysis. Monitoring tools were completed and analysed for 36 patients. The tool was found to be more effective in identifying adverse effects of a physical nature (such as peripheral neuropathy and lipodystrophy) than the usual methods of monitoring employed by the clinic, whilst the diary, used alone, was found to be less effective. Use of the tool and diary combined resulted in the most significant identification and recording of central nervous system related adverse effects and physical adverse effects. However due to the low return rate of the diaries and the majority of the monitoring tool not being completed in many instances the results of this study may not be generalisable. The study results did however suggest that combining the tool and the diary methods of adverse effect identification, yielded the most favourable results when compared to each method alone. This may be attributed to the fact that the tool is useful in identifying objective symptoms and the diaries subjective symptoms, particularly in instances where the patients forget to report their symptoms to healthcare professional whilst at the clinic. The diaries were also reported to improve adherence for more than 90 percentage (n=31) of the patients. More research would be needed in order to verify the exact significance of the tool and the diary in identifying and recording adverse effects and symptoms of adverse effects.
  • Full Text:
  • Date Issued: 2010

Implementation of intravenous to oral antibiotic switch therapy guidelines in the general medical wards of a tertiary level hospital

  • Authors: Van Niekerk, Anida
  • Date: 2010
  • Subjects: Antibiotics -- Administration
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10160 , http://hdl.handle.net/10948/1325 , http://hdl.handle.net/10948/d1012901 , Antibiotics -- Administration
  • Description: The overuse of antibiotics and consequent resistance is a common problem in medical practice worldwide. Switch therapy is a technique that can be applied to streamline antibiotic therapy reducing unnecessary prolonged Intravenous (IV) antibiotic therapy. Antibiotic switch therapy has several other benefits such as: decreasing length of hospital stay; decreasing the incidence of adverse events associated with the administration of IV antibiotics; decreasing direct and indirect hospitalisation costs while improving patients’ comfort and mobility; and decreasing the risk of acquiring nosocomial infections. Certain elements are required to make the implementation of any guideline, including a switch therapy guideline, a success and probably one of the most important is the support from a motivated multidisciplinary team. The role of such a team, in the South African context, would be filled by the Pharmacy and Therapeutics Committee (PTC). In addition, to make a guideline successful it should be continuously implemented. This responsibility traditionally falls to a pharmacist. In the United Kingdom (UK) and the United States of America (USA) pharmacists are used to promote the appropriate use of antibiotics in hospitals as this has shown to have several economic advantages. The objectives of the study were: to determine, by means of a survey, whether guidelines for IV to oral switch were employed in South African regional, tertiary and national government hospitals; to design and implement an IV to oral antibiotic switch therapy (IVOST) guideline for a local public sector tertiary level hospital; to evaluate the effectiveness of guideline implementation; and to capture, via a questionnaire, the perceptions of prescribers regarding antibiotic prescribing, including switch therapy. The Survey of Current IV Switch Therapy Practice Questionnaire was distributed to Responsible Pharmacists at regional, provincial tertiary and national central government hospitals to determine whether IVOST guidelines were employed in South African government hospitals. Following the survey, an IVOST Guideline was designed by the researcher in consultation with the Department of Medicine and the Department of Pharmacy. The IVOST Guideline was implemented following approval by the PTC at a local tertiary level government hospital. A presentation was held for prescribers, guideline documents were distributed, posters were placed in the medical wards and the ward pharmacist/researcher integrated the guideline into daily practice by placing “reminder stickers” in patient medical folders. A pre-implementation audit and two post-implementation audits, each consisting of 150 patient medical records, were conducted and compared to determine the effect of IVOST guideline implementation on prescribing patterns and to determine whether any changes could be sustained. The Prescriber Antibiotic Survey was then conducted to capture the perceptions of prescribers regarding antibiotic therapy, including switch therapy.
  • Full Text:
  • Date Issued: 2010

Implementation of the dual therapy prevention of mother-to-child transmission protocol

