WHO/INRUD Core drug use indicators and commonly prescribed medicines: a National Survey from Sri Lanka

Background

Identification of internationally comparable indicators of medicines use are important for a country to implement strategies and regulations to improve usage of medicines. Sri Lanka established a new National Medicines Regulatory Authority in 2015 and this survey evaluated the medication use indicators in Sri Lanka, according to the International Network on Rational Use of Drugs (INRUD), prior to its implementation.

Methods

This descriptive-cross-sectional study was conducted in 80 pharmacies, representing all 25 districts of the country. Three pharmacy categories were included; privately owned pharmacies, ‘Rajya Osusala’ pharmacies operated by the State Pharmaceuticals Corporation (SPC) of Sri Lanka and SPC Franchisee pharmacy outlets. Selection of pharmacies from respective districts were done proportionate to estimated population. Data were collected to identify WHO/INRUD core drug use indicators and the commonly prescribed medicines.

Results

Total of 2328 prescriptions were included (‘Rajya Osusala 559; SPC Franchise 711; private pharmacies 1058). Altogether 7,255 medicines were prescribed, and the 3 most commonly prescribed medicines were atorvastatin, losartan and metformin. Average number of medicines per encounter was 3.1±1.9 (Median: 3; range 1-12) Highest average number of medicines per encounter was reported in prescriptions received at ‘Rajya Osusala’ pharmacies (3.6±2.2), significantly higher than in other categories of pharmacies (p<0.001). Percentage of medicines prescribed by generic name was only 35.5%, highest at the ‘Rajya Osusala’ pharmacies (40.6%), significantly higher than other categories of pharmacies. The overall percentage of medicines prescribed from essential medicine list (EML) was 68.8%, without any significant variation between different categories of pharmacies. The percentage of medicines actually dispensed and accurately labelled were 92.4 and 98.5% respectively.

Conclusions

The average number of medicines per encounter was higher than the WHO recommended value but the usage of antibiotic and injectable drugs were within recommended standards. Generic prescribing, was very much lower. The EML prescribing, labelling and percentage dispensed medicines fared much better although lower than the WHO recommended 100% compliance. This island wide study has provided national wide data before the implementation of key changes in regulation of medicines in Sri Lanka and a repeat survey will be useful to identify impact of the new legislations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40360-021-00535-5.

Induction of oxidative stress and histopathological changes by sub-chronic doses of triazophos

The effect of triazophos (O, O-diethyl O-1-phenyl-1 H-1, 2, 4-triazol-3-yl phosphorothioate), a widely used insecticide was studied on the induction of oxidative stress and histological alterations at sub-chronic doses in male albino rats. Oral administration of triazophos at concentrations of 1.64, 3.2 and 8.2 mg/kg body wt for 30 days produced dose as well as time-dependent increase in the lipid peroxidation (determined by malondialdehyde levels) and glutathione-S-transferase (GST) activity in serum with aconcomitant decrease in ferric reducing ability of plasma (FRAP) and blood glutathione (GSH) content. Histopathological examination of liver of triazophos-treated rats showed significant and progressive degenerative changes as compared to control, which could be due to induction of oxidative stress. However, no significant histopathological changes were observed in spleen, kidney and brain at either dose of triazophos with respect to control. These results indicated that oral administration of triazophos was associated with enhanced lipid peroxidation and compromised antioxidant defence in rats in dose and time-dependent manner. Thus the present study demonstrated for the first time the role of oxidative stress as the important mechanism involved in the stimulation of hepatic histoarchitectural alterations at sub-chronic doses of triazophos in rats.

Co-sleeping and clinical correlates in children seen at a child guidance clinic

INTRODUCTION

Co-sleeping or bed-sharing is a common practice that has been little researched. While often viewed as being "cultural" in nature, there is a suggestion that it may be a parental response to sleep problems. Some studies link co-sleeping with behavioural and temperamental difficulties. The objectives of the current study were to determine the prevalence of co-sleeping and how they relate to sleeping problems among a cohort of children and adolescents seen in a child guidance clinic.

METHODS

Parents or guardians of all new patients seen at the child guidance clinic were asked to complete a questionnaire upon their consent to participate in the study. The questionnaire included socio-demographical data and frequency of sleep problems in the past six months. A list of nine common sleep problems was included.

RESULTS

The prevalence of co-sleeping was found to be 72.7 percent. The children who co-sleep were significantly younger and there was a decrease in the practice with increasing age. Sleep starts and nightmares were significantly more among those sleeping alone.

CONCLUSION

Co-sleeping was not associated with significant sleep problems in our cohort. Co-sleeping may have been initiated in response to an existing sleep problem but eventually resolved the problem. If co-sleeping is not permitted, the sleep problem could be compounded, giving rise to a higher prevalence of sleep starts and nightmares among those in our cohort who slept alone.

