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International Network for the Rational

Use of Drugs
Network for the Rational Use of Drugs

Newsletter of the International Network for the Rational Use of Drugs

January 2011

Volume 21, Number 1

The World Medicines Situation Report 2010

Richard Laing, Edelisa Carandang,
and Kathleen Hurst

In 1988 and again in 2004, the World Health

Organization (WHO) published reports on the
World Medicines Situation. The first edition
was brief and described the beginning of the
essential medicines movement. In 2004, a more
comprehensive report was issued that contained
nine chapters that reviewed all aspects of
medicines in both developed and developing
In 2009, WHO decided to produce a new World
Medicines Situation Report in 2010. As times have
changed, the report will be released electronically
in a series of individual chapters, with the first
five chapters being released in December 2010.
This time, there will be 24 chapters, each written
by different authors and covering topics related

to production and consumption, innovation,

regulation, and safety. The report will include
chapters about medicines selection, procurement,
supply management, rational use, financing, and
pricing. There are also cross-cutting chapters
related to household medicines use, access and
human rights, good governance, human resources,
and national medicines policies.
Identifying lead authors (who frequently created
teams to work with them) was the first step in
producing these chapters. The first draft was
extensively reviewed by members of various WHO
expert panels, WHO country staff, academics, and
nongovernmental organization staff who work
on essential medicines issues. IMS Health staff
produced two chapters and provided data for others.
The first five chapters to be released on the WHO
Medicines web site in December 2010 will be
Rational Use of Medicines
Good Governance for the
Pharmaceutical Sector
Prices, Availability, and Affordability
Access to Controlled Medicines
Traditional Medicine: Global
Situation, Issues, and Challenges
This process produced some interesting
findings. For example, according to
the National Health Accounts for 2005
and 2006, 18 percent of the worlds

In This Issue
INRUD Group Reports..................................................................................................................3
Comments on Recent Articles..............................................................................................20
Recent Articles..........................................................................................................................28

population living in high-income countries

consumed 80.3 percent of the worlds medicines by
value and the 10.6 percent of the worlds population
living in low-income countries consumed 0.5
percent of the
worlds medicines
by value.
In terms of
volumes, the
situation was
less extreme. In
the 67 countries
where IMS Health
collected data,
they estimated
that 55 percent
of the volume of
medicines was
consumed in highincome countries
whereas 8 percent of the volume was consumed in
low-income countries.

INRUD News, January 2011

When looking at the use of medicines, the new

edition reveals that, although many of the INRUD
indicators have not changed much since the last
report, adherence to treatment guidelines has
increased to close
to 50 percent and
the rate of injection
use has fallen. The
report includes short
case studies that
identify examples
of successful
projects or national
programs. Authors
do not provide
for what countries
should do, but
provide substantial
information on the
national choices that can be made. The main
target audience for the new edition is senior health
policy-makers, primarily those in developing and
transitional countries.

group reports
Boston Core Group
Dr. Dennis Ross-Degnan

The INRUD/Boston group consists of faculty and

staff members from the World Health Organization
(WHO) Collaborating Center in Pharmaceutical
Policy. The center is involved in a wide range of
teaching and research activities related to access to
and use of medicines. Its biweekly pharmaceutical
policy research seminar in the Department of
Population Medicine focuses on methods for
pharmaceutical policy research and international
and domestic medicine policy issues. Presentation
slides and background readings are posted online
and live participation included staff members from
the National Public Health Institute in Mexico
and faculty members from the University of
Nottingham in the UK via video conference.
The INRUD/Boston group continues to be actively
involved in the development of the Third ICIUM
Conference, which will be held in Alexandria,
Egypt, April 1014, 2011. The Scientific Program
Committee is chaired by Dr. Anita Wagner,
with Dr. Catherine Vialle-Valentin coordinating
the work of the groups developing the eight
conference tracks.
Members of the INRUD/Boston group from
the Center for Global Health and Development
and Department of International Health, located
at Boston University, continue their work in
medicines policy and practice. Policies for treating
particular illnesses with appropriate drugs do not
immediately translate into improved access to
those drugs for affected populations. There may be
a disincentive to create new medicines for certain
diseases because a market is lacking. Trade and
intellectual property barriers may impede access.
Distribution channels may lag behind policy
protocol so that medications are understocked at
pharmaciesparticularly in remote regionsor
are too expensive for the people for whom they are
intended. Corruption in the pharmaceutical sector

