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Laari L, Duma SE. Barriers to nurses health advocacy role. Nurs Ethics 2023; 30:844-856. [PMID: 36999769 DOI: 10.1177/09697330221146241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Speaking up to safeguard patients is a crucial ethical and moral obligation for nurses, but it is also a difficult and potentially dangerous component of nursing work. Health advocacy is gaining impetus in the medical literature, despite being hampered by barriers resulting in many nurses in Ghana remaining mute when faced with advocacy-required situations. We explored situations that thwart nurses from performing their health advocacy role. RESEARCH QUESTION What would cause nurses to take no action when they witness situations that require them to act as health advocates for their clients or communities? RESEARCH DESIGN An inductive, descriptive qualitative design was used to collect and analyse data on barriers that prevent nurses from practising their health advocacy role in Ghana. Individual one-on-one in-depth interviews were conducted using a semi-structured interview guide. The data were analysed using qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT Twenty-four professional nurses and midwives registered with the Nursing and Midwifery Council were recruited from three regional hospitals in Ghana. These public hospitals were chosen from the upper, middle and coastal regions. ETHICAL CONSIDERATIONS The UKZN Ethics Review Committee in South Africa and the GHS Ethics Review Committee in Ghana both gave their approval for this study. FINDINGS Intrapersonal barriers, interpersonal barriers, and structural barriers emerged as major obstacles that nurses experience when performing their health advocacy role. CONCLUSIONS Barriers to health advocacy have undermined nurses' ability to function as health advocates and are preventing them from utilising their health advocacy position in nursing practise. Giving nursing students positive role models in the classroom and in the clinic can help them become more effective health advocates.
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Affiliation(s)
- Luke Laari
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Sinegugu E Duma
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Aborigo RA, Welaga P, Oduro A, Shaum A, Opare J, Dodoo A, Ampadu H, Gidudu JF. Optimising reporting of adverse events following immunisation by healthcare workers in Ghana: A qualitative study in four regions. PLoS One 2022; 17:e0277197. [PMID: 36538549 PMCID: PMC9767370 DOI: 10.1371/journal.pone.0277197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Despite the emphasis on reporting of Adverse Events Following Immunisation (AEFIs) during didactic training sessions, especially prior to new vaccine introductions, it remains low in Ghana. We explored the factors underlying the under-reporting of AEFI by healthcare workers (HCWs) to provide guidance on appropriate interventions to increase reporting. METHODS We conducted an exploratory descriptive in-depth study of the factors contributing to low reporting of AEFI among HCWs in four regions in Ghana. Key informant interviews (KII) were held with purposively selected individuals that are relevant to the AEFI reporting process at the district, regional, and national levels. We used KII guides to conduct in-depth interviews and used NVivo 10 qualitative software to analyse the data. Themes on factors influencing AEFI reporting were derived inductively from the data, and illustrative quotes from respondents were used to support the narratives. RESULTS We conducted 116 KIIs with the health managers, regulators and frontline HCWs and found that lack of information on reportable AEFIs and reporting structures, misunderstanding of reportable AEFIs, heavy workload, cost of reporting AEFIs, fear of blame by supervisors, lack of motivation, and inadequate feedback as factors responsible for underreporting of AEFIs. Respondents suggested that capacity building for frontline HCWs, effective supervision, the provision of motivation and feedback, simplification of reporting procedures, incentives for integrating AEFI reporting into routine monitoring and reporting, standardization of reporting procedures across regions, and developing appropriate interventions to address the fear of personal consequences would help improve AEFI reporting. CONCLUSION From the perspectives of a broad range of key informants at all levels of the vaccine safety system, we found multiple factors (both structural and behavioural), that may impact HCW reporting of AEFI in Ghana. Improvements in line with the suggestions are necessary for increased AEFI reporting in Ghana.
