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Jha N, Thapa B, Pathak SB, Kafle S, Mudvari A, Shankar PR. Availability of access, watch, and reserve (AWaRe) group of antibiotics in community pharmacies located close to a tertiary care hospital in Lalitpur, Nepal. PLoS One 2023; 18:e0294644. [PMID: 37983218 PMCID: PMC10659150 DOI: 10.1371/journal.pone.0294644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION The access, watch, and reserve (AWaRe) classification of antibiotics was developed in 2019 by the WHO Expert Committee on the Selection and Use of Essential Medicines as a tool to support antibiotic stewardship efforts at local, national, and global levels. The objectives of this study were to assess the availability of antibiotics as per WHO AWaRe classification at community pharmacies located around a tertiary care hospital in Lalitpur and to compare these antibiotics with the national essential medicine list of Nepal. METHOD The cross-sectional study was conducted at community pharmacies located within a two-kilometer radius of a teaching hospital from August to November 2022. A total of 82 community pharmacies registered with the Nepal Chemist and Druggists Association and the Department of Drug Administration were studied. Data was collected using a standard proforma containing the names of the antibiotics classified as per the WHO's AWaRe classification. RESULTS Access group of antibiotics, Ampicillin, (82;100%), Amoxycillin, (82;100%), Flucloxacillin, (82;100%), and Metronidazole, (82;100%) were available in all community pharmacies. Results from the watch group showed that Azithromycin, (80; 97.6%) was available in all pharmacies followed by Cefixime, (80; 97.6%), Ciprofloxacin, (73; 89%), Levofloxacin, (74; 90.2%)and Ofloxacin, (74; 90.2%). Linezolid, (24; 29.3%) was the most common antibiotics available from the reserve group of antibiotics. Colistin was the second commonly available antibiotic. The most available antibiotic from the not recommended group were Ampicillin/Cloxacillin (82; 100%), followed by Piperacillin/Sulbactam, (39; 47.6%). There were differences in the classification of antibiotics between the WHO AWaRe list and the Essential Medicines list of Nepal in terms of numbers of antibiotics listed. CONCLUSION Antibiotics from the not recommended and reserve groups were commonly available in community pharmacies. The implementation of antibiotic guidelines should be emphasized along with strict monitoring of the sale of antibiotics without a prescription in community pharmacy settings.
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Affiliation(s)
- Nisha Jha
- Department of Clinical Pharmacology and Therapeutics, KIST Medical College, Lalitpur, Nepal
| | - Bibechan Thapa
- Department of Emergency Medicine, Kirtipur Hospital, Kirtipur, Nepal
| | - Samyam Bickram Pathak
- Department of Intensive Care Unit and Critical care, Nepal Mediciti Hospital, Sainbu, Bhaisepati, Nepal
| | - Sajala Kafle
- Department of Clinical Pharmacology and Therapeutics, KIST Medical College, Lalitpur, Nepal
| | - Anish Mudvari
- Department of Pharmacology, Maharajgunj Medical Campus, Maharajgunj, Kathmandu, Nepal
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Shrestha S, Danekhu K, KC B, Palaian S, Ibrahim MIM. Bibliometric analysis of adverse drug reactions and pharmacovigilance research activities in Nepal. Ther Adv Drug Saf 2020; 11:2042098620922480. [PMID: 32587678 PMCID: PMC7294481 DOI: 10.1177/2042098620922480] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 04/02/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Bibliometric analyses have been used previously to study the measures of quality and impact of research performed in several health-related areas such as adverse drug reactions (ADRs) and pharmacovigilance (PV), etc. This method can assess the research performance of publications quantitatively and statistically. There is no evidence of bibilometric studies analyzing ADRs and PV from Nepal. Therefore, the present study aimed to assess scientific output on ADRs and PV-related research activities in Nepal using a bibliometric analysis of publications from 2004 January to December 2018, that is, 15 years. Methods: A systematic search was conducted in PubMed, Web of Science, Google Scholar, Scopus and Nepal Journal Online (NepJOL) databases. ‘Adverse Drug Reactions‘ or ‘ADRs‘ or ‘ADR‘ or ‘Adverse drug reaction‘ or ‘AE‘ or ‘Adverse Event‘ or ‘Drug-Induced Reaction‘ or ‘Pharmacovigilance‘ or ‘PV‘ and ‘Nepal‘. The search covered 15 years (January 2004 to December 2018) of study on ADRs and PV in Nepal. Only articles retrieved from databases were included, whereas published/unpublished drug bulletins, pharmacy newsletters and thesis were excluded. The articles thus retrieved were recorded, and thereafter analyzed. Word count code was used for the analysis of keywords used in the retrieved articles. Results: A total of 124 articles were retrieved, with the highest rate of publications