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Abraham NA, Tesfagaber M, Tesfamariam S. Stakeholders' Perspective on the Integration of Pharmacovigilance Activities into the Eritrean Healthcare System: A Qualitative Study. Risk Manag Healthc Policy 2023; 16:747-757. [PMID: 37113312 PMCID: PMC10128073 DOI: 10.2147/rmhp.s398811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
Purpose Understanding the integration of pharmacovigilance activities in the healthcare system and identifying existing hindering factors systematically through the eyes of stakeholders has paramount importance to realize a successful integration. Thus, this study aimed to assess the perspectives of the stakeholders of the Eritrean Pharmacovigilance Center (EPC) on the integration of pharmacovigilance activities into the Eritrean healthcare system. Methods An exploratory qualitative assessment of the integration of pharmacovigilance activities into the healthcare system was conducted. Key informant interviews were conducted among the major stakeholders of the EPC via face-to-face and telephone interviews. Data were collected between October 2020 and February 2021, and analyzed through thematic framework analysis. Results A total of 11 interviews were completed. The integration of the EPC in the healthcare system was rated as good and encouraging except in the National Blood Bank, and Health Promotion. The relationship between the EPC and Public health programs was described as mutual with an eminent impact. Several facilitating factors for integration were identified namely: the unique work culture of the EPC; provision of basic and advanced training; motivating and recognizing healthcare professionals in vigilance activities; and the financial and technical support provided to the EPC from national and international stakeholders. On the other hand, the absence of concrete communication systems, inconsistencies in training and communication, the absence of data-sharing mechanisms and policies, and the absence of designated pharmacovigilance focal persons were identified as barriers to successful integration. Conclusion Integration of the EPC in the healthcare system was found to be commendable except in some areas of the healthcare system. Therefore, the EPC should work towards identifying further areas of integration, mitigate the identified limitations and at the same time sustain the integration already initiated.
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Affiliation(s)
- Natnael Araya Abraham
- University of Oxford, Nuffield Department of Medicine, Center of Tropical Medicine and Global Health, Oxford, UK
| | - Meron Tesfagaber
- Product Evaluation and Registration Unit, National Medicines and Food Administration, Asmara, Eritrea
- Correspondence: Meron Tesfagaber, Tel +291-7501923, Fax +291-1-122899, Email
| | - Sirak Tesfamariam
- Product Evaluation and Registration Unit, National Medicines and Food Administration, Asmara, Eritrea
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Eritrean Pharmacovigilance System: Key Strategies, Success Stories, Challenges and Lessons Learned. Drug Saf 2021; 44:1021-1032. [PMID: 34472048 DOI: 10.1007/s40264-021-01102-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
Establishing a mature pharmacovigilance system in a low-income country is a challenge. Nevertheless, Eritrea, one such low-income country, was able to achieve a fully fledged pharmacovigilance system within a period of almost 9 years. In the last five years (2014-2019), the Eritrean Pharmacovigilance Centre has submitted, on average, 646 individual case safety reports (ICSRs) per million inhabitants per year to the World Health Organization (WHO) global database of ICSRs. As a result, Eritrea has been rated among the top reporting countries in Africa. The center has detected about 30 safety signals, achieved maturity level three on the WHO rapid benchmarking assessment, and gained huge political commitment. In the last few years, monitoring of product quality through the pharmacovigilance system found approximately 55 medical products that were either substandard or falsified and were subsequently recalled from the Eritrean market by the National Medicines and Food Administration. The aim of this article is to describe Eritrea's success stories, key strategies for success, challenges encountered, and lessons learned to share them with the international pharmacovigilance community and beyond.
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Chalon S, Chughlay MF, Abla N, Marie Tchouatieu A, Haouala A, Hutter B, Lorch U, Macintyre F. Unanticipated CNS Safety Signal in a Placebo-Controlled, Randomized Trial of Co-Administered Atovaquone-Proguanil and Amodiaquine. Clin Pharmacol Ther 2021; 111:867-877. [PMID: 34453327 PMCID: PMC9291514 DOI: 10.1002/cpt.2404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/29/2021] [Indexed: 01/28/2023]
Abstract
Atovaquone‐proguanil (ATV‐PG) plus amodiaquine (AQ) has been considered as a potential replacement for sulfadoxine‐pyrimethamine plus AQ for seasonal malaria chemoprevention in African children. This randomized, double‐blind, placebo‐controlled, parallel group study assessed the safety, tolerability, and pharmacokinetics (PKs) of ATV‐PG plus AQ in healthy adult males and females of Black sub‐Saharan African origin. Participants were randomized to four treatment groups: ATV‐PG/AQ (n = 8), ATV‐PG/placebo (n = 12), AQ/placebo (n = 12), and placebo/placebo (n = 12). Treatments were administered orally once daily for 3 days (days 1–3) at daily doses of ATV‐PQ 1000/400 mg and AQ 612 mg. Co‐administration of ATV‐PG/AQ had no clinically relevant effect on PK parameters for ATV, PG, the PG metabolite cycloguanil, AQ, or the AQ metabolite N‐desethyl‐amodiaquine. Adverse events occurred in 8 of 8 (100%) of participants receiving ATV‐PG/AQ, 11 of 12 (91.7%) receiving ATV‐PG, 11 of 12 (91.7%) receiving AQ, and 3 of 12 (25%) receiving placebo. The safety and tolerability profiles of ATV‐PG and AQ were consistent with previous reports. In the ATV‐PG/AQ group, 2 of 8 participants experienced extrapyramidal adverse effects (EPAEs) on day 3, both psychiatric and physical, which appeared unrelated to drug plasma PKs or cytochrome P450 2C8 phenotype. Although rare cases are reported with AQ administration, the high incidence of EPAE was unexpected in this small study. Owing to the unanticipated increased frequency of EPAE observed, the combination of ATV‐PQ plus AQ is not recommended for further evaluation in prophylaxis of malaria in African children.
