Adaku Efuribe – A clinical Pharmacist/UN SDGs Advocate
“Safe and effective medicines for all” is the theme of this year’s World Pharmacists Day. (25th September 2019).The theme aims to promote pharmacists’ crucial role in safeguarding patient safety through improving medicines use and reducing medication errors.
“Pharmacists use their broad knowledge and unique expertise to ensure that people get the best from their medicines. We ensure access to medicines and their appropriate use, improve adherence, coordinate care transitions and so much more. Today, more than ever, pharmacists are charged with the responsibility to ensure that when a patient uses a medicine, it will not cause harm”, says FIP President Dominique Jordan.
I believe Nigerian pharmacists are better placed to safeguard patient safety through medicines optimisation and patient centered care. I have observed that this service tends to be lacking in our primary and secondary care facilities because there is a lack of multidisciplinary team approach in some settings. We need to start having these conversations and change the status quo.We need to embrace integrated healthcare. A lot of patients using clinical facilities, do not come in contact with a pharmacist, they do not get their medicines reconciled or reviewed, resulting to exposure to adverse drug-drug interactions and lack of concordance.
As long as we still have some clinicians in Nigeria diagnosing, prescribing, dispensing medication and ‘hiding’ the name of the medicine from the patient; duplication of therapy, adverse drug reactions and drug-drug interactions are inevitable.
Patients have the right to know the medicines they are taking to help achieve concordance and prevent medication errors and overdose.
Pharmacists led medicines review, reconciliation/ optimisation prevents medication errors & adverse drug reactions.
Medicines reconciliation is a process whereby patient’s medicines are reconciled as they move between different stages of healthcare, from primary – secondary care interface. Pharmacists are better placed and equipped to complete the medicines reconciliation process.
Pharmacist led medication review tends to be more in-depth ,capturing all the essence of patient centred care as it offers more time for the patient to ask medicines related questions which enhances concordance.
Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring; like methotrexate, diuretics, digoxin etc.
According to the Royal Pharmaceutical Society ‘Medicines optimisation represents that step change. It is a patient-focused approach to getting the best from investment in and use of medicines that requires a holistic approach, an enhanced level of patient centered professionalism, and partnership between clinical professionals and a patient’.
I believe medicines optimisation is about ensuring that patients receive the right kind of medication at the right time. It focuses on making patients get the best out of their medicines. Evidence has shown that a good number of medicines prescribed end up not being taken due to lack of concordance and compliance.
My experience with patient returned medication has shown that patients who do not understand the rationale for prescribed medication are more likely not to use the medication. Also medication used for preventative measures are at a higher risk of non-compliance as patients do not appreciate the benefits of taking such medication.
The gains of patient centered care cannot be overemphasised, all medical needs have to be tailored to the individual patient, considering their personal circumstances, other co-morbidities, and sometimes frailty comes into consideration for some elderly patients as well.
In some clinical settings, a lot of patients do not know what regular medicines they are taking or the reason why it has been prescribed, their indication or side effects to expect and they have never had their medication reviewed by a pharmacist since their long term condition was diagnosed.
Part of the role of the pharmacist in a clinical setting is to complete medicines reconciliation and medication reviews especially for patients taking regular medication for long term condition like Hypertension, Diabetes, Arthritis, Asthma etc.We need to create the enabling environment for this to be achieved.
For instance, a patent living in Kaduna with a history of hypertension, takes antihypertensive –Calcium channel blocker (CCB) – amlodipine tablets prescribed by his local doctor.
Patient travels to Lagos on official assignment and falls ill, patient gets admitted to a hospital ,diagnosed with very high blood pressure(HBP), patient receives treatment and gets discharged with three other medicines which includes another –CCB-Nifedipine , without being asked about his past medication history or told what medicines to stop /continue.
Patient continues to take two CCB –nifedipine and amlodipine at the same time and suffers hypotension (low blood pressure), which makes his condition worse. Patient is re-admitted to hospital in Kaduna, his medication is reviewed by a pharmacist, and he is told to stop Nifedipine and continue taking only Amlodipne.
Learning points- We need to utilise the expertise of pharmacists in all clinical settings.
A medication reconciliation process with a pharmacist during the hospital admission/discharge process in Lagos could have prevented the hypotension resulting from a duplication of therapy.
Evidence has shown that when patients understand the side effects of the medication they take, they are more likely to comply with the dosage regimen.