in 2006 and 2007, with 16 papers each. Among the articles, 10 (8.1%) were published in Kathmandu University Medical Journal (KUMJ). Single papers were published in 38 different journals. Brief reports (1.6%), case reports (31.2%), case series (0.8%), education forums (0.8%), letters to the editor (5.6%), original research articles (41.9%), review articles (9.7%), short communications and short reports (8.1%) on ADRs and PV were recorded. Out of 124 papers, 52 (41.9%) were original research publications. The majority (74.1%) of research was done in the category of ADR incidence, types, prevention, and management, followed by policy and suggestions for strengthening national and regional pharmacovigilance centers of Nepal (14.5%). Conclusions: During the study years, there was an increase in scientific publications on drug safety. A total of 124 published articles were found during bibliometric analysis of ADRs and PV research activities in Nepal.
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Affiliation(s)
| | - Krisha Danekhu
- Department of Pharmaceutical and Health Service Research, Nepal Health Research and Innovation Foundation, Lalitpur, Nepal
| | - Bhuvan KC
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Selangor, Malaysia
| | - Subish Palaian
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
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Poudel A, Mohamed Ibrahim MIB, Mishra P, Palaian S. Evaluation of the registration status of fixed-dose drug combinations in Nepal. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Arjun Poudel
- Postdoctoral Research Associate; School of Clinical Sciences; Faculty of Health, Queensland University of Technology; Brisbane Qld Australia
- Department of Hospital and Clinical Pharmacy; Manipal Teaching Hospital; Pokhara Nepal
| | | | - Pranaya Mishra
- Department of Hospital and Clinical Pharmacy; Manipal Teaching Hospital; Pokhara Nepal
- Department of Pharmacology; American University of the Caribbean School of Medicine; Cupecoy St. Maarten
| | - Subish Palaian
- Department of Hospital and Clinical Pharmacy; Manipal Teaching Hospital; Pokhara Nepal
- Department of Pharmacy Practice; College of Pharmacy; Gulf Medical University; Ajman United Arab Emirates
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Poudel A, Mohamed Ibrahim MI, Mishra P, Palaian S. Assessment of utilization pattern of fixed dose drug combinations in primary, secondary and tertiary healthcare centers in Nepal: a cross-sectional study. BMC Pharmacol Toxicol 2017; 18:69. [PMID: 29096701 PMCID: PMC5667497 DOI: 10.1186/s40360-017-0176-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 10/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background Prescription practices, especially in South Asian countries, have come under investigation for quality. Although there have been no studies in Nepal that have analyzed the prescription pattern of FDCs for different levels of health care centers, several studies from Nepal and other countries in the region have revealed poor medicine use practices, including irrational use of fixed-dose drug combinations (FDCs). This research aimed at assessing the utilization pattern of FDCs among primary (PHC), secondary (SHC) and tertiary health care (THC) centers in Western region of Nepal. Methods A cross-sectional descriptive study was conducted at primary, secondary and tertiary health care centers in Western Nepal. One hundred prescriptions from each health care center were chosen through systematic random sampling. The International Network for Rational Use of Drug (INRUD) indicators were used to assess the rationality of prescribing. Both descriptive and inferential statistics were applied. The alpha level used was 0.05. Results At the PHC center, 206 medicines were prescribed, of which 20.0% were FDCs. Antimicrobials were the most prescribed FDCs (57.1%). The unit prices of all FDCs were below 100 Nepalese Price Rupees (NPRs). At the SHC center, 309 medicines were prescribed, and 30% were FDCs. Vitamins, minerals and dietary supplements were the most prescribed FDCs (25.8%). The costs of 63.5% of FDCs were below 100 NPRs. At the THC center, 33.5% of 270 medicines were FDCs. As at the SHC center, vitamins, minerals and dietary supplements were the most prescribed FDCs (40.6%). The costs of 50.5% of FDCs were below 100 NPRs. Conclusions FDCs were used extensively at different health care centers. The number of prescription in private centers, following established guidelines and the essential drug list (EDL), was much lower. The cost associated with the utilization of FDCs was higher in private sectors compared to public health care centers. In certain cases, the use of FDCs was questionable, and this study found a low use of essential medicines. Education to improve prescription practices at different healthcare levels is recommended. Electronic supplementary material The online version of this article (10.1186/s40360-017-0176-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arjun Poudel