INRUD News, January 2011

and counterfeit medicines may hamper efforts to

provide quality-assured medicines. In addition,
people may be reluctant to take various drugs for
many reasons, including economic constraints,
cultural taboos, and lack of information. Finally,
sometimes available drugs are taken when they
shouldnt be because of a lack of understanding
about the conditions for which they are
appropriate. Boston Universitys research aims
to improve understanding of these gaps between
policy and practice and recommend actions to
address them.
The pilot phase of the Medicines Transparency
Alliance (MeTA) is now completed. Both MeTA
tools developed by members of the INRUD/
Boston group and the pharmaceutical sector
baseline assessments of several pilot countries are
now available on line. The INRUD/Boston group
continues to support WHO in its efforts to improve
existing tools that monitor country pharmaceutical
situations and produce meaningful country
The Harvard Fellowship in Pharmaceutical
Policy Research is pleased to begin a program
supported by the China Medical Board targeted at
junior faculty from Chinese universities who are
interested in six months of specialized training
in pharmaceutical policy research. This is a
very timely program, given the importance of
pharmaceutical policy issues in the recent China
health reform. The first two fellows are Yang Li
and Bin Jiang, both from Peking University.
Recent publications by members of the INRUD/
Boston group include
Miller, C. M., Ketlhapile, M., Rybasack-Smith,
H., Rosen, S. Why are Antiretroviral Treatment
Patients Lost to Follow-Up? A Qualitative Study
from South Africa Trop. Med. Int. Health. 2010
Jul; 15 Suppl 1:48-54.
Sabin, L. L., DeSilva, M. B., Hamer, D. H., Xu,
K., Zhang, J., Li, T., Wilson, I. B., Gill, C. J. Using

group reports
Electronic Drug Monitor Feedback to Improve
Adherence to Antiretroviral Therapy among HIVPositive Patients in China. AIDS Behav. 2009 Sep;
Wagner, A. K., Graves, A. J., Reiss, S., LeCates,
R., Zhang, F., Ross-Degnan, D. Access to Care and
Medicines, Burden of Health Care Expenditures,
and Risk Protection: Results from the World
Health Survey. Health Policy 2010. DOI:
Yeboah-Antwi, K., Pilingana, P., Macleod,
W. B., Semrau, K., Siazeele, K., Kalesha, P.,
Hamainza, B., Seidenberg, P., Mazimba, A., Sabin,
L., Kamholz, K., Thea, D. M., Hamer, D. H.
Community Case Management of Fever Due to
Malaria and Pneumonia in Children Under Five in
Zambia: A Cluster Randomized Controlled Trial.
PLoS Med. 2010 Sep; 7(9).
Faden, L., Vialle-Valentin, C., Ross-Degnan, D.,
Wagner, A. K. Active Pharmaceutical Management
Strategies of Health Insurance Systems to Improve
Cost-Effective Use of Medicines in Low- and
Middle-Income Countries: A Systematic Review
of Current Evidence. Health Policy (in press).
Carapinha, J., Ross-Degnan, D., Desta, A.,
Wagner, A. K. Health insurance systems in five
Sub-Saharan African countries: Medicines benefits
and data for decision making. Health Policy (in

Ethiopia Core Group

Tenaw Andualem

Patient Education and Empowerment:

Antiretroviral Treatment Adherence Aids in
Medicines safety and adherence are the challenges
in chronic care disease management and were also
supported during the antiretroviral therapy (ART)
determinants assessment in Ethiopia. As one of
the interventions to assist patients to cope with
these difficulties, we developed patient education
and empowerment booklets in Amharic on nine
different fixed-dose-combination first line and
alternative ART regimens.
These materials stress the importance of
adherence, how to recognize side effects and
differentiate from co-morbidity, and how to
manage the side effects of the medicines. At the
end of every side effects management, there is also
space to record their encounters, actions taken,
and improvements as a result of the actions. The
fixed dose combination regimes for which ART
adherence aids were developed are TDF 3TC EFV,