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Affiliation(s)
- Raymond Akawire Aborigo
- Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana
- * E-mail:
| | - Paul Welaga
- Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana
| | - Abraham Oduro
- Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana
| | - Anna Shaum
- Center for Global Health, Global Immunisation Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Joseph Opare
- The Ghana Second Year of Life Vaccine Platform (2YL), Accra, Ghana
| | - Alex Dodoo
- The African Collaborating Centre for Pharmacovigilance, Accra, Ghana
| | - Hilda Ampadu
- The African Collaborating Centre for Pharmacovigilance, Accra, Ghana
| | - Jane F. Gidudu
- Center for Global Health, Global Immunisation Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Osei Tutu B, Laryea EB, Asante R, Darko DA. Evaluation of surveillance system for post market activities on pre-packaged foods in Greater Accra Region, Ghana, 2021. PUBLIC HEALTH IN PRACTICE 2022; 4:100292. [PMID: 36570390 PMCID: PMC9773048 DOI: 10.1016/j.puhip.2022.100292] [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: 03/17/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives This evaluation was to assess the usefulness and attributes of the surveillance system for post market activities on pre-packaged foods in the Greater Accra Region of Ghana and also to determine if the systems objectives are being met. Methods A descriptive cross-sectional design was used for the evaluation. Data/records on Food Market Surveillance collected between 2018 and 2020 was reviewed and key stakeholders involved in the Food Market Surveillance interviewed using a semi-structured questionnaire. Surveillance operations were also observed. Quantitative data was analyzed using descriptive summary statistics. Information gathered from interviews were put under themes. Result Some policy decision taken were based on analysis of data from the surveillance system. The system is useful in detecting trends signaling changes on label of registered prepackage food products. The system can permit assessment of the compliance of levels of importers/manufacturers; however, such analysis was not done. The system involves single step notification and processing steps and can incorporate data from other systems. Some retailers perceived the system as a hindrance to business. Completion of notification forms takes 2-5 min and 1-5 working days to process and take regulatory action. The surveillance system had a data accuracy and completeness of 94.6% (194/205) and 94.1% (193/205) respectively with less than 0.1% (3/95) double entries. The system did not have any data validation process or team in place. Conclusion The system was partially meeting its intended objectives and found useful despite some gaps and challenges observed. The system is simple, flexible, accepted by most of the stakeholders and covers almost the entire districts in the Greater Accra Region. We recommend that data validation process or team be instituted to ensure reliability of data generated for policy and regulatory decisions.
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Affiliation(s)
- Benjamin Osei Tutu
- Food and Drugs Authority, Accra, Ghana,Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana,Corresponding author. Food and Drugs Authority, Accra, Ghana.
| | - Eunice Baiden Laryea
- Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Rita Asante
- Food and Drugs Authority, Accra, Ghana,Ghana Field Epidemiology and Laboratory Training Programme (GFELTP), Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Accra, Ghana
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Lv H, Pan X, Wang Y, Liang H, Yu H. Barriers to healthcare workers reporting adverse events following immunization in Zhejiang province, China. Hum Vaccin Immunother 2022; 18:2083865. [PMID: 35820038 PMCID: PMC9621061 DOI: 10.1080/21645515.2022.2083865] [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] [Indexed: 12/02/2022] Open
Abstract
Objectives A cross-sectional survey was conducted among healthcare workers (HCWs) to assess their knowledge, attitude, and reporting behavior in adverse event following immunization (AEFI) surveillance as well as to identify barriers. Methods A simple random sample of 170 vaccination clinics was selected and one HCW was informed to participate in this survey in each selected vaccination clinic. The survey was developed using a secure online platform and consisted of a structured online questionnaire. The distributions of the respondents’ characteristics were presented. Training status, knowledge, attitude, and reporting behavior were compared between sub-groups of HCWs. Barriers and suggestions on AEFI reporting were also summarized. Results Of the 170 surveyed HCWs, 61.76% received the training on AEFI surveillance while 15.88% had no AEFI training at all. The higher level of knowledge and the more positive attitude and reporting behavior on AEFI surveillance were observed among HCWs with the longer working duration on AEFI surveillance, or among HCWs who received the training. The most critical barrier to reporting an AEFI was ‘not being sure if the AEFI is related to the vaccine’ (122, 71.76%). Other barriers were: ‘I do not want to raise unnecessary public alarm about a vaccine’ (105, 61.76%); ‘reporting form or other method being too complicated’ (65, 38.23%). Conclusion The study findings highlighted the need to prioritize training on AEFI surveillance for HCWs. It is recommended that the development of the targeted interventions to strengthen AEFI surveillance system be required based on the barriers found in this study.