- Research Associate, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Department of Hospital and Clinical Pharmacy, Manipal Teaching Hospital, Phulbari-11, Pokhara, Nepal
| | | | - Pranaya Mishra
- Department of Hospital and Clinical Pharmacy, Manipal Teaching Hospital, Phulbari-11, Pokhara, Nepal.,Department of Pharmacology, American University of the Caribbean School of Medicine, University Drive at Jordan Road, Cupecoy, St. Maarten, Coral Gables, USA
| | - Subish Palaian
- Department of Hospital and Clinical Pharmacy, Manipal Teaching Hospital, Phulbari-11, Pokhara, Nepal.,Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
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Poudel A, Alam K, Palaian S, Ibrahim MIM. Herbal Fixed Dose Combinations in Nepal: Growing Concerns in a Developing Country. J Clin Diagn Res 2016; 10:FM01-FM03. [PMID: 27891352 DOI: 10.7860/jcdr/2016/20519.8686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/21/2016] [Indexed: 01/01/2023]
Abstract
Herbal medicines are mostly prepared as a combination therapy that has been used since therapeutic was first practiced. Combination products, also known as Fixed Dose Combinations (FDCs) of herbal remedies are in widespread use in Nepal. Herbal FDCs are in common practice because it is believed to have better adherence, less side effects and easy accessibility. Nevertheless, combination products possess greater risk of adverse effects, increases costs associated with treatments and leads to an ineffective dosages. Herbal FDCs are used extensively in Nepal although the rationality beyond the use of these combinations is still unidentified and at times are questionable. Legislations governing the use of herbal medicines is lacking in Nepal. Many herbal FDCs are not supported by any scientific data and test for the presence of ingredients mentioned in the package insert/container label is always difficult. A FDC of herbal products must be based on clear criteria that guarantee consumer safety and appropriate indications. These criteria helps to protect the consumers or patients from the misleading claims and risk associated with the use of unjustifiable combination of herbal substances. Strict monitoring from the regulatory body and the public awareness on the cost as well as advantages and disadvantages of herbal FDCs is urgently required.
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Affiliation(s)
- Arjun Poudel
- Research Associate, School of Clinical Sciences, Faculty of Health, Queensland University of Technology , Brisbane, Australia
| | - Kadir Alam
- Associate Professor, Department of Clinical Pharmacology and Therapeutics, B.P. Koirala Institute of Health Sciences , Dharan, Nepal
| | - Subish Palaian
- Associate Professor, Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University , Ajman, United Arab Emirates
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Balat JD, Gandhi AM, Patel PP, Dikshit RK. A study of use of fixed dose combinations in Ahmedabad, India. Indian J Pharmacol 2015; 46:503-9. [PMID: 25298579 PMCID: PMC4175886 DOI: 10.4103/0253-7613.140581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/11/2013] [Accepted: 07/24/2014] [Indexed: 11/12/2022] Open
Abstract
Objective: The aim of this study was to evaluate the pattern of fixed dose combinations (FDCs) in Ahmedabad, a city in western part of India. Materials and Methods: Over a period of 24 months, prescriptions were collected from 24 pharmacy stores across 6 zones of Ahmedabad city. The information was recorded in pre-formed Data Record Form after written consent from the patients (or relative (s) of the patients). The pattern of use of FDC, rationality and seasonal variation in their use were analyzed. At the end of study, results were analyzed using Chi-square test. Results: Out of the total 1170 prescriptions, 941 (80.3%) contained 1647 FDC formulations. The average number of FDCs prescribed was 1.41 ± 1.04 (mean ± SD). The FDCs were more frequently prescribed in the age group of 31 to 40 years (23.7%) and in males (54.4%). FDCs were most commonly prescribed by oral route (92.7%). As per drug category analysis, a higher number of FDCs containing nutritional supplements (20.2%), and those for CNS (18.1%) complaints were prescribed. A seasonal analysis showed that FDCs were commonly prescribed for respiratory complaints (23.4%), central nervous system (CNS) complaints (20.3%) and as nutritional supplements (22.4%) in winter, monsoon and summer months, respectively. Only 5.8%, 9.8% and 10.9% FDCs prescribed were included in WHO (2010), National (2011) and Gujarat State (2011) Essential Medicines Lists (EML), respectively (P < 0.0001). Irrational FDCs that are banned or FDCs containing irrational active ingredients were 1343 (81.5%) and 203 (12.3%), respectively. Conclusion: FDCs are widely prescribed with seasonal influence in their use. FDCs containing banned or controversial ingredients are prescribed widely.
