Girma Gutema - Academia.edu (original) (raw)

Papers by Girma Gutema

medRxiv (Cold Spring Harbor Laboratory), Feb 5, 2021

implement strategies outlined in the national strategic plan, despite some challenges. This has r... more implement strategies outlined in the national strategic plan, despite some challenges. This has resulted in restricting the use of antibiotics thereby maintaining favorable environment to promote their prudent use. Conclusion: By and large, the findings affirm that the Norwegian healthcare system is characterized by a conservative use of antibiotics that has a positive impact on resistance containment. The authorities need to work further on issues such as adherence to guidelines and infection prevention/control so as to further maximize the prevailing good conditions.

Background Oromia is the largest national regional state in the Ethiopian federation. It covers o... more Background Oromia is the largest national regional state in the Ethiopian federation. It covers over a third of the country’s landmass. In terms of shear geography, Oromia is about the size of the sovereign European state of Germany. Demographically, Oromia closely matches with Poland among other European countries. Since early 2019, there are actively ongoing armed conflicts in Oromia damaging the public health infrastructure.Objective The objective of this study is to assess and document the impacts of armed conflicts in Oromia on the public health infrastructure.Method The study is a quantitative review of administrative records and reports employing a qualitative analytical prism.Results Oromia has 22 administrative zones of which 11 (50%) host 142 sites sheltering about 1.5 million Internally Displaced Persons (IDPs). A total of 1072 public healthcare facilities sustained attacks in areas of armed conflicts across Oromia. Among the 159 motor vehicles attacked (ambulances, distr...

The authors have requested that this preprint be withdrawn due to erroneous posting.

Cureus

Background The processes involving resistance development against antibiotics have historically b... more Background The processes involving resistance development against antibiotics have historically been part of the Darwinian evolution. However, the increasing use of antibiotics in modern medicine has intensified the selection pressures with an acute gear-up, rather than as part of this very slow evolutionary process that selects for enhanced fitness for survival. Two major recommendations have been made in the past to tackle this challenge: (1) incentivizing the pharmaceutical industry to invest more in research and development endeavors so that they come up with new antibiotics, and (2) implementing antimicrobial stewardship programs in healthcare systems. Methodology In this study, the third and emerging approach, namely, documenting antibiotic footprint, was employed as a communication tool that targets individual consumers of antibiotics. Data obtained from the Ethiopian Pharmaceutical Supply Agency were curated to systematically compile antibiotic consumption at each of the agency's regional hubs. The exact geospatial locations of the hubs were generated and synchronized to depict the size of the antibiotic footprint infograph as proportional to the antibiotic consumption data at each hub. Moreover, the cumulative and per-capita consumption of these antibiotics at the country level (overall antibiotic footprint) were calculated by including estimated data for the livestock sector. Results A total of 698.2 tons of antibiotics were used in Ethiopia in 2018, and the per-capita consumption of antibiotics was 5.8 g per person. Extended-spectrum (J01CA) and beta-lactamase-resistant penicillins (J01CF) were the most commonly utilized classes of antibiotics which accounted for, respectively, 38.3% and 20.8% of all antibiotics used in the country's public health sector. Hubs in Addis Ababa (14%) and Hawassa (12%) topped the overall antibiotic consumption in the country. Contrarily, hubs in Gambella and Semera received relatively smaller quantities of antibiotics, with totals of 4.8 tons (0.9%) and 10.2 tons (1.9%), respectively. Conclusions This study shows that the newly emerging concept of the antibiotic footprint is a simple and suitable tool for public health policy communications targeting individual consumers of antibiotics. If implemented judicially, the concept of the antibiotic footprint has a huge potential to support global scientific efforts and collaborations in setting standards that help to reduce the overuse and misuse of antibiotics in the future.

Additional file 1: Table S1. Availability of the commonly prescribed antibiotics in the private a... more Additional file 1: Table S1. Availability of the commonly prescribed antibiotics in the private and public pharmacies around TASH, Addis Ababa (April 2015).

