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Item Appropriateness of the UNAM Bachelor of Pharmacy honours Degree curriculum and its implementation, to meet the perceived health needs of Namibia(University of Namibia, 2023) Lates, Jenmifer A.Since Independence in 1990 Namibia has struggled with a chronic shortage of pharmacists. To address this, a Bachelor of Pharmacy honours degree (BPharm) was developed and the first intake of BPharm students at UNAM was in 2011. This study is the first formal assessment of the appropriateness of the curriculum to the health needs of Namibia. A cross-sectional survey was shared with all registered pharmacists in Namibia, requesting them to rate the appropriateness of the BPharm modules to their field of pharmacy practice. Additionally, respondents rated the competence of UNAM BPharm graduates, if they had worked with them and made further comments on the appropriateness of the current curriculum. Internship assessment marks for 2016-2019 were also analysed. The survey was completed by 210 of 610 pharmacists registered in Namibia (34%). The mean appropriateness rating for 37 different modules ranged from 3.7 to 4.7 (scale: 1- not appropriate at all to 5-very appropriate). The mean rating of graduates’ perceived competence for the different domains ranged from 2.8 to 3.7 (scale: 1-not competent at all to 5-highly competent). Respondents’ comments suggested several enhancements to the current curriculum, with the most frequent suggestions being to strengthen business, management and leadership training. In relation to professional examinations, interns trained at UNAM performed better on the Legal assessment compared to interns trained elsewhere, but there was no significant difference between the two groups for the Calculation or Observed Structured Clinical Examination (OSCE) assessments. Results suggest that the current BPharm curriculum is appropriate for Namibia’s health needs, though more emphasis needs to be placed on some key areas. It is recommended that the results of this study guide the UNAM BPharm curriculum transformation. This study also demonstrates a cost-effective method for critical assessment of health professions training curricula that can be utilised in resource-limited settings.Item The effect of pharmacist-provided discharge counselling on medication knowledge and adherence among patients with cardiovascular diseases at Windhoek central hospital, Namibia(University of Namibia, 2022) Anguuo, Liisa NdapewaBackground: Pharmacists are ideally placed to provide medication counselling to patients during the discharge stage of the patient care journey due to their extensive knowledge of medications. The provision of tailored educational counselling and adequate information about medications may improve patients’ adherence, level of confidence, self-efficacy, and understanding of how to take their medications. Objectives: To pilot the implementation of a pharmacist-provided discharge counselling service and to measure patients’ level of medication knowledge and adherence before and after implementation of the service. Methods: A prospective quasi-experimental study was completed among adult patients with cardiovascular diseases admitted to Windhoek Central Hospital during between November 2020 and May 2021. Patients taking at least one chronic medicine prior to admission and at discharge were included in the study. The study comprised of a control phase prior to implementation of the pharmacist-provided discharge counselling service and an intervention phase following implementation. Each phase was 3 months long with a one-month period between the two phases that was devoted to educational programmes. Patients in the intervention group received discharge counselling by trained pharmacists while patients in the control group received usual care. Patients’ level of medication adherence and medication knowledge were assessed through interviews within a day of admission and on days 7 and 14 post-discharge. Repeated measures analysis of covariance was used to compare the level of medication knowledge and adherence among patients in the control and intervention groups. A p < 0.05 was considered statistically significant. Results: A total of 84 patients comprising 42 patients in each group were evaluated. Female patients accounted for 59.5% (25/42) and 69.0% (29/42) of the patients in the control and intervention group, respectively. The mean age of patients in the control group was 45.5 years (range: 18-80 years) compared to 39.3 years (range: 18-69 years) in the intervention group. After controlling for the level of adherence at admission, there