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Affiliation(s)
| | - Anuradha M Gandhi
- Department of Pharmacology, B. J. Medical College, Ahmedabad Gujarat, India
| | - Prakruti P Patel
- Department of Pharmacology, B. J. Medical College, Ahmedabad Gujarat, India
| | - Ram K Dikshit
- Department of Pharmacology, B. J. Medical College, Ahmedabad Gujarat, India
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Goswami N, Gandhi A, Patel P, Dikshit R. An evaluation of knowledge, attitude and practices about prescribing fixed dose combinations among resident doctors. Perspect Clin Res 2013; 4:130-5. [PMID: 23833738 PMCID: PMC3700327 DOI: 10.4103/2229-3485.111797] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Fixed Dose Combinations (FDCs) improve patient compliance and decrease pill burden. However, irrational prescribing of FDCs is a major health concern. As resident doctors are primarily involved in patient management at tertiary care hospitals, knowledge about prescribing FDCs is of paramount importance. Objective: To evaluate knowledge, attitude and practice, regarding use of FDCs by resident doctors at a tertiary care teaching hospital. Materials and Methods: The study was carried out among resident doctors working at Civil Hospital, Ahmedabad, a tertiary care teaching hospital. One hundred resident doctors from the departments of medicine, obstetrics and gynaecology, surgery, paediatrics, skin and psychiatry, who gave their informed consent, were enrolled. A prevalidated questionnaire regarding knowledge, attitude and prescribing practice of fixed dose combinations was filled up. Data was analyzed with suitable statistical tests. Results: Out of the 100 residents recruited for the study, 34, 33 and 33 residents were selected from the 1st, 2nd and 3rd year respectively. The resident doctors were not aware about all of the advantages and disadvantages of FDCs. On an average, only 31% of the residents (lowest 16% among 1st year residents) had knowledge about the Essential Medicine List (EML). Knowledge about rationality of given FDCs was lacking in 81% of the residents. Only 47% could name a single banned FDC in India. Common sources of information about FDCs were medical representatives, colleagues/peers, the Monthly Index of Medical Specialities (MIMS) and Continuous Medical Education (CMEs). A majority of residents (96%) agreed that FDCs should be allowed to be marketed. The residents opined that most commonly prescribed FDCs were of antimicrobial drugs, amongst which amoxicillin + clavulanic acid was the most frequent. Conclusion: There is need to improve knowledge about rationality, EML, usage and banned FDCs in post graduate medical students to promote the rational use of drugs.
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Affiliation(s)
- Nimit Goswami
- Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India
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Abstract
Nepal experiences several medicine-use problems like any other developing country. In the recent years, there have been initiatives to introduce the concept of social pharmacy in Nepal, and there has been only a limited research in this area. The staff members at the Manipal College of Medical Sciences, Pokhara have shown keen interest in initiating several social pharmacy-related researches in the country. The members of this institute have been collaborating with two international universities, namely Universiti Sains Malaysia located in Malaysia and Chulalongkorn University located in Thailand, to get academic and technical supports. In this manuscript, the authors share their experiences in initiating social pharmacy research in the country. Authors have also mentioned the priority areas of social pharmacy research in Nepal and the importance of initiating this concept in the country.