The availability of numerous brands of co-trimoxazole in our local market today places health pro... more The availability of numerous brands of co-trimoxazole in our local market today places health professionals in a difficult situation of choice of a suitable brand or the possibility of alternative use. The aim of the study was to predict the physicochemical and in-vitro bioavailability equivalence of six brands of co-trimoxazole tablets marketed in Tigray, Ethiopia. Weight uniformity, friability, hardness, disintegration, assay and dissolution profile were performed using methods described in British and United State Pharmacopoeias and all these tablets passed compendial specifications. Statistical analysis (ANOVA) of thickness, weight and disintegration data showed a significant difference (p<0.05) between generic and innovator brands. Similarly, a significant difference was found between the mean % release of trimethoprim (p<0.0002) and sulfamethoxazole (p<0.0001) of the generic and innovator brands at the pharmacopoeia specified time, 60 min. These statistical results in...

Artemisinin and its derivatives have successfully been used in treatment of falciparum malaria in... more Artemisinin and its derivatives have successfully been used in treatment of falciparum malaria infections in various parts of the world. More importantly, they have proved effective against strains resistant to conventional antimalarials such as chloroquine and mefloquine in those parts of the world where malaria is endemic. Only one clinically relevant artemisinin-resistant human malaria has been reported recently in South East Asia, although there are reports published on development of the rodent malaria parasite strains resistant to the drug earlier. This article reviews the implications of combination therapy on the pharmacokinetics and hence clinical efficacy of Artemisinins using relevant and published papers. It gives detailed account on the general chemistry and mechanism of action of the parent compound Artemisinin before considering its pharmacokinetics. Artemisinin-based combination treatments (ACTs) are now generally accepted as the best treatment options for uncomplica...

Essential medicines (EMs) save lives and improve health. But still, lack of access to EMs remains... more Essential medicines (EMs) save lives and improve health. But still, lack of access to EMs remains to be one of the most serious global public health problems. This study evaluates patient price, availability and affordability of essential medicines in Mekelle, and compares the private and public health care facilities with respect to these parameters. A cross-sectional prospective survey was conducted using WHO/HAI standardized methods for surveying medicines’ prices, availability, affordability, and price components in low-income countries with the necessary adjustments in line with local situations. The patient price of lowest price generic (LPGs) products in private pharmacies and drug shops were 1.90 and 1.62 times patient price in public Health care facilities (PHCFs), respectively. The overall % availability of the selected EMs in PHCFs, private drug shops (PDSs) and private pharmacies (PPs) were found to be 81.25%, 86.25% and 90%, respectively. There were no innovator brand p...

Objective In this study, we aim to synthesize some evidence on the impacts that COVID-19 is havin... more Objective In this study, we aim to synthesize some evidence on the impacts that COVID-19 is having on the epidemiology of Antimicrobial Resistance (AMR) in Africa since it was declared global pandemic by WHO in March 2020. Methodology A scoping review was undertaken by collecting and curating relevant resources from peer-reviewed articles and also from the gray literature. Mixed approaches of extracting data (qualitative and quantitative) were employed in synthesizing evidence, as suggested by Health Evidence Network (HEN). Findings A model constructed based on the synthesis of early evidences available on the effects of factors linked to COVID-19 in impacting the evolution of AMR in Africa predicted that, in cumulative terms, those factors favoring the evolution of AMR outpace those disfavoring it by no less than three folds. Conclusion COVID-19 is fueling the evolution of AMR almost unhindered in Africa. Due recognition of this crisis, concerted efforts for resource mobilization a...

International Journal of Pharmaceutical Sciences and Nanotechnology, 2013

The availability of multisource generic brands of amoxicillin in the market today places health p... more The availability of multisource generic brands of amoxicillin in the market today places health professionals and patients in a difficult situation about the choice of a suitable product among numerous generic brands. The purpose of this study was to estimate the bioequivalence of amoxicillin capsules marketed in Ethiopia using in vitro tests in order to determine their interchangeability. The in vitro dissolution study was carried out on the six brands of amoxicillin capsules according to USP guidelines. To compare the dissolution profiles, a difference factor (f1), similarity factor (f2), dissolution efficiency (DE) and statistical methods were employed. Results have shown significant differences in the dissolution profiles of the brands based on the statistical analysis (p<0.0001). Pair-wise comparisons using Dunnett’s test indicated that the innovator brand has a significantly faster dissolution than the generic brands, except brand D. According to f1, f2 and DE calculations,...