was a statistically significant difference in the levels of patient adherence to medication on days 7 and 14 post discharge as a consequence of pharmacist-provided counselling, (F (1, 81) = 110.626, p < 0.001, ηp2 = 0.577). Estimated marginal means of adherence levels were different in the control (M = 80.273, SE = 0.46) and intervention (M = 87.14, SE = 0.46) groups. The level of adherence at admission was significantly related to the levels of adherence on days 7 and 14 post-discharge, F (1, 81) = 126.35, p < 0.001, ηp2 = 0.609). In addition, there was no significant difference in the levels of adherence measured on days 7 and 14 after discharge from hospital, F (1, 81) = 0.030, p = 0.862, ηp2 = 0.001). After controlling for patient’s level of medication knowledge at admission, there was a significant effect of pharmacist-provided counselling on the levels of patients’ medication knowledge measured on days 7 and 14 post-discharge, (F (1, 81) = 41.49, p < 0.001, ηp2 = 0.339). Estimated marginal means of levels of knowledge were different in the control (M = 62.20, SE = 0.72) and intervention (M = 68.76, SE = 0.72) groups. The level of medication knowledge at admission was significantly related to the levels of medication knowledge on days 7 and 14 post-discharge, F (1, 81) = 273.79, p < 0.001, ηp2 = 0.772). Furthermore, there was a significant difference in the levels of medication knowledge measured on days 7 and 14 after discharge from hospital, F (1, 81) = 9.03, p = 0.004, ηp2 = 0.1). ii Conclusions: Implementation of a pharmacist-provided discharge counselling service resulted in improvements in the level of medication knowledge and adherence among patients.Item Effectiveness of post-operative pain management among patients in a surgical ward at Windhoek central hospital in Namibia(University of Namibia, 2022) Mika, Maano Nelao O.Effective management of post-operative pain improves patient outcomes and quality of life. Although internationally validated pain scales have been implemented for evaluation of post-surgical pain, the majority of patients who undergo surgery in both high-income and low- and middle-income countries continue to experience ineffective management of acute pain. This study aimed to assess effectiveness of post-operative pain management among patients in a surgical ward at Windhoek Central hospital in Namibia by comparing the proportion of patients with moderate to severe pain at 24 h and 48 hours post-operatively. A prospective cohort design was utilized to assess post operative pain at 24 hours and 48 hours using two different pain assessment tools. Data related to prescribing patterns were collected from patient’s clinical records using a standardized data collection tool. Data were analyzed using SPSS v22 software. The study was conducted among 75 participants. Of 75 participants, 48 (64.0%) were males. The mean age was 37.41± 11.13 years. Among the patients involved in the study, 74.7% experienced moderate to severe pain at 24 hours post-operatively which reduced to 41.3% by 48 hours. The difference was statistically significant. Overall, over 5% of the study participants experienced moderate to severe pain at 48 hours post operatively compared to a UK target of less than 5%, showing inadequate management of pain. The cumulative median pain scores for visual analogue scale and numeric pain scale were 5.50 at 24 h and 2.00 at 48 h post-operatively. The difference in median pain scores was statistically significant (p< 0.05). The commonly prescribed analgesics were paracetamol injection (68%), strong opioids (54%) and weak opioids (23%) while adjuvants, and NSAIDs accounted for 8% each, respectively. Out of 75 clinical records reviewed, only 47 (62.7 %) followed WHO guidelines on pain management. There is a need to more frequently assess patient’s level of pain after surgery to ensure effective pain management. In conclusion, post-operative pain is inadequately controlled at WCH.Item Quality of diabetic care among patients with diabetes mellitus type 2 at Oshikuku hospital in Namibia(University of Namibia, 2022) Kayombo, Clarice MIntroduction: Diabetes Mellitus Type 2 (T2DM) is a major public health problem worldwide, including in Namibia with an estimated prevalence of 5.4 %. The World Health Organisation (WHO) recommends quality care which includes promotion of blood glucose (BG) control, diet, physical activity, monitoring of blood pressure (BP), lipids, regular screening for T2DM complications, education on diabetes, and self-care practices. The study aim was to assess the quality of care offered to patients with T2DM, describe glycaemic control of