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Mustafa AA, Kowalski SR. A need for the standardization of the pharmaceutical sector in Libya. Libyan J Med 2010; 5. [PMID: 21483563 PMCID: PMC3066775 DOI: 10.3402/ljm.v5i0.5440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 09/22/2010] [Indexed: 11/14/2022] Open
Abstract
Medicines are health technologies that can translate into tangible benefits for numerous acute as well as chronic health conditions. A nation's pharmaceutical sector needs to be appropriately structured and managed in order to ensure a safe, effective and quality supply of medicines to society. The process of medicines management involves the sequential management of five critical activity areas; namely; registration, selection, procurement, distribution and use. Formalized and standardized management of all five critical activity areas positively influences the availability, quality and affordability of medicines and ultimately increases the reliability and quality of the national healthcare system.
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Affiliation(s)
- Asma Abubakr Mustafa
- Department of Pharmaceutics, Faculty of Pharmacy, Al-Arab Medical University, Benghazi, Libya
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Palaian S, Ibrahim MIM, Mishra P. Pattern of adverse drug reactions reported by the community pharmacists in Nepal. Pharm Pract (Granada) 2010; 8:201-7. [PMID: 25126141 PMCID: PMC4127056 DOI: 10.4321/s1886-36552010000300008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 07/13/2010] [Indexed: 02/07/2023] Open
Abstract
The pharmacovigilance program in Nepal is less than a decade old, and is hospital centered. This study highlights the findings of a community based pharmacovigilance program involving the community pharmacists. Objectives: To collect the demographic details of the patients experiencing adverse drug reactions (ADR) reported by the community pharmacists; to identify the common drugs causing the ADRs, the common types of ADRs; and to carry out the causality, severity and preventability assessments of the reported ADRs. Methods: The baseline Knowledge-Attitude-Practices (KAP) of 116 community pharmacists from Pokhara valley towards drug safety was evaluated using a validated (Cronbach alpha=0.61) KAP questionnaire having 20 questions [(knowledge 11, attitude 5 and practice 4) maximum possible score 40]. Thirty community pharmacists with high scores were selected for three training sessions, each session lasting for one to two hours, covering the basic knowledge required for the community pharmacists for ADR reporting. Pharmacist from the regional pharmacovigilance center visited the trained community pharmacists every alternate day and collected the filled ADR reporting forms. Results: Altogether 71 ADRs, from 71 patients (37 males) were reported. Antibiotics/ antibacterials caused 42% (n=37) of the total ADRs followed by non steroidal anti-inflammatory drugs [25% (n=22)]. Ibuprofen/paracetamol combination accounted for ten ADRs. The most common type of ADR was itching [17.2 % (n=20), followed by generalized edema [8.6 % (n=10)]. In order to manage the ADRs, the patients needed medical treatment in 69% (n=49) of the cases. Over two third (69%) of the ADRs had a ‘possible’ association with the suspected drugs and a high percentage (70.4%) were of ‘mild (level 2)’ type. Nearly two third [64.7 % (n=46)] of the ADRs were ‘definitely preventable’. Conclusion: The common class of drugs known to cause ADRs was antibacterial/ antibiotics. Ibuprofen/ Paracetamol combination use of the drug was responsible for more number of ADRs and the most common ADRs were related to dermatological system. Strengthening this program might improve safe use of medicines in the community.
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Affiliation(s)
- Subish Palaian
- Discipline of Social and Administrative Pharmacy. School of Pharmaceutical Sciences, Universiti Sains Malaysia . Penang ( Malaysia ); and Department of Hospital and Clinical Pharmacy/Pharmacology. Manipal Teaching Hospital/Manipal College of Medical Sciences. Pokhara ( Nepal )
| | - Mohamed I M Ibrahim
- Discipline of Social and Administrative Pharmacy. School of Pharmaceutical Sciences, Universiti Sains Malaysia . Penang ( Malaysia )
| | - Pranaya Mishra
- Department of Pharmacology. Saba University School of Medicine. Saba, ( Netherlands Antilles )
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Ibrahim MIM. Effective Pharmaceutical Management and Policy in Developing Countries. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2010. [DOI: 10.1002/j.2055-2335.2010.tb00510.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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