The magnitude and predictors of self-medication amongst street dwellers in Ethiopia: a multicentre study

Background

Low levels of living standards amongst street dwellers worldwide limit their access to conventional healthcare services, resulting in self-medication use for the treatment of an illness. Nevertheless, self-medication use has risks, including adverse drug reactions, increased polypharmacy, drug resistance, drug dependence, drug interactions and incorrect diagnosis. Ethiopia has a large street-dwelling community; however, there are no studies conducted in Ethiopia assessing self-medication use amongst street dwellers. This study provides insight into self-medication use and predictors amongst street dwellers in Ethiopia.

Methods

A community-based, multicentre cross- sectional study was conducted amongst street dwellers from 1 September 2022 to 1 February 2023 at community drug-retail outlets in the three major cities in the Amhara region of Ethiopia. The data were obtained using an interviewer-administered questionnaire. Frequencies and percentages of descriptive statistics were calculated. Bivariable and multivariable logistic regression analyses were employed to indicate predictors of self-medication use. To determine statistical significance, a 95% confidence interval with a p value below 0.05 was utilized.

Results

The prevalence of self-medication use was 67.4%. Time and financial savings were reported as the reasons for most self-medication use. The most commonly reported illnesses for which people sought self-medication were gastrointestinal diseases. Low monthly income (adjusted OR 3.72, 95% CI 2.34-5.91) and residing near sewage areas (adjusted OR 3.37, 95% CI 2.03-5.58) were significantly associated with self-medication use.

Conclusion

Street dwellers had a high rate of self- medication use. Residing near sewage areas and having a low level of income were factors in self-medication use. Gastrointestinal diseases, respiratory ailments and dermatological conditions were the most frequently reported complaints, whereas antimicrobials and anthelmintics were the most commonly used medications. We recommend that healthcare services enhance outreach programmes to the most vulnerable people, such as street dwellers, especially those with lower monthly incomes and who live near sewage areas, to reduce self-medication rates.

In vivo antidiarrheal activity of the crude extract and solvent fractions of Rhamnus prinoides (Rhamnaceae) leaves

Background

Even though numerous conventional anti-diarrheal agents are available, the inherent toxicities of the drugs urge the search for alternative drugs that are safe and effective.

Objective

To evaluate the in-vivo anti-diarrheal activity of crude extract and solvent fractions of Rhamnus prinoides leaves.

Materials and methods

The Rhamnus prinoides leaves were macerated using absolute methanol and then fractionated using solvents of different polarity indexes. For in-vivo antidiarrheal activity evaluation of the crude extract and solvent fraction, castor oil-induced diarrhea, castor oil-induced anti-enteropolling, and intestinal transit models were used. One-way analysis of variance was used to analyze the data, followed by a Tukey post-test. The standard and negative control groups were treated with loperamide and 2% tween 80 respectively.

Results

A significant (p˂0.01) reduction in the frequency of wet stools and watery content of diarrhea, intestinal motility, intestinal fluid accumulation, and delaying the onset of diarrhea as compared with controls were observed in mice treated with 200 mg/kg and 400 mg/kg methanol crude extract. However the effect increased dose-dependently, and the 400 mg/kg methanol crude extract produced a comparable effect with the standard drug in all models. Amongst the solvent fractions, n-BF significantly delayed the time of diarrheal onset and reduced the frequency of defecation, and intestinal motility at doses of 200 mg/kg and 400 mg/kg. Furthermore, the maximum percentage inhibition of intestinal fluid accumulation was observed in mice treated with 400 mg/kg n-butanol extract (p˂0.01; 61.05%).

Conclusions

The results of this study showed that crude extract and solvent fractions of Rhamnus prinoides leaves showed a significant anti-diarrheal activity which supports its traditional use as a diarrhea treatment.

Cognitive adverse effects of epilepsy and its predictors attending outpatient department of South Gondar zone hospitals, Amhara Region, Ethiopia 2020 /2021

BACKGROUND

Epilepsy is the most common neurologic disorder which is further complicated by neurobehavioral co-morbidities, cognitive impairment, psychiatric disorders, and social problems. However, assessments of cognitive status of epileptic patients are far too low during clinical visits. This calls for early neuropsychological assessment soon after the diagnosis of epilepsy for a better treatment plan and outcome for epileptic patients.

OBJECTIVE

This study aimed to assess the cognitive adverse effects of epilepsy and its predictors attending outpatient departments of South Gondar Zone hospitals Amhara region Ethiopia 2020/2021.