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Affiliation(s)
- Huakun Lv
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Xuejiao Pan
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Ying Wang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hui Liang
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
| | - Hu Yu
- Institute of Immunization and Prevention, Zhejiang Center for Disease Control and Prevention, Hangzhou, China
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Enhanced surveillance for adverse events following immunization during the 2019 typhoid conjugate vaccine campaign in Harare, Zimbabwe. Vaccine 2022; 40:3573-3580. [PMID: 35568590 PMCID: PMC10116805 DOI: 10.1016/j.vaccine.2022.04.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND During February 25-March 4, 2019, Zimbabwe's Ministry of Health and Child Care conducted an emergency campaign using 342,000 doses of typhoid conjugate vaccine (TCV) targeting individuals 6 months-15 years of age in eight high-risk suburbs of Harare and up to 45 years of age in one suburb of Harare. The campaign represented the first use of TCV in Africa outside of clinical trials. METHODS Three methods were used to capture adverse events during the campaign and for 42 days following the last dose administered: (1) active surveillance in two Harare hospitals, (2) national passive surveillance, and (3) a post-campaign coverage survey. RESULTS Thirty-nine adverse events were identified during active surveillance, including 19 seizure cases (16 were febrile), 16 hypersensitivity cases, 1 thrombocytopenia case, 1 anaphylaxis case, and two cases with two conditions. Only 21 (54%) of 39 patients were hospitalized and 38 recovered without sequelae. Attack rates per 100,000 TCV doses administered were highest for seizures (6.27) and hypersensitivity (5.02). Only 6 adverse events were reported through passive surveillance by facilities other than the two active surveillance hospitals. A total of 177 (10%) of 1,817 vaccinees surveyed reported experiencing an adverse event during the post-campaign coverage survey, of which 25 (14%) sought care. CONCLUSIONS In line with previous evaluations of TCV, enhanced adverse event monitoring during an emergency campaign supports the safety of TCV. The majority of reported events were minor or resulted in recovery without long-term sequelae. Attack rates for seizures and hypersensitivity were low compared with previous active surveillance studies conducted in Kenya and Burkina Faso. Strengthening adverse event monitoring in Zimbabwe and establishing background rates of conditions of interest in the general population may improve future safety monitoring during new vaccine introductions.
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Laryea EB, Frimpong JA, Noora CL, Tengey J, Bandoh D, Sabblah G, Ameme D, Kenu E, Amponsa-Achiano K. Evaluation of the adverse events following immunization surveillance system, Ghana, 2019. PLoS One 2022; 17:e0264697. [PMID: 35231049 PMCID: PMC8887767 DOI: 10.1371/journal.pone.0264697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With over 80% of children worldwide vaccinated, concerns about vaccine safety continues to be a public health issue. Ghana's Adverse Events Following Immunization surveillance started in 1978 with the objective to promptly detect and manage AEFI cases either real or perceived. Periodic evaluation of the surveillance system is critical for optimal performance; hence we evaluated the system to assess its attributes, usefulness and system's performance in meeting its objectives. METHODS A case of AEFI was defined as any untoward medical event occurring within 28 days after vaccination and may not necessarily have causal relationship with the vaccine use. We reviewed surveillance data and procedures for the period 2014 to 2018 and interviewed key stakeholders. Adapting the CDC's Updated Guidelines for Evaluating Public Health Surveillance Systems, we assessed the system's attributes and usefulness. We performed summary descriptive statistics on quantitative data and directed content analysis on information gathered from interviews. RESULTS In all, 2,282 AEFI cases including 476 (21%) serious cases (life threatening events) were reported for the period. The highest case detection rates of 61.45 AEFIs per 100,000 surviving infants was recorded in 2018. Reporting forms were modified to accommodate new indicators without any disruption in the function of the system. At the national level, completeness of 100 randomly sampled reporting forms (100%) and was higher than the region (27%) but timeliness (50%) was lower than the region (83%). All (16/16) Community Health Nurses interviewed indicated "fear of being victimized" as the reason for underreporting, nonetheless, the system was useful as it made them cautious when vaccinating children to prevent reactions. Data on AEFI surveillance was also useful in guiding training needs and provision of vaccination logistics. CONCLUSION The AEFI surveillance system is useful at all levels but partially meeting its objective due to underreporting. We recommend training and supportive supervision to improve timeliness of reporting, data completeness and acceptability.