BMC Research Notes, 2018

Objective: In national drug policies of many countries, ensuring availability and affordability o... more Objective: In national drug policies of many countries, ensuring availability and affordability of essential medicines is indicated among the major policy objectives. To achieve the objectives, countries with low and middle income compile such medicines into NEMLs. This study aims to determine availability and affordability of commonly prescribed antibiotics at a tertiary hospital in Ethiopia by assessing (in private and public pharmacies) 13 antibiotics constituting DU90% at the hospital. Results: Availability of the antibiotics in the private and public pharmacies was 92.3% and 98.5%, respectively. Average MPRs for the antibiotics were 4.1 and 2.7, respectively, in the private and public pharmacies. The days' wages (in median prices) ranged from 0.2 for treating acute diarrhea with doxycycline to 415.8 for treating HAP in public pharmacies. Costs of a single day treatment with antibiotics purchased from the public pharmacies ranged from USD 0.1 for acute diarrhea to USD 29.7 for HAP. For the private pharmacies, the range was from USD 0.1 for toxoplasmosis to USD 54.9 for HAP. This study showed that treatments of commonly diagnosed infectious conditions at TASH remain unaffordable according to the WHO/HAI criteria.

BMC Health Services Research, 2018

Background: This project aims to study the use of antibiotics in three clinical wards in the larg... more Background: This project aims to study the use of antibiotics in three clinical wards in the largest tertiary teaching hospital in Ethiopia for a period of 1 year. The specific aims were to assess the prevalence of patients on antibiotics, quantify the antibiotic consumption and identify the main indications of use. Method: The material was all the medical charts (n = 2231) retrieved from three clinical wards (internal medicine, gynecology/obstetrics and surgery) in Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa between September 2013 and September 2014. Data collection was performed manually by four pharmacists. Results: Each medical chart represented one patient. About 60% of the patients were admitted to internal medicine, 20% to each of the other two wards. The number of bed days (BD) was on average 16.5. Antibiotics for systemic use were prescribed to 73.7% of the patients (on average: 2.1 antibiotics/patient) of whom 86.6% got a third or fourth generation cephalosporin (mainly ceftriaxone). The average consumption of antibiotics was 81.6 DDD/100BD, varying from 91.8 in internal medicine and 71.6 in surgery to 47.6 in gynecology/obstetrics. The five most frequently occurring infections were pneumonia (26.6%), surgical site infections (21.5%), neutropenic fever (6.9%), sepsis (6.4%) and urinary tract infections (4.7%). About one fourth of the prescriptions were for prophylactic purposes. Hospital acquired infections occurred in 23.5% of the patients (353 cases of surgical site infection). The prescribing was based on empirical treatment and sensitivity testing was reported in only 3.8% of the cases. Conclusions: In the present study from three wards in the largest tertiary teaching hospital in Ethiopia, three out of four patients were prescribed antibiotics, primarily empirically. The mean antibiotic consumption was 81.6 DDD/100BD. Surgical site infections constituted a large burden of the infections treated in the hospital, despite extensive prescribing of prophylaxis. The findings show the need to implement antibiotic stewardship programs in Ethiopian hospitals with focus on rational prescribing, increased sensitivity testing and better procedures to prevent hospital acquired infections.

Clinical Therapeutics, 2017

Clinical Therapeutics e80 Volume 39 Number 8S 24.6% knew they act only against bacterial infectio... more Clinical Therapeutics e80 Volume 39 Number 8S 24.6% knew they act only against bacterial infections. 77.3% identified amoxicillin as an antibiotic. Majority (88.5%) did not know about antimicrobial resistance. 98.1% agreed that they should know whether there is any allergy to the drug before taking it. 88.5% indicated that type and dose of the antibiotic should change based on the age. 95.9% knew that if a woman is going to take an antibiotic, it is important to know whether she is pregnant or lactating. 62.6% agreed that they should know about the liver & kidney function before taking a drug. Conclusions: In this population with high rates of antibiotic selfmedication, the knowledge related to indications for antibiotics and antimicrobial resistance was poor. However the majority of the participants were knowledgeable about the important precautions. Improving public awareness and knowledge is needed to prevent antibiotic misuse.