  • Authors: Singh, Vikesh
  • Date: 2010
  • Subjects: HIV infections -- Transmission -- South Africa , AIDS (Disease) in pregnancy -- Prevention -- South Africa , Antiretroviral agents
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10138 , http://hdl.handle.net/10948/1374 , HIV infections -- Transmission -- South Africa , AIDS (Disease) in pregnancy -- Prevention -- South Africa , Antiretroviral agents
  • Description: Antiretroviral drugs taken during pregnancy, reduce the rates of mother-to-child transmission from 35 percent to as low as 1 to 2 percent (UNAIDS, 2009). In 2002, the Prevention of Mother-to-Child Transmission (PMTCT) programme was implemented in South Africa. Studies on the implementation of the PMTCT programme have shown that understaffed and under-developed health care facilities were key barriers to the provision of PMTCT services (Health Systems Trust, 2002: 6; Skinner et al., 2003). The aim of this study was to assess the challenges experienced by health care workers working in public sector facilities in the Nelson Mandela Metropole after implementation of the dual therapy PMTCT programme. Four areas were investigated: Infrastructure; Drug Supply Management; Clinic Procedures and Staffing. A quantitative descriptive study was conducted in August 2009 at nine public health care facilities in the Nelson Mandela Metropole, South Africa. Questionnaires were issued to 81 nurses and 41 pharmacy personnel (pharmacists and pharmacist assistants). Checklist audit forms were issued to the Facility Manager of each facility and completed with the researcher. The key findings for Infrastructure were lack of space at patient waiting rooms (9; 100 percent n=9), counselling area (5; 55.5 percent; n=9), nurse consultation rooms (6; 66.6 percent; n=9), storage areas (5; 55.5 percent; n=9) and filing areas (7; 77.7 percent; n=9). The key findings for Drug Supply Management were none of the dispensaries (0 percent; n=10) were fully compliant with Good Pharmacy Practice, pharmacy personnel indicated that there were no stock cards for medication (13; 31.7 percent; n=41); there was less than two weeks supply of buffer stock kept for zidovudine and nevirapine (13; 35.1percent; n=37) and medication orders were placed without any reference to minimum and maximum levels of medication (15; 36.5 percent; n=41) . The key findings for Clinic Procedures were only two facilities followed up on patients that had missed appointments (22.2 percent; n=9) and four facilities (44.4 percent; n=9) had a tracking system for patients that had defaulted. Of the nine facilities only three (33.3 percent; n=9) updated patient demographic details regularly. The key findings for Staffing were a shortage of doctors, nurses, counsellors and pharmacists at the facilities. One of the major challenges identified was the lack of training offered on new PMTCT protocols with 56.2 percent (45; n=80) of the nurses stating that no training was provided on the dual PMTCT protocol. Only 54.3 percent (44; n=81) of nurses stated that they knew the criteria to start the mother on dual PMTCT therapy. In conclusion there is an urgent need for barriers such as lack of staff, lack of space, lack of training on PMTCT and standard procedures for follow up of patients to be addressed in order to ensure the successful scaling up of PMTCT.
  • Full Text:
  • Date Issued: 2010

The impact of HAART on sexuality and medicine taking behaviours among people living with HIV/AIDS in Grahamstown

  • Authors: Chizanga, Tongai Aldridge
  • Date: 2010
  • Subjects: AIDS (Disease) -- Treatment -- South Africa -- Grahamstown HIV infections -- Treatment -- South Africa -- Grahamstown Antiretroviral agents -- South Africa -- Grahamstown Patient compliance -- South Africa -- Grahamstown AIDS (Disease) -- Social aspects -- South Africa -- Grahamstown HIV infections -- Social aspects -- South Africa -- Grahamstown AIDS (Disease) -- Patients -- South Africa -- Grahamstown -- Sexual behavior HIV-positive persons -- South Africa -- Grahamstown -- Sexual behavior Patient education -- South Africa -- Grahamstown
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:3750 , http://hdl.handle.net/10962/d1003228
  • Description: Introduction: Adherence to Highly Active Antiretroviral Therapy (HAART) is critical for optimal therapeutic outcomes. A possible factor in adherence is the impact of HAART on sexual functioning. Methods: A mixed methods approach was used. A cohort of 14 people living with HIV/AIDS (PLWHA) in Grahamstown was identified. Two semi-structured interviews and two structured questionnaires were administered. In-depth interviews were conducted with two HIV counsellors in so as to obtain a different perspective on the topics. The theoretical framework used three health behaviour models: the Health Belief Model, Leventhal‘s Common-Sense Model of self regulation and the Transtheoretical model. Results: The participants were between 27 and 49 years old and had been on HAART for between 9 months and 10 years. Six participants were support staff members from Rhodes University and eight from the Raphael Centre – a local NGO which assists PLWHA.In most of the participants HAART was associated with increased libido and improved sexual functioning (sexual activity and sexual enjoyment). The use of alcohol increased risky sexual behaviour. Issues of adherence were seemingly not directly affected by the effects of HAART on sexuality. PLWHA, especially women, face challenges related to their sexuality, some of which are not directly related to their illness and treatment. The fear of transmitting drug resistant HIV or getting re-infected, stigma, disclosure issues,difficulties negotiating for safe sex among women, HAART-related lipodystrophic changes that affect one‘s sense of self and unmet reproductive needs are some of the problems that were reported. The men‘s dislike for condoms was overt and blatant. Discussion: Being diagnosed with HIV and reaching a point where treatment is requiredare life-changing events. Making decisions about one‘s life (including adherence to HAART, alcohol use and knowingly partaking in risky sexual encounters) become all the more significant in the context of AIDS. Intentional non-adherence is informed by the individual‘s assessment of the costs and benefits of taking treatment. Cultural influences,gendered power relations and misconceptions strongly influence sexual behaviours. Conclusion: The general lack of attention among health care providers concerning issues related to PLWHA‘s sexuality and reproductive issues needs to be addressed. Insights fromthe theoretical models should be integrated with empirical findings in designing adherence interventions.
  • Full Text:
  • Date Issued: 2010

