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The World Health Organization (WHO) addressed drug utilization as the marketing, distribution, prescription and use of drugs in a society, considering its consequences, either medical, social, (and) or economic. The increasing importance of drug utilization studies as a valuable investigative resource in pharmacoepidemiology has bridged it with other health related areas, such as public health. Surveillance of drug use by the doctors within the institution as well as in the community is assuming an increasingly key role in therapeutics. This was a cross-sectional study of prescription pattern and drug utilization trends at the Lions International Eye Centre (LIEC) of the Korle Bu Teaching Hospital and adherence to the standard prescription form at the Eye Centre. Prescriptions that were presented to the LIEC pharmacy unit within the period from October 2015 to March 2016 were captured and reviewed. The total number of drugs in the 588 prescriptions was 1265. The average number of drugs per prescription was 2.1. Drug dosage, route of administration, frequency, and duration of treatment record were mentioned in 95.01% (1202/1265), 97% (1227/1265), 98.46% (1240/1265) 96.05% (1215/1265) of the prescriptions respectively. Anti-glaucoma medicines were the most prescribed 21.8% (276/1265), Prescribing by generic name slightly dominated with 51.1% (645/1265) of the total number of drugs prescribed. Use of Ophthalmic antibiotics alone and the use of ophthalmic antibiotics in combination with other medicines were 13.5% (171/1265) and 11.9% (142/1265) respectively.: The findings of this study revealed that the drug utilization pattern was not in line with the recommended standard values of WHO prescribing indicators even though the level of compliance to the requirements on the standard prescription form of the hospital for drug prescribers was remarkably high. The availability of key medicines should be improved whilst generic prescribing from EDL should also be encouraged.

Background There is limited information on patterns of treatment change among new initiators of highly active antiretroviral therapy (HAART) in the regions most affected by HIV/AIDS. This makes it difficult to identify the determinants of treatment change. In this retrospective cohort study, we examined treatment change patterns over a five-year period among initiators of HAART. Methods De-identified data were obtained from the Fevers’ Unit Database at the Korle-Bu Teaching Hospital. All adult treatment-naive patients who started treatment with first line HAART between 1st January, 2008 and 31st December, 2012 were followed over a minimum period of three months. The main outcome was the first treatment change, defined as the first substitution/switch in accordance with the standard treatment guidelines. Data were analyzed stratified by year of treatment initiation. Crude and adjusted hazard ratios were calculated. Results A total of 3933 patients were followed with almost equal numbers of initiators per year. The mean age (standard deviation) at treatment initiation was 39 (10.3) years. The most prescribed HAART combination was AZT/3TC/EFV and overall for initiators zidovudine combination therapy was about 60%. Utilization of stavudine containing HAART increased gradually until 2010 and then dropped to zero. Over the study period, 44.9% of recorded deaths were from those initiated with a stavudine backbone, 41.1% from a zidovudine backbone, and 11.5% from a tenofovir backbone. Females had a significantly higher rate of treatment change compared to males (p-value = 0.0002), and d4T/3TC/EFV and d4T/3TC/NVP recorded independent treatment change hazard ratios of 12.05 (CI 9.58 to 15.16) and 12.03 (CI 9.27 to 15.61) respectively.. Kaplan-Meier curves showed that treatment change was higher among those who started treatment later in the study period compared with those who started earlier. Conclusion A major treatment change in the utilization of antiretroviral medicines in Ghana occurred during the study period which was associated with type of treatment, year of treatment, gender and disease stage. The influence of a policy change during the period may have made a significant impact.. For diseases involving life-long treatment in particular, it is important to monitor and periodically evaluation treatment utilization patterns.