patients and serve as a gap analysis to identify areas that need improvement. Methods: This cross-sectional study evaluated diabetes quality measures including glycaemic control, co-morbidity management, diabetes knowledge, and self-management activities amongst outpatients at Oshikuku District Hospital in Namibia. Data was collected from health record review and patient interviews using a standard questionnaire. Data was analysed using descriptive statistics. Diabetes control was defined as an A1C <8%. Predictors of diabetes and hypertension control were determined through binary and logistic regressions. The groups were assessed for any variable differences, using Pearson’s Chi-square test. The confidence level was set at 95% and the p-value at <0.05. A correlation analysis was done on knowledge and treatment outcomes. This research was approved by the Ministry of Health and Social Services. Results: A total of 108 patients with T2DM were recruited, however only 84 had available A1Cs and were included in the analysis. All were Namibian. Most were female (63.1%) and married (81.0%). Few had tertiary level education (6.0%). Many were unemployed (59.5%), and pensioners (58.3%). Most (60.7%) had poor glycaemic control with an average A1C of 10.24%. Fewer than one-third of patients had annual monitoring for A1C (29.8%) and lipids (29.8%). Fewer than 25% were prescribed statins. Most (82%) had hypertension with few (16%) at goal. Foot (11.9%) and eye examinations (13.1%) were performed infrequently. Many (69%) had low diabetes knowledge. The only factor found to predict poor glycaemic control was a BMI greater than 25 (OR=1.2). Conclusion: The quality of diabetic care at Oshikuku Hospital was below for all markers of quality including A1C testing and control, co-morbidity management, and self management. Hence there is need to develop interventions to improve the quality of care, which may ultimately improve treatment outcomes.Item Evaluation of the compliance of antibiotic prescribing with international clinical practice guidelines for surgical antibiotic prophylaxis at intermediate hospital Rundu, Namibia(University of Namibia, 2022) Chola, BrianCompliance with guidelines of surgical antibiotic prophylaxis (SAP) has been shown to reduce the prevalence of surgical site infections by approximately 40%. However, globally, 30 to 90% of antibiotics used for SAP purposes, are irrationally utilized. The aim of this study was to estimate the level of compliance with international clinical practice (ICP) guidelines for SAP and determine predictors of non compliance at Intermediate Hospital Rundu (IHR). This was a quantitative, analytical retrospective clinical record review. Data were collected from April 2019 to June 2019 from the clinical records of post-operative patients in theatre unit using a standardized assessment form. Compliance was evaluated in terms of correct antibiotic prophylaxis choice, timing, route of administration, dose and discontinuation. A total of 153 surgical procedures were evaluated. Of these, 149 warranted SAP but only 92.0% received antibiotic prophylaxis. The level of compliance with SAP guidelines was high with regards to correct route (99.3%) and moderate with respect to timing of administration (38.7%). Compliance with SAP guidelines was low with regards to correct antibiotic choice (15.3%), dosing (9.5%) and antibiotic discontinuation within 24 hours (0.7%). None of the records complied with the parameters of ICP guidelines for SAP. The main predictors of non-compliance to prescribing correct SAP were general medical officers OR = 34.29 (95% CI 8.71 to 134.95) and specialists OR = 6.35 (95% CI 2.63 to 37.61). Elective surgical procedures OR = 2.96 (95% CI 1.32 to 6.65) independently predicted non compliance to appropriate timing of antibiotic administration. General medical officers OR = 53.03 (95% CI 8.35 to 336.66), specialist OR = 14.11 (95% CI 2.4 to 83.24) and age of patient OR = 1.09 (95% CI 1.02 to 1.16) were predictors of non compliance to correct dosing of prophylactic antibiotics. Compliance with internationally recognized guidelines was sub-optimal. There is need to develop local SAP guidelines and access to improve rational antibiotics use in surgery at IHRItem Antibiotics’ susceptibility patterns of bacterial isolates causing lower respiratory tract infections in ICU patients at referral hospitals in Namibia(University of Namibia, 2022) Simeon, PiaIntroduction: LRTIs are a particularly important problem in Namibia, as they are rated the second leading cause of death in the country and cause around 300 deaths in children under 5 years in 2016. To reduce the