The gains of patient centered care cannot be overemphasized; all medical needs have to be tailored to the individual patient, considering their personal circumstance. Pharmacists are better placed to undertake this piece of work.
In the course of completing a medication review with one of my patients, It came to light why patient’s chronic obstructive pulmonary disease (COPD) was not well managed .This patient happened to be visually impaired and was unable to read the small typed instructions on the dispensing label and so assumed tiotropium capsules needed to be swallowed whole and not inserted into the inhalation device. After I offered education, guidance and support to this patient, the patient was able to use her inhaler as intended and her COPD symptoms were well controlled eventually. In this case a possible COPD exacerbation or even hospital admission/death was prevented.
Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring; like methotrexate, diuretics, digoxin etc.Annual blood tests are routinely checked because if dosage regimens are not adjusted or vital blood checks are not made, this may lead to increased harm to the patient or even death.
As we work towards achieving SDG3 and universal health coverage in Nigeria,
The following simple steps could help reduce the risk of medication errors and medicines related deaths in Nigeria:
- We have to develop and implement a nationwide strategy which will bring about the desired change in the healthcare system.
- We need to optimise integrated healthcare and patient centred care using a multidisciplinary team approach.
- We need to begin to put the patient at the centre of care and utilise the pharmacists expertise and input if we must provide safe and effective medicines for all.
The Ministry of health needs to develop and enforce policies around medicines reconciliation and medication reviews especially for patients with long term conditions who need regular medication to improve their quality of life and increase life expectancy and they must ensure that the ‘drug experts’ are given the opportunity to bring their expertise to the table.
Nigerian Clinicians need to work together to ensure adequate measures are put in place and everyone contributes their own quota towards effective healthcare delivery.
The role of the pharmacist in medicines optimisation and patient centred care cannot be overemphasized.
Article by Adaku Efuribe- A clinical Pharmacist/UN SDGs Advocate
Kasha Global Inc. secures $1 Million DFC equity investment to grow and scale across East Africa
Kasha Global Inc. beneficiaries (Source: DFC)
U.S. International Development Finance Corporation (DFC) today announced the disbursement of a $1 million equity investment in Kasha Global Inc., an e-commerce company that provides women’s health and personal care products to customers in Rwanda and Kenya, alongside investments from Finnfund and Swedfund. This investment was made through DFC’s Portfolio for Impact and Innovation (PI2) initiative, which aims to finance early-stage, high-impact solutions to challenges facing developing countries.
“High quality and equitable health services and products are fundamental to the wellbeing, and ultimately the economic potential, of women and girls in the developing world,” said Vice President for DFC’s Office of External Affairs Algene Sajery. “DFC is proud to support Kasha’s innovative business model, which is helping transform the personal care and health system supply chain in East Africa, and provide financing that strengthens economic growth in the region.”
“Kasha is excited to bring DFC on as an investor and as a long term partner,” said Kasha Global Founder & CEO Joanna Bichsel. “With the U.S. Government’s significant ongoing investments in the areas of Global Health and with DFC’s focus on supporting businesses proven to drive both commercial returns as well as social impact, we see strong win-win opportunities as Kasha continues to grow and scale across East Africa and beyond. We have been impressed with the level of support DFC is extending into emerging market businesses and into women-led and women-focused businesses.”
Many women in emerging markets lack access to safe, high-quality, and affordable health and personal care products as well as information surrounding these products. As products are often out of stock or counterfeit, the purchasing experience can be frustrating and disempowering for many women. Further, the stigma surrounding women’s health and personal care products in some cultures can have serious consequences. A UNESCO report estimates that one out of 10 girls in sub-Saharan Africa misses school during her menstrual period, amounting to as much as 20 percent of the school year.
Since 2016, Kasha has helped address women’s lack of access to health and personal care products by delivering a unique, discreet and user-friendly purchasing experience to the customers it serves. Through its e-commerce platform, Kasha has reconfigured the supply chain, delivery channel, and customer experience in order to meet demand. Kasha’s business-to-customer line of business directly sells products to customers in rural and urban locations across East Africa, especially low income communities. Kasha empowers over 400 local women to enter hard to reach communities to provide information and assist customers in purchasing products. The company’s business model is optimized to reach low income communities. Kasha has delivered over 1 million product units to over 130,000 unique customers, of which 63% are low income customers in Rwanda and Kenya.