The pharmacotherapeutic treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents

  • Authors: Oettle, Judith Ann Elizabeth
  • Date: 2010
  • Subjects: Attention-deficit hyperactivity disorder -- Treatment -- South Africa , Attention-deficit hyperactivity disorder -- Alternative treatment -- South Africa , Attention-deficit-disordered children -- Treatment -- South Africa , Attention-deficit disorder in adolescence -- Treatment -- South Africa , Drug utilization -- South Africa
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10134 , http://hdl.handle.net/10948/1438 , Attention-deficit hyperactivity disorder -- Treatment -- South Africa , Attention-deficit hyperactivity disorder -- Alternative treatment -- South Africa , Attention-deficit-disordered children -- Treatment -- South Africa , Attention-deficit disorder in adolescence -- Treatment -- South Africa , Drug utilization -- South Africa
  • Description: Background: The ideal treatment of Attention-Deficit/Hyperactivity Disorder is a highly debated issue. Opposition to pharmacological treatments has resulted in the popular use of non-pharmacological measures which are not necessarily efficacious for the management of ADHD. Objectives: The primary aim was to evaluate the treatment of children and adolescents diagnosed with ADHD in South Africa. Methods: The study consisted of two parts, a drug utilisation review (DUR) and questionnaire-based surveys. The DUR was conducted using a database containing central nervous system (CNS) drug prescriptions which were dispensed during 2008. A total of 21 650 prescriptions dispensed to 7 202 patients constituted the Primary study population which was analysed. The questionnaires were distributed to the parents/caregivers of children diagnosed with ADHD. A response rate of 20.81 percent was obtained. Results: The average age of patients in the DUR was 11.60 ±3.01 years. Male patients represented 74.09 percent (5 336: n = 7 202) of patients. Methylphenidate was the most commonly prescribed of the two drugs indicated for the treatment of ADHD (85.89 percent, 18 956: n = 21 650). A prescribing bias by practitioners in different parts of South Africa was identified. Drug holidays were identified during March and December of 2008. The average age of patients in the questionnaire was 10.67 ±2.83 years, with a male patient majority (86.11 percent, 31: n = 36). Methylphenidate was the most commonly used prescription treatment (93.75 percent, 30: n = 32). Drug holiday use was reported in 56.25 percent (18: n = 32) of patients. Most participants reported supplement use (83.33 percent, 30: n = 36), but 86.67 percent (26: n = 30) of these participants did not find them useful. Conclusion: ADHD is a poorly understood disorder which affects people in all spheres of life. Treatment of the disorder should be individualised and based on scientifically proven effectiveness. Further studies, both in South Africa and worldwide, need to be conducted on the treatment of ADHD
  • Full Text:
  • Date Issued: 2010

Management of type 2 diabetes mellitus : a pharmacoepidemiological review

  • Authors: Saugur, Anusooya
  • Date: 2011
  • Subjects: Diabetes , Diabetes -- Management , Diabetes -- Diet therapy , Diabetes -- Prevention , Insulin -- Therapeutic use , Hypoglycemia
  • Language: English
  • Type: Thesis , Masters , MPharm
  • Identifier: vital:10129 , http://hdl.handle.net/10948/1635 , Diabetes , Diabetes -- Management , Diabetes -- Diet therapy , Diabetes -- Prevention , Insulin -- Therapeutic use , Hypoglycemia
  • Description: Type 2 diabetes mellitus (DM) is a progressive disease characterised by hyperglycaemia caused by defects in insulin secretion and insulin action. In early stages of type 2 DM, dietary and lifestyle changes are often sufficient to control blood glucose levels. However, over time, many patients experience β cell dysfunction and require insulin therapy, either alone or in combination with oral agents. There are guidelines available to structure the management of this disease state, including both the use of oral hypoglycaemic agents and or insulin. Besides health complications, there are economic burdens associated with the management of type 2 diabetes mellitus. The aim of this study was to determine the management of type 2 DM in a South African sample group of patients drawn from a large medical aid database. The objectives of the study were: to establish the prevalence of type 2 DM relative to age, examine the nature of chronic comorbid disease states, establish trends in the prescribing of insulin relative to other oral hypoglycaemic agents, investigate cost implications, and determine trends in the use of blood and urine monitoring materials by patients. The study was quantitative and retrospective and descriptive statistics were used in the analysis. DM was found to be most prevalent amongst patients between 50 and 59 years old. Results also demonstrated that 83% of DM patients also suffered from other chronic comorbid diseases, with cardiovascular diseases, especially hypertension and hypercholesterolaemia being the most prominent. This study also revealed that DM is predominantly managed with oral hypoglycaemic agents. Changes in drug prescribing, for chronic disease states such as DM may have medical, social and economic implications both for individual patients and for society and it is envisaged that the results of this study can be used to influence future management of DM. Keywords: Pharmacoepidemiology, management, type 2 diabetes mellitus
  • Full Text:
  • Date Issued: 2011
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