International …, 2011

... Girma B. Gutema*1, Mussie G. Hadera1, Abrham W. Dagne1, Yohannes A. Mamo2 1Department of Phar... more ... Girma B. Gutema*1, Mussie G. Hadera1, Abrham W. Dagne1, Yohannes A. Mamo2 1Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia 2School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia Research Article ...

Journal of Applied …, 2011

Self-medication is the selection and use of non-prescription medicines by individuals' own initia... more Self-medication is the selection and use of non-prescription medicines by individuals' own initiatives to treat self-recognized illnesses or symptoms. It is practiced significantly worldwide even though its type, extent and reasons for its practice may vary. No data is available on the current status of self-medication practices among health sciences students of Ayder campus of Mekelle University (ACMU). Descriptive cross sectional study was conducted on 307 health sciences students in ACMU from April to June 2011. Pre-tested and validated questionnaires were employed as tools for data collection. Study populations were determined by using two stages stratified random sampling methods. Among 148 reported illnesses prior to the study period, 94(63.50%) were males and 48(36.50%) were females with mean age of 21.5(18-25) years. The prevalence of self-medication in this study was 43.24% with most frequently reported symptom being headache 33(51.56%) followed by cough and common cold 28(44.80%). The two main reasons for self-medication were prior experience 25(39.10%) and mildness of the disease 24(37.50%). Paracetamol 31(48.44%) and NSAIDs 27(42.20%) were the two most frequently consumed medications with drug retail outlets 26(40.63%) as the main source of drugs to practice self-medication. Self-decisions 41(64.00%) followed by family/friends 20(31.65%) were the two most frequently reported source of drug information for self-medication in this study. More than half of the respondents disagreed with the practice of self-medication in the present study. Moreover there were statistically significant differences between respondents who reported practicing self-medication based on gender, specific field of study and study year.

PLOS ONE, 2021

Studies on antibiotic utilization trends are invaluable because they offer data for evaluation of... more Studies on antibiotic utilization trends are invaluable because they offer data for evaluation of impacts of antimicrobial stewardship policies. Such studies help determine correlations between the use of specific antibiotic classes and trends in emergence of resistance (resistance-epidemiology). This study aims to quantify the consumption systemic antibiotics (J01)—in defined daily doses (DDD) per 1000 inhabitants per day (DID)—in Ethiopia’s public healthcare sector (2016–2020). By so doing, it attempts to capture the extent of population exposure to antibiotics in the country. Data were also compared with those from Norway to establish rough estimate of the country’s status vis-à-vis some globally acknowledged better practices with regard to optimal use of antibiotics. Raw data obtained from registers of Ethiopian Pharmaceutical Supply Agency were converted into DDD, per the standard methodology recommended by WHO. To control for population size, antibiotics consumption data were ...

In this study, we aim to synthesize some evidence on the impacts that coronavirus disease 2019 (C... more In this study, we aim to synthesize some evidence on the impacts that coronavirus disease 2019 (COVID-19) is having on the epidemiology of antimicrobial resistance (AMR) in Africa since it was declared a global pandemic by the WHO in March 2020. A scoping review was undertaken by collecting and curating relevant resources from peer-reviewed articles and also from the gray literature. Mixed approaches of extracting data (qualitative and quantitative) were employed in synthesizing evidence, as suggested by the Health Evidence Network. A model constructed based on the synthesis of early evidence available on the effects of factors linked to COVID-19 in impacting the evolution of AMR in Africa predicted that, in cumulative terms, those factors favoring the evolution of AMR outpace those disfavoring it by no less than three folds. COVID-19 is likely fueling the evolution of AMR almost unhindered in Africa. Due to the recognition of this crisis, concerted efforts for resource mobilization and global cooperation are needed to tackle it.