burden of Lower Respiratory Tract Infection (LRTIs) on health systems and ensure appropriate patient management, it is critical to know the most prevalent pathogens leading to LRTIs and the susceptibility patterns of those pathogens in the local setting. Aim: To formulate cumulative antibiograms for ICUs of referral hospitals in Namibia for the period studied. Methods: This retrospective analytical cross-sectional study was conducted over two years: 2017 and 2018. The cumulative antibiograms were constructed according to CLSI guidelines and the chi-square test was used to compare the changes in susceptibility rates from 2017 to 2018. The data used to develop the cumulative antigrams was obtained from NIP. Results: Klebsiella pneumoniae (8.8%, 8.1%) was a predominant pathogen in Windhoek Central hospital ICU in 2017 and 2018. In Oshakati intermediate hospital ICU, Enterobacter sp. (22.2%) and Pseudomonas aeruginosa (37.5%) were the common pathogens in 2017 and 2018. Acinetobacter baumannii isolates were > 90% susceptibility to colistin, carbapenems and tigecycline in 2017. In 2028, Acinetobacter baumannii isolates were highly susceptibility to amikacin, carbapenems and colistin, but moderately susceptible to tigecyclines. In 2017, Klebsiella pneumoniae isolates were more susceptible to carbapenems (imipenem 94% and meropenem 93.8%), amikacin 89.3% and tigecycline 88.7%. In 2018, Klebsiella pneumoniae isolates were 100% susceptible to amikacin, colistin and carbapenems. Stenotrophomonas maltophilia isolates were more than 80% susceptible to all the tested antibiotics. Staphylococcus aureus isolates were 100% susceptible to linezolid, rifampicin, teicoplanin, vancomycin in 2017 and 2018, its susceptibility to these antibiotics did not change. Conclusion: The susceptibility patterns of the common isolated gram-negative pathogens were highly variable. Meropenem combined with gentamicin, is now the recommended empiric therapy for patients with LRTIs in Windhoek Central hospital ICU.Item The effect of pharmacist-provided discharge counselling on medication knowledge and adherence among patients with cardiovascular diseases at Windhoek central hospital, Namibia(University of Namibia, 2022) Anguuo, L.N.Cardiovascular diseases (CVDs) are the leading cause of death globally and are a major contributor to reduced quality of life(1) . According to the World Health Organization (WHO), an estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke. Over three quarters of CVD deaths take place in low- and middle-income countries. Sub-Saharan Africa is ravaged by a growing burden of CVDs (2). Hypertension (HTN) is one of the most important modifiable risk factors for cardiovascular disease. HTN, as well as, heart failure (HF) are common causes of premature morbidity and mortality. They account for about 7.5 million deaths worldwide every year, with 82% occurring in low- and middle-income countries (3). HTN is defined as persistently elevated arterial blood pressure with a systolic blood pressure more than 140 mmHg and diastolic blood pressure more than 90 mmHg (3). HTN is known as the “silent killer”, as uncontrolled HTN is often asymptomatic. Left untreated, HTN can lead to myocardial infarction, left ventricular hypertrophy, congestive HF, aneurysm, stroke, chronic kidney disease (HTN nephropathy), and HTN retinopathy (4). HF is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen (4). Both HTN and HF require lifelong use of medications to prolong life, prevent complications, and reduce hospitalizations (3). Health care workers should accompany lifelong therapy with counselling, education, and adherence support. As medication experts, pharmacist are best placed to provide this support. 2 Counselling can be valuable at any point of the patient care journey but the current study focuses on the discharge stage. During inpatient hospital stay, a patient’s medications are administered by nurses and adherence is usually maintained. However, upon discharge, the patient (or a family member) must take responsibility for medication adherence in order to achieve and maintain their health status. The safety and efficacy of medication therapy depends on the correct information being shared with and understood by patients about their medication and patient understanding of that information (5). Therefore, the pharmacist undertaking discharge counselling should possess adequate knowledge and should be an effective communicator, making use of verbal and non-verbal communication skills (5). During medication counselling patients are provided with advice and information on their medicines. Patient counselling may be verbal