Clinical and Social Correlates of Duration of Untreated Psychosis in First-episode Psychosis Patients

Introduction: This study aims to examine the socio-demographic and clinical correlates of the duration of untreated psychosis (DUP) in first-episode psychosis patients in an Asian country. Materials and Methods: Three hundred thirty-four patients from the Early Psychosis Intervention Programme (EPIP) of Singapore were recruited for the study. Socio-demographic data were collected and patients were diagnosed using SCID I (Structural Clinical Interview for DSM-IV Axis I Disorders). Other assessment scales were used to assess the level of psychopathology, overall functioning and the awareness of mental illness. Results: Mean (SD) DUP was 16.3 (31.5) months. Patients who were single, unemployed, or brought by the police had a significantly longer DUP. Patients with a diagnosis of schizophrenia had a longer DUP as compared to patients with other forms of psychosis. The better functioning patients as indicated by a higher Global Assessment of Functioning score and those who were more insightful had a shorter DUP. Conclusions: This study suggests that certain socio-demographic features and clinical diagnosis may determine DUP. Key words: Psychotic disorder, Schizophrenia

Clinical and social correlates of duration of untreated psychosis in first-episode psychosis patients

INTRODUCTION

This study aims to examine the socio-demographic and clinical correlates of the duration of untreated psychosis (DUP) in first-episode psychosis patients in an Asian country.

MATERIAL AND METHODS

Three hundred thirty-four patients from the Early Psychosis Intervention Programme (EPIP) of Singapore were recruited for the study. Socio-demographic data were collected and patients were diagnosed using SCID I (Structural Clinical Interview for DSM-IV Axis I Disorders). Other assessment scales were used to assess the level of psychopathology, overall functioning and the awareness of mental illness.

RESULTS

Mean (SD) DUP was 16.3 (31.5) months. Patients who were single, unemployed, or brought by the police had a significantly longer DUP. Patients with a diagnosis of schizophrenia had a longer DUP as compared to patients with other forms of psychosis. The better functioning patients as indicated by a higher Global Assessment of Functioning score and those who were more insightful had a shorter DUP.

CONCLUSIONS

This study suggests that certain socio-demographic features and clinical diagnosis may determine DUP.

Reducing the duration of untreated psychosis and changing help-seeking behaviour in Singapore

AIM

This study was conducted to examine the impact of early detection strategies of an early psychosis intervention programme on the duration of untreated psychosis (DUP) and the pattern of help-seeking behaviour.

METHOD

Patients with first-episode psychosis were compared before and after the initiation of a programme of public education and networking with primary health care providers. These two groups were compared on the DUP and the change in the pattern of help-seeking.

RESULTS

The DUP was significantly reduced from a median of 12 to median of 4 months (p=0.002, Mann-Whitney U-test). There was an increase in the proportion of self and family referrals, and a fall in the proportion of police referrals.

CONCLUSION

Awareness campaigns which target multiple groups and use various modes of communication are effective in influencing the DUP and patterns of help-seeking.

Post-SARS psychological morbidity and stigma among general practitioners and traditional Chinese medicine practitioners in Singapore

INTRODUCTION

The severe acute respiratory syndrome (SARS) outbreak has been unique in recent history in its rapidity of transmission, its concentration in healthcare settings, and the large number of healthcare workers who have been infected. This study aims to examine the psychological impact of SARS on general practitioners (GPs) and traditional Chinese medicine (TCM) practitioners in Singapore.

MATERIALS AND METHODS

Two months after the SARS outbreak, all the GPs and TCM practitioners in Singapore were mailed a set of self-reported questionnaires, which included the General Health Questionnaire (GHQ), the Impact of Event Scale-R (IES-R), and a questionnaire to measure the perception of stigma.

RESULTS

A total of 721 (29%) GPs and 329 (22%) TCM practitioners responded to the survey. Significantly more GPs had worked in SARS affected facilities and had been directly involved in the care of patients with SARS than the TCM practitioners (P <0.001). Those GPs who were directly involved in the care of patients with SARS were significantly more likely to be GHQ case as compared to those not involved in the care of patients with SARS (P = 0.02; OR = 2.9; 95% CI, 1.3-6.3). The mean score of the GHQ somatic, anxiety and social dysfunction subscales were significantly higher in GPs as compared to TCM Practitioners (P <0.001). The GHQ total score as well as the subscales was significantly correlated with the IES-R and stigma subscales (P <0.05).

CONCLUSION

The fear, uncertainty and stigma caused by SARS are associated with psychological distress among some of the primary healthcare providers in Singapore.

Psychiatric comorbidity in first episode psychosis: the Early Psychosis Intervention Program (EPIP) experience

OBJECTIVE

To determine the prevalence rates of psychiatric comorbidity in a hospitalized Asian patient group with first episode psychosis and examine its clinical correlates.

METHOD

Seventy-nine consecutively admitted patients with first episode psychosis were assessed using the Structured Clinical Interview for DSM-IV-axis I disorders (patient edition), Positive and Negative Symptom Scale (PANSS), Scale to assess Unawareness of Mental Disorders (SUMD) and Global Assessment of Functioning (GAF) scales.

RESULTS

Psychiatric comorbidity was present in 36.7% (n = 29) of the patients. Patients with psychiatric comorbidity were younger (P < 0.05), had an earlier onset of illness (P < 0.05) and better insight on social consequences and flat affect items (P < 0.05) on the SUMD. No significant differences were found between the two groups with and without psychiatric comorbidity in gender, ethnicity, marital status, length of education, employment status, living arrangements, duration of hospitalization and untreated psychosis as well as total PANSS and GAF scores.

CONCLUSION

Psychiatric comorbidity is common thus calling for a greater awareness in clinicians of these conditions, which are often under-recognized, under-diagnosed and untreated.