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Affiliation(s)
| | | | - Nada Abla
- Medicines for Malaria Venture, Geneva, Switzerland
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Habtemikael L, Russom M, Bahta I, Mihreteab S, Berhane A, Mårtensson A, Gil JP. Prevalence of CYP2C8*2 and *3 among Eritreans and its Potential Impact on Artesunate/Amodiaquine Treatment. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2020; 13:571-575. [PMID: 33209048 PMCID: PMC7669516 DOI: 10.2147/pgpm.s276215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/16/2020] [Indexed: 12/23/2022]
Abstract
Background In Eritrea, artesunate–amodiaquine is the first-line treatment against uncomplicated malaria. Amodiaquine, which is mainly bio-transformed by CYP2C8, is known to be associated with adverse events of different severity. Extrapyramidal events are among the less common but have been reported with non-negligible frequency in Eritrea. This study was conducted to investigate the allele frequencies of CYP2C8*2 and *3, both associated with decreased amodiaquine metabolism, among the Eritrean population. Methods During September–November 2018, dried blood samples from 380 participants and 17 patients who previously had experienced extrapyramidal symptoms following treatment of artesunate–amodiaquine were collected and PCR-RFLP genotyped for CYP2C8*2 and *3. Results The allele frequencies of CYP2C8*2 and *3 were determined as 5.9% (95% CI: 4.4–7.8) and 4.6% (95% CI: 3.2–6.3), respectively. Four out of the 17 patients with extrapyramidal reactions showed to be carriers of the alleles. Conclusion CYP2C8*2 and *3 frequencies among Eritreans were found to be intermediate between the documented for Caucasian and African populations. These findings, along with the alleles not being decisive for the occurrence of extrapyramidal events, might be of importance regarding the amodiaquine-containing malaria treatment in Eritrea. Furthermore, it suggests a significant proportion of slow amodiaquine metabolizers in the Sahel region, information of potential interest in the context of amodiaquine-involving seasonal malaria chemoprevention.
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Affiliation(s)
- Lidia Habtemikael
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Mulugeta Russom
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Iyassu Bahta
- National Medicines and Food Administration, Ministry of Health, Asmara, Eritrea
| | - Selam Mihreteab
- National Malaria Control Programme, Ministry of Health, Asmara, Eritrea
| | - Araia Berhane
- Communicable Diseases Control Division, Ministry of Health, Asmara, Eritrea
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
| | - Jose Pedro Gil
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden.,Department of Microbiology and Tumour Cell Biology, Karolinska Institute, Stockholm, Sweden.,Biosystems & Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, Lisbon, Portugal
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van Hunsel F, van de Koppel S, van Puijenbroek E, Kant A. Vitamin B6 in Health Supplements and Neuropathy: Case Series Assessment of Spontaneously Reported Cases. Drug Saf 2018; 41:859-869. [DOI: 10.1007/s40264-018-0664-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kovacs SD, Mills BM, Stergachis A. Donor support for quality assurance and pharmacovigilance of anti-malarials in malaria-endemic countries. Malar J 2017; 16:282. [PMID: 28693488 PMCID: PMC5504670 DOI: 10.1186/s12936-017-1921-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/28/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Malaria control efforts have been strengthened by funding from donor groups and government agencies. The Global Fund to Fight AIDS, Tuberculosis and the Malaria (Global Fund), the US President's Malaria Initiative (PMI) account for the majority of donor support for malaria control and prevention efforts. Pharmacovigilance (PV), which encompasses all activities relating to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problem, is a necessary part of efforts to reduce drug resistance and improve treatment outcomes. This paper reports on an analysis of PV plans in the Global Fund and PMI and World Bank's grants for malaria prevention and control. METHODS All active malaria grants as of September 2015 funded by the Global Fund and World Bank, and fiscal year 2015 and 2016 PMI Malaria Operational Plans (MOP) were identified. The total amount awarded for PV-related activities and drug quality assurance was abstracted. A Key-Word-in-Context (KWIC) analysis was conducted for the content of each grant. Specific search terms consisted of pharmacovigilance, pregn*, registry, safety, adverse drug, mass drug administration, primaquine, counterfeit, sub-standard, and falsified. Grants that mentioned PV activities identified in the KWIC search, listed PV in their budgets, or included the keywords: counterfeit, sub-standard, falsified, mass drug administration, or adverse event were thematically coded using Dedoose software version 7.0. RESULTS The search identified 159 active malaria grants including 107 Global Fund grants, 39 fiscal year 2015 and 2016 PMI grants and 13 World Bank grants. These grants were primarily awarded to low-income countries (57.2%) and in sub-Saharan Africa (SSA) (70.4%). Thirty-seven (23.3%) grants included a budget line for PV- or drug quality assurance-related activities, including 21 PMI grants and 16 Global Fund grants. Only 23 (14.5%) grants directly mentioned PV. The primary focus area was improving drug quality monitoring, especially among the PMI grants. CONCLUSIONS The results of the analysis demonstrate that funding for PV has not been sufficiently prioritized by either the key malaria donor organizations or by the recipient countries, as reflected in their grant proposal submissions and MOPs.