or written, performed on an individual basis or in groups, and provided directly to the patient or caregiver (6). One of the pharmacist’s responsibilities is to optimize the patient's medication therapy by promoting adherence through good medication counseling. Pharmacists are ideally placed to provide useful medication counselling to patients at the time of discharge due to their extensive knowledge of medications (7). Providing tailored educational counselling and adequate information about medications, such as medication indications and clear instructions on medication use, improves adherence and increases patient confidence, self-efficacy and understanding on how to take their medications (8). Previous studies suggest that direct pharmacist interaction with patients through medication reconciliation, discharge counselling, and post discharge phone calls decreases the number of adverse drug events (ADEs) and plays a positive role in transitional care (9). For example, a study done by Fernandez and colleagues on the effect of pharmacist interventions on antidepressant medication adherence in 3 outpatients concluded that patients who received a pharmacist intervention were over 60% more likely to adhere to their medication than those who did not (OR=1.6, [95% Cl 1.2 to 2.2]) (10). Furthermore, some studies(11,12) have demonstrated the benefits of interventions provided by pharmacists in improving adherence and other patient outcomes. In addition to improved adherence, pharmacists can play an important role in the prevention of readmissions by counselling patients and providing relevant medication information. A study by Jackevicius et al., showed that after acute myocardial infarction, nearly 24% of patients did not fill their medications within seven days of discharge, and one third of patients decided to stop at least one medication in the first month (13). The relationship between medication knowledge and medication adherence is complicated. Some studies suggest that improved medication knowledge improves adherence (14), although, other reports show that counselling has little or no effect on adherence (15). Providing counselling to in-patients is one of the important tasks of hospital pharmacists. This study evaluated the impact of pharmacist-provided discharge counselling on patients’ medication knowledge and adherence.Item Predictors of treatment success among patients with drug resistant Tuberculosis in Namibia(University of Namibia, 2022) Nangombe, Vulika Namutse TuyambekaDrug resistant tuberculosis (DR-TB) is a considerable barrier to ending TB globally. In Namibia, the burden of DR-TB, among new and previously treated TB patients is estimated at 3.3% and 18% respectively. The study aimed to determine predictors and patterns of treatment success rates (TSR) among patients with DR-TB in Namibia, to inform national TB program and guidelines. A nationwide case-control study of predictors of DR-TB TSR utilized patient data in the national TB register over 5 years period (201-2019). The data on treatment outcomes, patient socio-demographic, clinical and treatment, and TB programme covariates were analysed in SPSS v22. TSR patterns and crude predictors were determined using descriptive and univariate analysis respectively. Adjusted odd ratios (aOR) (adjusted for the confounders abuse of alcohol and time to treatment) were determined to identify independent predictors of TSR in DR-TB, using multivariate logistic regression. Of the 1494 analysed record 56.3% (n=841) were for males, the mean age was 35.6±14.2 years, and 8.3% had HIV coinfection. The overall TSR was 66.5% (n=994). Prevalent adverse drug reactions (ADRs) were ototoxicity/tinnitus (n=1.8%, 27), vomiting (0.6 %, n=9), 0.4% for joint pains and peripheral neuropathy, 3% for renal impairment, visual disturbance and skin rash. The independent socio-demographic predictors of treatment success were female sex (aOR=0.6, 95%CI:0.34, 0.89; p=0.015), young age <5 years (aOR=0.1, 95%CI:0.0007, 0.421; p=0.005) and 5-14years (aOR=0.0, 95%CI:0.002,0.269; p=0.002), and Namibian citizenship (aOR=0.3; 95%CI: 0.089,0.961; p=0.043). Clinical predictors were; baseline mono-resistance (aOR=7.6, 95%CI:1.427,40.631; p=0.018), and bilateral pulmonary forms (aOR=0.2, 95%CI:0.057,0.498; p=0.001). Whilst TSRs have improved, they remain below global targets and vary by type, regions and patient populations. There is need to individualize DR-TB treatment with targeted at males, older patients, expats, baseline resistance to more than one drug and bilateral pulmonary disease administer using a community-based Directly Observed Treatment (DOTS) approach.