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Affiliation(s)
- Eunice Baiden Laryea
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Joseph Asamoah Frimpong
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
- * E-mail:
| | - Charles Lwanga Noora
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - John Tengey
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Delia Bandoh
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - George Sabblah
- Department of Pharmacovigilance, Food and Drugs Authority, Accra, Ghana
| | - Donne Ameme
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
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Adverse events following immunization: Findings from 2017/2018 measles vaccination campaign, Nigeria AEFI reporting in 2017/2018 measles vaccination campaign. Vaccine 2021; 39 Suppl 3:C82-C88. [PMID: 33714655 DOI: 10.1016/j.vaccine.2021.02.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION An Adverse event following immunization (AEFI) is an untoward medical occurrence following immunization and which may not have a necessary causal relationship with the usage of a vaccine. The World Health Organization categories AEFI into two; serious and non-serious. An AEFI is considered serious if it is life-threatening, requires inpatient hospitalization or results in death. The measles vaccine is safe and effective however because it is a live-attenuated injectable vaccine it is more prone to AEFI as compared to non-injectable vaccines when given in large numbers over a short period as is the nature of measles mass vaccination campaigns (MVC). This article describes Nigeria's experience on AEFI reporting during the 2017/2018 Measles vaccination campaign (MVC). METHODS We reviewed various materials which included the Open Data Kit (ODK) which is an open source smartphone-based data collecting tool, operations room reports, measles campaign tally sheets, AEFI line listing forms, the post measles campaign coverage survey report and the report of the AEFI national expert committee review of the 2017/2018 Nigeria measles MVC. RESULTS A total of 6,214 suspected cases of AEFI were line listed from all 36 states and the Federal Capital Territory(FCT) during the 2017/2018 MVC with Fever(38%) and pain at injection site the (30%)most common reports. Overall, 99.7% AEFIs were reported to be non-serious AEFIs, with almost all cases resolved fully with no long-term sequalae.. The national incidence of suspected AEFI per 100,000 population was 16.3 with subnational incidence highest in Kebbi state (101.3/100,000) and lowest in Bayelsa state (0.8/100,000). CONCLUSION Adequate AEFI reporting, Investigation and management remains important in managing the risk of a disruption of mass campaigns. The deployment of supervisors during campaign may play an important role in improving the identification and reporting of suspected AEFI. Further inquiries about AEFIs during the post campaign coverage evaluation also played a role in improving AEFI reporting and documentation. The real-time, on the spot, follow up by the national operations team helped with decision making and intervention including AEFI investigations and assessments.
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Constantine M, Cremance T, Juru TP, Gerald S, Notion GT, Peter N, Mufuta T. Evaluation of the adverse events following immunization surveillance system in Guruve district, Mashonaland Central 2017. Pan Afr Med J 2019; 31:202. [PMID: 31452827 PMCID: PMC6693787 DOI: 10.11604/pamj.2018.31.202.16573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/29/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION An adverse event following immunisation is any untoward medical occurrence which follows vaccination. Frequency of adverse events ranges from 13% to 34% and they should be reported regardless of severity. From the beginning of 2016 to mid-2017, Guruve district in Zimbabwe did not report any AEFIs. This suggests the surveillance system may be failing to detect adverse events. We therefore evaluated the AEFI surveillance system in Guruve district. METHODS We conducted a surveillance system evaluation using the updated Centers for Disease Control guidelines for evaluating public health surveillance systems. We interviewed health workers and caregivers of babies under 2 years in Guruve district. We also reviewed all records on AEFI surveillance for the period of January 2016 to November 2017. RESULTS We recruited 31 health workers and 33 caregivers into the study. Between January 2016 and mid-2017, 39% of the caregivers had children who had suffered AEFIs and 45% of the health workers had encountered AEFIs but none had been notified. The main reasons for failure to report AEFIs included health workers' fear of personal consequences and caregivers thinking that an adverse event was not serious enough to report. Knowledge of the surveillance system was good amongst the majority of health workers. All the resources needed by the surveillance system were available. CONCLUSION We concluded that health workers in Guruve district were afraid to report adverse events following immunization and caregivers were reluctant to report mild adverse events hence the surveillance system was performing poorly and was not useful. However, the stability of the system and the good knowledge gives a good foundation for improving the surveillance system.