METHODS

A multi-center institutional-based cross-sectional study was conducted. A total of 509 respondents were included with a response rate of 93.9%. Previously adapted pretested structured questionnaire was used containing, socio-demographic, clinical, and seizure related factors. Mini-Mental State Examination (MMSE) was used to measure cognitive impairment. A systematic random sampling technique was applied. Data were entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive statistics, bivariable and multivariable binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05.

RESULTS

Prevalence of cognitive impairment in this study was 69.2% (95%CI; 65.4, 73.1). Rural residents (AOR = 4.16,95%CI, 1.99,8.67), respondents who couldn't read and write (AOR = 2.62, 95%CI; 1.24, 5.5,) longer duration of seizure disorder (AOR = 4.59,95%CI; 2.01,10.52), taking combined Phenobarbital and Phenytoin (AOR = 4.69,95%CI; 1.88,11.69), having history of head injury (AOR = 3.29,95%CI;1.30,8.32), having depression (AOR = 4.76,95%CI;2.83,7.98), and anxiety (AOR = 3.11,95%CI; 1.58,6.12) were significantly associated with cognitive impairment.

CONCLUSIONS

Prevalence of cognitive impairment in this study was high. Regular neuropsychiatric assessment of patients with epilepsy should be encouraged especially for those participants with longer durations of illness, who are rural residents, who take combined Phenobarbital and Phenytoin, participants who had a history of head injury, depression, and anxiety.

Evaluation of In Vivo Wound-Healing and Anti-Inflammatory Activities of Solvent Fractions of Fruits of Argemone mexicana L. (Papaveraceae)

INTRODUCTION

The solvent fractions of the fruits of Argemone mexicana L. (Papaveraceae) have not yet been explored scientifically for in vivo wound healing and anti-inflammatory activities. The objective of this study was, therefore, to evaluate in vivo wound healing and anti-inflammatory activities of the solvent fractions of the fruit of Argemone mexicana L. (Papaveraceae) in rats.

METHOD

The crude extract of Argemone mexicana was fractionated with n-hexane, ethyl acetate, and distilled water. Wound healing activity was evaluated using excision and incision wound models while anti-inflammatory activity was evaluated using carrageenan-induced rat paw and cotton pellet-induced granuloma models. The fractions were evaluated at 5 and 10% ointments using moist-exposed burn ointment as the standard drug, and 100, 200, and 400 mg/kg test doses using aspirin, and dexamethasone as standard drugs for wound healing and anti-inflammatory activities, respectively. All treatment administrations were made orally for anti-inflammatory activity and applied topically for wound healing activity.

RESULT

The 10% w/w ethyl acetate fraction ointment showed a significant percentage of wound contraction, reduced period of epithelialization, increased amount of fibrosis, neovascularization, and collagen tissue formation (p < 0.01). The ethyl acetate fraction also showed a significant increase in tensile strength (55%; p < 0.01) and (81.10%; p < 0.01) at the tested doses of 5 and 10% w/w ointments, which was comparable to moist-exposed burn ointment. The ethyl acetate fraction also revealed a significant percent edema inhibition (61.41%; p < 0.01), suppression of the exudate (38.09% p < 0.01), and granuloma mass formations (53.47% p < 0.01) at the tested dose of 400 mg/kg.

CONCLUSION

The results of this study showed that the Ethyl acetate fraction of Argemone mexicana fruit has significant wound healing and anti-inflammatory activities which support the traditional claims of the experimental plant.

Evaluation of prescription completeness, rational drug-use patterns using WHO prescribing, patient-care and facility indicators in Debre Tabor Comprehensive Specialized Hospital, Ethiopia: A cross-sectional study

Objective:

Irrational medicine use results in diseases worsening, disability, death, and wastage of limited resources. This study was predominantly aimed to evaluate the rationality of medicine use patterns by assessing prescribing, patient-care, and facility indicators at Debre Tabor Comprehensive Specialized Hospital by using World Health Organization core drug use indicators.

Methods:

A cross-sectional design was conducted to collect prescribing indicator data from 780 prescriptions retrospectively from 1 July 2020 to 30 June 2021 at outpatient pharmacy of the hospital and exit interview was held prospectively on 150 patients to evaluate patient-care indicators. In addition, indicators for health-facility were assessed by actual observation of the presence of different guidelines. Descriptive analysis of the collected data was computed using SPSS version 25.