Cases of the A(H1N1) 2009 influenza were first recorded in Ghana in July 2009. In June 2010 when prioritized vaccination against the novel A(H1N1) 2009 influenza virus started in the country, health workers were among the selected groups to receive the vaccination.The aim of this study was to determine the distribution and types of adverse events reported following immunization of healthcare workers at the Korle-Bu Teaching Hospital from the day vaccination started until 1 week after the end of vaccination.Safety data collected during the A(H1N1) 2009 influenza vaccination of health workers at the Korle-Bu Teaching Hospital (Accra, Ghana) were used for this study. All workers aged 18 years and over were eligible for vaccination. For uniformity, 0.5 mL of Pandemrix(®) (equivalent to 3.75 μg of hemagglutinin antigen) was administered intramuscularly into the deltoid muscle of the left arm. Each vaccinee was issued with a card and was advised to report any adverse events following immunization (AEFI) to designated health workers for follow-up. Incidence rates of adverse events were estimated and compared with the Pandemrix(®) Summary of Product Characteristics (SPC) RESULTS: A total of 5870 people (64.9 % females) with a mean age of 34.0 years were vaccinated. In total, 140 vaccinees reported adverse events. The mean age among vaccinees reporting adverse events was 36.1 years. The overall incidence of vaccinees reporting adverse events and the overall incidence of adverse events was 232 (95 % CI 199-320) per 10,000 people and 930 (95 % CI 820-1070) per 10,000 people, respectively. In particular, we found no difference in the way males reported AEFI compared with females (Chi-squared [χ(2)] = 0.59; p 0.2), and we did not find any association between age as a categorical variable and vaccine adverse event reporting (χ(2) = 5.24; p 0.1). There were only three serious cases that led to hospitalization. All three cases occurred within 24 hours of receiving the vaccine. The incidence rates for the various reported events were all lower compared with those in the Pandemrix(®) SPC, but while injection-site pain was the most frequent in the SPC and other foreign studies, we recorded headache as the most frequent. Even fatigue, muscle/joint aches and fever had higher incidence rates compared with injection-site pain. Tachycardia (n = 6), tinnitus (n = 1) and decreased appetite (n = 4) were reported although were not included in the SPC.The most prominent adverse events reported were headaches, dizziness, muscle and joint aches, weakness, fever and injection-site pain. Although similar events were reported in other studies, the incidence was different and there were a few differences in the most frequently reported events. More studies of a similar nature should be encouraged in low- and medium-income countries to bridge the information gap with the developed world.

Objective: A level of 95% adherence to antiretroviral therapy (ART) has been found to benefit HIV/AIDS patients. Low adherence may lead to treatment failure, and may subsequently result in treatment change. The main objective of this study was to evaluate the effect of ART adherence on treatment change Methods: Data were extracted from available written clinical and pharmacy records, and the electronic database at the Korle-Bu Teaching Hospital. Cases comprised all those (≥15 years) who experienced a first treatment change after starting first-line ART between 1/1/2004 and 31/12/2009. Controls (who did not change treatment) were sampled from the same cohort of ART starters and matched to cases on date ART was started. Adherence was determined using the proportion of days covered (PDC) approach and poor adherence was defined as PDC levels below 95%. Measures of effect were calculated using conditional logistic regression. Results: The 298 cases and 298 matched controls were similar in most baseline characteristics. Among cases 20.1% (60/298) switched to second-line therapy and the rest had treatment substitutions. Overall, 88.9% of controls compared with 79.9% of cases had adherence levels greater than or equal to 95% (p=0.003). After adjusting for possible confounders, an adherence level below 95% was associated with almost four times (ORadj=3.56 (95% CI 1.60 to 7.88)) the likelihood of having a treatment change. Conclusion: This study showed that insufficient ART adherence was associated with about four times the likelihood of treatment change. Policy makers must partner researchers to engage patients more often, to unravel the causes of non-adherence, and make the necessary interventions for patients to achieve maximum benefits from dispensed medicines.

Background Among the most vulnerable people in society are children and this is especially so in their access to health care Off-label prescription of paediatric medicines is known to be associated with safety outcomes some of which may be serious. This study identifies frequently prescribed children’s medicines that are not readily available in Ghana and are prepared extemporaneously. Method All prescriptions for extemporaneous oral preparations for children presented to the local production unit of the Korle-Bu Teaching Hospital from November, 2013 were eligible for the study. Information from such prescriptions was recorded in a systematic format. Presence of the prescribed medicine on the World Health Organization Children’s Medicine List was ascertained in addition to the anatomical and therapeutic classification code. The registration of the prescribed medicine for paediatric use by the Food and Drugs Authority, Ghana was also checked. Descriptive statistics of the data was presented. Results In all 622 prescriptions for 35 different paediatric formulations were served. Prescriptions from several health facilities including government hospitals (6.6 %, N = 622), private hospitals (2.4 %, N = 622) and the University of Ghana hospital (1.1 %, N = 622) were all honoured. Some of the prescribed medicines (Baclofen, Clonazepam, Hydroxyurea and Lamotrigine) were neither on the World Health Organization Children’s Medicine list nor registered with the Food and Drugs Authority, Ghana. Most prescribed medicines (88.6 %, N = 35) were for non-communicable diseases. Conclusion Paediatric prescriptions including off-label medicines are prescribed and formulated extemporaneously in this setting. Steps should be taken to improve access and monitor benefit-risk profiles of paediatric medicines in order to improve treatment outcomes among children.