Despite Kasha’s rapid growth and loyal customer base, fundraising is extremely challenging for start-ups in emerging markets, particularly during the COVID-19 pandemic. By investing $1 million in equity through the PI2 program, DFC aims to help Kasha fill the financing gap, providing the e-commerce company with the capital required to scale its business.
DFC’s investment advances its 2X Women’s Initiative, which has committed more than $4 billion of investment in projects that empower women in developing countries. The Kasha investment also qualifies for the 2X Challenge, an initiative of the G7 countries to support women’s economic empowerment. Kasha was co-founded by two women, 50 percent of Kasha’s senior leadership team are women, 75 percent of board members are women, 64 percent of Kasha’s employees are women, and the company’s products center around care for women and girls. Based on Kasha’s commitment to the 2X Challenge criteria, Kasha, DFC, Finnfund and Swedfund have signed a side letter which highlights Kasha’s 2X accomplishments and sets an example for other companies that seek to improve their businesses using the 2X Challenge criteria.
By focusing on innovative care delivery models and supply chain innovations, DFC’s financing also advances the agency’s Health and Prosperity Initiative, helping respond to COVID-19 and other health-related issues in Rwanda and Kenya.
Swedfund is Sweden’s development finance institution. Finnfund is the Finnish development finance institution.
Play Zuri Health launches its first mHealth App to help provide affordable and accessible healthcare solutions
Play Zuri Health Limited Mobile App (Source: Zuri Health)
Play Zuri Health Limited, a branch of the Play Communications Limited announced the launch of their first mobile app, Zuri Health; that can be downloaded from the Google Play Store, Apple Store as well as the Zuri Health website.
Zuri Health’s mission is to provide certified, affordable and accessible healthcare solutions via mobile with dedicated apps, wap and SMS services based on availability, location and specialization of the medical providers.
Users will have access to a myriad of professionals and services from across their home counties. They are able to book appointments instantly with any medical professional or hospital within their geographic regions, book laboratory tests, chat with the practitioners via both message and video as an added feature and request for home visits by the Licensed and Certified Medical Practitioners.
Under Pharmacy, users can get their prescription and over the counter medication online and have it delivered to their doorstep.
The SMS service functionality of Zuri Health has been designed to reach a wide range of individuals or users who may not have access to WAP or internet enabled devices.
The app’s code was written with the daily challenges patients face in the journey of seeking affordable and accessible healthcare solutions. We solve the problem of expensive and inconvenient hospital trips for small or minor diagnosis and prescriptions, long waiting times and queues during doctors’ visits and appointments scheduling and booking which can be tasking.
Through our mobile app, we also help doctors to tap into a wider market of on-demand patients and earn extra money while saving lives.
“Zuri Health App is very personal to me. Millions of people in Africa do not have access to quality medical care. At Zuri Health we have taken time to develop a product that will fill that gap, giving doctors a wider and easier platform to reach patients who need them. With Zuri Health the underserved populace can now access affordable and sustainable healthcare.” Arthur Ikechukwu Anoke- C.E.O and Co- Founder Zuri Health.
Daisy Isiaho Project Manager and Co-founder in an interview said, “In my view, there is an urgent need to drive more meaningful conversations in relation to frameworks around Telemedicine because in Africa very few countries have these yet its fundamental if we should achieve the Sustainable Development Goals.”
Since the beta launch in November 2020 the company’s predicted three year growth plan is to have more than 20,000 registered doctors listed, 250,000 premium users and at least 1,000,000 mobile downloads.
Live A Full Life With Sickle Cell Disease
Kunle Tometi a Pharmacist, Entrepreneur and Public Health Advocate.
The World Sickle Cell Day is a United Nation’s recognized day to raise awareness about sickle cell disease (SCD) at a national and international level. On 22nd December 2008, the UN General Assembly adopted a resolution that recognizes sickle cell disease as a public health issue and “one of the world’s foremost genetic diseases.” The resolution calls for UN member states to raise awareness about sickle cell on June 19th of each year.
In this article, I would be creating awareness on sickle cell disease, the causes, symptoms, treatment and prevention.
What is sickle cell disease (SCD)
Sickle cell anemia (sickle cell disease) is a disorder of the blood caused by inherited abnormal hemoglobin (the oxygen-carrying protein within the red blood cells). The abnormal hemoglobin causes distorted (sickled) red blood cells.