Result:

Totally, 1521 drugs were prescribed to 780 encounters. On average, 1.95 drugs were prescribed per prescription. Percentage of encounters by generic name, encounters with antibiotics and injection, and drugs from essential drug list were 99.9%, 35.4%, 15.3%, and 100%, respectively. From healthcare provider–related information, the names of prescribers and dispensers were correctly written in 93.59% and 77.69%, respectively. Frequency (97.18%) and route (86.15%) of drug administration were better stated in the reviewed encounters, whereas dosage form is poorly stated (7.44%). Labeling of dispensed medicine was obtained for only 10% of patients and patient knowledge for correct dose was 94%. Availability of facility indicators was 95%.

Conclusion:

From the results of this study, it is possible to conclude that the prescribing, patient-care, and facility indicators did not fulfill many World Health Organization standards. Therefore, it is important if all prescribers, dispensers, patients themselves, and the governing bodies take an action to improve the prescribing and patient-care indicators for the best of the end users.

Evaluation of Antidiarrheal Activity of 80% Methanol Extract and Solvent Fractions of the Leaves of Withania somnifera (L.) Dunal in Swiss Albino Mice

Background

Withaniasomnifera is an important medicinal plant for the treatment of diarrhea in Ethiopian folklore medicine. The aim of this study was to evaluate the antidiarrheal activity of Withania somnifera leaves in Swiss albino mice.

Materials and Methods

Hydromethanolic crude extraction and solvent fractionation were done using cold maceration technique. 80% methanol was used as a solvent in crude extraction, while distilled water, n-butanol, and chloroform were employed during fractionation. Castor oil-induced diarrhea, enteropooling, and gastrointestinal motility models were employed to evaluate antidiarrheal activity. Mice were randomly divided into five groups (six mice per group): negative control, which received 2% Tween 80 in distilled water; positive control, which received 3 mg/kg loperamide; and three test groups (III, IV, and V), which were treated with 100 mg/kg, 200 mg/kg, and 400 mg/kg of crude extract and solvent fractions, respectively.

Results

The crude extract, aqueous, and n-butanol fractions significantly delayed the onset of diarrhea at 200 mg/kg and 400 mg/kg dose. There was a significant reduction in the number and weight of stools at all tested doses of the crude extract and aqueous fraction, and at 200 mg/kg and 400 mg/kg of n-butanol fraction. Significant reduction in volume and weight of intestinal contents was observed at all tested doses of the crude extract, and at 200 mg/kg and 400 mg/kg of aqueous and n-butanol fractions. All tested doses of the crude extract and 200 mg/kg and 400 mg/kg of the aqueous and n-butanol fractions significantly reduced the motility of charcoal meal.

Conclusion

This study demonstrated that the crude extract and solvent fractions of the Withania somnifera leaves have antidiarrheal activity and supported the folklore use of the plant.

Antidiarrheal Effect of 80% Methanol Extract and Fractions of Clerodendrum myricoides (Hochst.) Vatke (Lamiaceae) Leaf in Swiss Albino Mice

BACKGROUND

Diarrhea is one of the tempting symptoms of diseases in the world. In Ethiopian traditional medicine practices, Clerodendrum myricoides is utilized for the treatment of diarrhea without scientific evidence.

OBJECTIVE

This study was aimed to evaluate the antidiarrheal activity of 80% methanol extract and fractions of the leaf of Clerodendrum myricoides in mice.

METHODS

The crude extract was prepared by maceration in 80% methanol and then fractionated using hexane, chloroform, and distilled water. Antidiarrheal activity was assessed by castor oil-induced diarrhea, enteropooling, and gastrointestinal motility models using onset of diarrhea, number and weight of feces, volume and weight of intestinal contents, and distance travelled by charcoal meal as main parameters. Negative controls received either distilled water or 2% Tween 80 (10 ml/kg), positive controls received 3 mg/kg loperamide or 1 mg/kg atropine, and the test groups received 100, 200, and 400 mg/kg doses of the extract.

RESULTS

The crude extract and chloroform fraction significantly prolonged the onset of diarrhea at 200 and 400 mg/kg and decreased the number of wet, total, and weight of fresh feces at all tested doses. Hexane fraction has a significant antidiarrheal effect on the onset, number, and weight of feces at 400 mg/kg. The crude extract and chloroform fraction at all tested doses, as well as aqueous fraction at 200 mg/kg and 100 mg/kg, produced significant reduction in volume and weight of intestinal contents. Additionally, hexane fraction showed significant reduction of volume and weight of the intestinal content at 400 mg/kg. In the gastrointestinal motility test model, both chloroform fraction and crude extract at all tested doses and aqueous fraction at 200 mg/kg and 400 mg/kg showed a significant antidiarrheal effect as compared to the negative control.

CONCLUSION

The leaf of Clerodendrum myricoides showed antidiarrheal activity which supports the traditional use.