Samples of the cover pages for AZT 3TC NVP and

TDF 3TC EFV regimens

INRUD News, January 2011

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These education aids target not only patients, but
also peer counselors and health care providers
who can use them for individual counseling
and group education sessions. These adherence
aids, along with other interventions that target
improving medicines dispensing practices and
counseling services, form synergy to promote the
rational use of medicines.
Live Rational Medicines Use Intervention
in Ethiopia
A one-hour live rational medicines use
intervention was transmitted through Ethiopian
television on October 30, 2010. The program
was interactive and was repeated on November
4 and 5, 2010. Tenaw Andualem from SPS and
Mengstab W. Aregay from the Food, Medicines,
and Health Care Administration and Control
Authority were interviewed by a journalist and
answered insightful questions from the audience.
E-mail and telephone feedback indicated that
the broadcast was well received. This broadcast
was the latest in a series of radio and print
transmissions on the different aspects of rational
medicines use, such as self-medication, adherence
to treatment, and antimicrobial resistance.

IndiaDelhi Core Group

Dr. Usha Gupta

INRUD/Delhi was involved in the following

activities between May and October 2010.

Two training programs for pharmacists

working at antiretroviral therapy centers in
India were conducted in Delhi on June 11
and 12 and September 7 and 8. The primary
objective of the training program was to test
the training manual developed by the group
and the National AIDS Control Organization
of India (NACO). The pharmacists were
trained in the procurement and rational
use of antiretroviral medicines, drug store
management, patient education, adverse drug
reactions, and drugdrug interactions. Because
the objective of the program was to test the
manual, the participants were evaluated on
their knowledge before and after the training;
it was concluded that the manual met the
educational requirements of the pharmacists.

Mr. R. Parameswar leads a session at the

antiretroviral therapy training program for
pharmacists sponsored by the National AIDS
Control Program, Phase III. Pharmacists and
faculty from NACO also participated.

INRUD News, January 2011

group reports
To measure health-seeking behavior and
medical treatment in the community, a survey
was conducted in different colonies of Delhi
that included households of varying socioeconomic status. The survey by trained field
investigators has since been completed and the
data are being analyzed.
Mr. R. Parameswar, Dr. Usha Gupta, and
Dr. Sangeeta Sharma participated in the
intercountry meeting on promoting rational
use of medicines organized by the World
Health Organization (WHO)/South-East Asia
Regional Office on June 1315. This was a
follow up to the meeting organized by WHO
in December 2007 in Bangkok on the role of
education in the rational use of medicines.
The Government of India has taken a step to
formulate a National Antimicrobial Policy.
A task force was created and Professor
Ranjit Roy Chaudhury and Professor Usha
Gupta were nominated as members. They
participated in a series of meetings to finalize
the policy; the last meeting of the task force
was held on October 20 at the India Habitat
Centre, New Delhi.

IndiaTamil Nadu Core Group

Dr. R. Murali

Seminar on the Rational Use of

Antiretroviral Therapy
SRM Medical College Hospital & Research
Centre organized a seminar on the Rational
Use of Antiretroviral Drugs for the resident
medical officers on October 12, 2010. Dr. S.
Gopalakrishnan, Professor Dr. K. R. John, and
Dr. M. Logaraj acted as resource persons.
The participants had a detailed discussion about
the various issues related to the initiation and
follow up of antiretroviral therapy and on various
factors which may hamper the continuation of
therapy. The session turned out to be highly
interactive with all the interns and faculty actively
participating and giving their inputs based on their
Seminar on Drug Interactions in the
Treatment of Pulmonary Hypertension
In the January 10, 2010, seminar Management
of Pulmonary Hypertension, organized by the
Department of Medicine, Chettinad Hospital and
Research Institute, cardiologist Dr. Chokkalingam
discussed the issues relating to drug interactions
and management of pulmonary hypertension at
the Chettinad health facility.
The discussion ranged from factors affecting
clearance of medicines to the highest recommended
doses that can be prescribed instead of the lowest
necessary dose to maintain control. The whole
session was highly informative and contributed
to the overall knowledge regarding the treatment
protocol of pulmonary hypertension. It was
enthusiastically attended by all the interns and
junior doctors, including some of the final year
M.B.B.S students who didnt hesitate to submit
queries which Dr. Chokkalingam answered.