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Affiliation(s)
| | - Tshuma Cremance
- Provincial Medical Director, Mashonaland Central Province, Zimbabwe
| | | | - Shambira Gerald
- University of Zimbabwe, Department of Community Medicine, Zimbabwe
| | | | | | - Tshimanga Mufuta
- University of Zimbabwe, Department of Community Medicine, Zimbabwe
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Yamoah P, Bangalee V, Oosthuizen F. Knowledge and Perceptions of Adverse Events Following Immunization among Healthcare Professionals in Africa: A Case Study from Ghana. Vaccines (Basel) 2019; 7:vaccines7010028. [PMID: 30857257 PMCID: PMC6466096 DOI: 10.3390/vaccines7010028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/12/2018] [Accepted: 12/17/2018] [Indexed: 12/31/2022] Open
Abstract
The spontaneous reporting of suspected adverse events following immunization (AEFI) by healthcare professionals (HCPs) is vital in monitoring post-licensure vaccine safety. The main objective of this study was to assess the knowledge and perceptions of AEFIs among healthcare professionals (HCPs) in Africa, using the situation in Ghana as a case study. The study was of a cross-sectional quantitative design, and was carried out from 1 July 2017 to 31 December 2017 with doctors, pharmacists, and nurses as the study participants. A 28-item paper-based questionnaire, delivered by hand to study participants, was the data collection tool in the study. The study was conducted in 4 hospitals after ethical approval was granted. The desired sample size was 686; however, 453 consented to partake in the study. Data were analyzed using SPSS (software version 22, IBM, Armonk, NY, USA), and chi-square and binary logistic regression tests were used for tests of association between HCPs’ characteristics and their knowledge and perceptions. Detailed knowledge of AEFIs was ascertained with a set of 9 questions, with 8 or 9 correctly answered questions signifying high knowledge, 5 to 7 correctly answered questions signifying moderate knowledge, and below 5 correctly answered questions signifying low knowledge. A set of 10 questions also ascertained HCPs’ positive and negative perceptions of AEFI. Results revealed that knowledge of AEFIs was high in 49 (10.8%) participants, moderate in 213 (47.0%) participants, and low in 191 (42.2%) participants. There was no statistically significant correlation between AEFI knowledge and professions. The highest negative perception was the lack of desire to learn more about how to diagnose, report, investigate, and manage AEFI, whereas the lowest was the lack of belief that surveillance improves public trust in immunization programs. There was a general awareness of AEFIs among HCPs in this study. However, negative perceptions and the lack of highly knowledgeable HCPs regarding AEFIs were possible setbacks to AEFI diagnosis, management, prevention, and reporting. More training and sensitization of HCPs on AEFIs and vaccine safety will be beneficial in improving the situation. Future research should focus on assessing the training materials and methodology used in informing HCPs about AEFIs and vaccine safety.
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Affiliation(s)
- Peter Yamoah
- Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi 00233, Ghana.
- College of Health Sciences, University of KwaZulu Natal, Durban 4041, South Africa.
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Accra Rd, Kumasi 00233, Ghana.
| | - Varsha Bangalee
- College of Health Sciences, University of KwaZulu Natal, Durban 4041, South Africa.
| | - Frasia Oosthuizen
- College of Health Sciences, University of KwaZulu Natal, Durban 4041, South Africa.
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