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Affiliation(s)
- Stephanie D. Kovacs
- Department of Epidemiology, University of Washington, 6123 SW Stevens Street Apt 302, Seattle, WA 98116 USA
| | - Brianna M. Mills
- Department of Epidemiology, University of Washington, 6123 SW Stevens Street Apt 302, Seattle, WA 98116 USA
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA USA
| | - Andy Stergachis
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Pharmacy, University of Washington, Seattle, WA USA
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Assi SB, Aba YT, Yavo JC, Nguessan AF, Tchiekoi NB, San KM, Bissagnéné E, Duparc S, Lameyre V, Tanoh MA. Safety of a fixed-dose combination of artesunate and amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in real-life conditions of use in Côte d'Ivoire. Malar J 2017; 16:8. [PMID: 28049523 PMCID: PMC5209945 DOI: 10.1186/s12936-016-1655-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background In many malaria-endemic, sub-Saharan African countries, existing pharmacovigilance systems are not sufficiently operational to document reliably the safety profile of anti-malarial drugs. This study describes the implantation of a community-based pharmacovigilance system in Côte d’Ivoire and its use to document the safety of ASAQ Winthrop® (artesunate–amodiaquine). Methods This prospective, longitudinal, descriptive, non-comparative, non-interventional study on the use of artesunate–amodiaquine in real-life conditions of use was conducted in seven Community Health Centres of the Agboville district in Côte d’Ivoire. Twenty trained Health Centre employees and 70 trained community health workers were involved in data collection in the field. All patients with suspected uncomplicated falciparum malaria, seeking treatment at one of the participating Health Centres, and treated with artesunate–amodiaquine could be enrolled. Two visits were planned, one for inclusion at the Health Centre and a second at home, performed by a community health worker 3–10 days after the inclusion visit. Administration of artesunate–amodiaquine was unsupervised. Adverse events (AEs) were documented at the home visit or during any unexpected visit to the Health Centre or to the hospital and coded and adjudicated by a local pharmacovigilance committee. Symptoms suggestive of hepatic failure, severe neutropaenia, extrapyramidal disorders and retinopathy were considered a priori as AEs of special interest. Results Some 15,228 malaria episodes in 12,198 patients were evaluated; 2545 AEs were documented during 1978 malaria episodes (13.0%). The most frequently observed events were asthenia (682 cases), vomiting (482 cases) and somnolence (174 cases). Most reported AEs were of mild or moderate intensity and resolved without corrective treatment. One-hundred and five (105) AEs reported during 100 episodes (0.7%) were considered as serious. Three serious cases of transient extrapyramidal disorders, identified as AEs of special interest were reported in three patients. Conclusion The fixed dose artesunate–amodiaquine combination ASAQ Winthrop® for the unsupervised treatment of uncomplicated falciparum malaria under real-life conditions of care in Côte d’Ivoire is well tolerated. The study emphasizes the interest of involving properly trained community health workers to collect pharmacovigilance data in the field in order to document rare AEs. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1655-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Serge-Brice Assi
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Ivory Coast. .,National Malaria Control Programme, Abidjan, Ivory Coast.
| | - Yapo Thomas Aba
- Infectious and Tropical Diseases Department, Bouaké University Hospital, Bouaké, Ivory Coast
| | - Jean Claude Yavo
- Pharmacovigilance Unit, Medical Sciences, Felix Houphouët-Boigny, Abidjan, Ivory Coast
| | - Abouo Franklin Nguessan
- Infectious and Tropical Diseases Unit, Treichville University Hospital, Abidjan, Ivory Coast
| | - N'cho Bertin Tchiekoi
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Ivory Coast
| | | | - Emmanuel Bissagnéné
- Infectious and Tropical Diseases Unit, Treichville University Hospital, Abidjan, Ivory Coast
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