SCD is more common in certain ethnic groups, including:
- People of African descent,
- Including African-Americans (among whom 1 in 12 carries a sickle cell gene)
- Hispanic-Americans from Central and South America
- People of Middle Eastern, Asian, Indian, and Mediterranean descent
- Approximately 2000 infants are born annually with the disease
- SCD affects approximately 200,000 Americans annually
- 1 in 365 African Americans
- 1 in 13 African Americans have the traits (carrying only 1 of the gene, S)
(CDC August 2017, Mayo Clinic)
Economics of SCD
10 years ago; Medical expenditure for children with SCD averaged $12,000 yearly for those with Medicaid and $15,000 yearly for those with commercial insurance.
There were also 113,000 hospitalizations costing over $500,000 paid by Medicare and Medicaid of which 75% of the visits were in adults and each with at least 3 Emergency Room visits per year. Children with SCD miss a minimum of 18 days per school year
Total healthcare costs nowadays for SCD is estimated at $2billion per year.
According to (David A.N et al 2018), ‘In Nigeria, the prevalence of SCD is 20–30/1000 live births. The burden of the disease has reached a level where it contributes 9–16% to under-five mortality in many West African countries. Hemoglobinopathies alone represent a health burden comparable to that of communicable and other major diseases’
Causes of SCD
Healthy red blood cells are round, and they move freely through small blood vessels to carry oxygen to all parts of the body. In SCD, the red blood cells become hard and sticky and look like a C-shaped called a “sickle” and they are not able to carry enough oxygen. When they travel through small blood vessels, they get stuck and clog the blood flow.
The sites most often affected by clogging or stacking of sickle cells are found in the lungs, liver, muscle, bone, spleen, eyes, and kidneys and other parts and tissues of the body: explains why patients complain of a lot of pain in these areas as the symptom of the disease.
Patients also have immunity suppression which leads to infections by bacteria, and viruses.
Symptoms of SCD includes;
- Excessive fatigue, irritability from anemia
- Jaundice (yellowing of eyes and skin), may also include retina damage
- Swelling and pain in hands, and feet, Pain in chest, back arms and legs, also damage of hip
- Frequent infections,
- Pain and problems in the spleen, (Nausea, vomiting, diarrhea)
- Delayed growth
- Stroke (20–30% of children stroke, 23% in African Americans)
- Genitalia (priapism, a constant erection, in which severe episodes may lead to impotency)
Treatment of Sickle Cell Anemia
Treatment of SCD pain or crisis is done in the following manner:
Rehydration: with IV fluids, helps Red blood cells return to normal shape
- Antibiotics: used to treat underlying infections. In some cases antibiotic prophylaxis, penicillins are recommended.
- Pain medications to treat acute pain
- Hydroxyurea: helps increase production of red blood cells
Immunization: Pneumococcal and Meningococcal vaccines have drastically reduced the rate of infections in SCD
Blood transfusion: improves oxygen and nutrients needed
Supplemental oxygen by mask makes breathing easier and improves oxygen levels in the blood
Bone marrow transplant: for severe complications and matching donors.
- Genetic counselling and testing (better before marriage and at pregnancy) can help prevent the likelihood of passing gene to your child
- Preventing infections can be achieved by practising simple hand washing techniques at every opportunity. Hand sanitiser gels and wipes are also available and affordable
- Immunisation is very important and one must assure shots and records are current to cut down on the rate of common infections.
- Re-hydration with fluids at all times is essential.
- Avoid staying in places with low concentration of oxygen, e.g. unpressurised air planes, or high altitudes
For more information about SCD, please speak to your Pharmacist or Doctor.
Article by Kunle Tometi a Pharmacist, Entrepreneur and Public Health Advocate.
- Mayo clinic https://www.gstatic.com/healthricherkp/pdf/sickle-cell-anemia.pdf
- CDC https://www.cdc.gov/ncbddd/sicklecell/data.html
- Sickle cell Disease: Public health agenda & Social, Economic and Health implications by CDR Althea M Grant, PhD September 2012
- Overview of the management & prognosis of sickle cell disease, Joseph Palermo, D.O.
- Economic impact of sickle cell Hospitalization. R Singh, Ryan Jordan and Charin Hanlon
- Prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria
Prevalence and impact of sickle cell trait on the clinical and laboratory parameters of HIV infected children in Lagos, Nigeria.
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