INRUD News, January 2011

group reports
Health Awareness Program on Drug
Dr. I. Selvaraj conducted a health awareness
program for the railway community in Chennai
division on drug compliance and adequate
monitoring of chronic illnesses like diabetes,
hypertension, and ischemic heart disease. The
program has been conducted at frequent intervals
in various health units in Chennai from April 2009
to September 2010. Glucose levels, lipid levels,
and other basic tests were carried out; health
education, adherence to treatment, regular follow
up, and dietary patterns were emphasized.
Screening programs for diabetes, hypertension,
carcinoma of the breast and cervix, and diesel
contact dermatitis were also conducted at all
Chennai health units during that time period.
In an advocacy program on medicines used for
treatment, medicines side effects were discussed
with the participants.
Training on the Rational Use of Drugs in
Psychiatric Disorders
A training program was organized for the health
care sector on rational use of drugs in psychiatric
disorders on September 14, 2010, at Shollinganallur, Karpakkam Centre, Kanjipuram District.
The program was primarily intended to be a
discussion forum on how to combat irrational drug
use; psychiatric problems are often misdiagnosed
and wrongly treated or not diagnosed at all. Dr.
Ravivarman, Professor of Community Medicine,
conducted the program and stressed the need for
vigilance in the treatment and follow up of patients
for early identification of drug interactions.

Dr. Ravivarman discusses the rational use of

drugs with participants

Training Programs for Health Workers

in the Medical Department at Chennai
Division Railways
In July 2009, a program was held for about 70
pharmacists on material management, inventory
control of medicines, procurement policy, and
quantitative and qualitative drug analysis. Dr. I.
Selvaraj acted as resource person for the training
In September 2009, a program was held for about
50 health inspectors to update them on integrated
vector control and the rational use of antimalarial
On September 29, 2009, a program for medical
officers was held on auditing medical prescriptions.
Dr. Sivakami, Dr. Muralither, and Dr. I. Selvaraj
acted as resource persons.
Mobile Medical Unit to Promote Rational
Drug Use
SRM Medical College Hospital & Research
Centre under SRM University has started a mobile
medical advocacy unit for the Kattankulathur
Block in the Kancheepuram District of Tamil
Nadu. The population of Kattankulathur Block is
274,574. The mobile health clinic will screen for

INRUD News, January 2011

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common illnesses and provide health education to
community leaders, self-help groups, and school
teachers and children on the ill effects caused by
irrational use of drugs.
Epidemiological Study on Mental Health
Morbidity in the Rural Population
An epidemiological study on mental health morbidity and the use of medicines to combat it was
conducted on those members of the population
who registered at the Rural Health Training
Center in Poonjeri. It is considered a baseline
study for further evaluation and assessment of the
prevalence of various mental health disorders and
the common medicines used for treatment.
On this occasion, Dr. Nambi, Professor of
Psychiatry, and Dr. Ravivarman appropriately
organized a program on alcoholism, dementia,
and the rational use of drugs for panchayat
members, self-help groups, the youth wing of
the village, and informal leaders at Poonjeri rural
health centers on September 25, 2010. The aim
of the program was to sensitize nongovernmental
organizations to the problem of taking medicines
without prescriptions.

Introduction of a credit-based continuing

medical education program in Tamil Nadu
Dr. M.G.R. Medical University, in collaboration
with Indian Medical Association Branch in
Tamil Nadu, to offer a course on the rational
use of drugs for medical officers in primary
health centers
Extend an invitation to the new working group
to share information on rational use of drugs
to medical officers in southern India through
the Indian Association of Occupational Health
and Indian Medical Association
Form a consultancy group to advise on
research activities on the rational use of drugs
in southern states in India

Participants attending the community health


Upcoming Events
Public and private medical colleges to organize
training programs on prescription audits, a
registry for drug interactions, and advocacy
programs for the public on rational use of drugs

INRUD News, January 2011

group reports

Kyrgyzstan Core Group Report

Saltanat Moldoisaeva

Almost all members of the INRUD/Kyrgyzstan

Core Group are faculty at the Basic and Clinical
Pharmacology Department (BCPD) of the Kyrgyz
State Medical Academy and provide guidance
on rational use of drugs. In September 2010,
the BCPD and the United Nations Educational,
Scientific, and Cultural Organization (UNESCO)
set up activities for testing UNESCOs Bioethics
Core Curriculum in our academic and post diploma
level programs. BCPD and UNESCO planned to
sign a memorandum of understanding in November
2010. It would be the first test of UNESCOs
Bioethics Core Curriculum in central Asia.
Two of our members, Professor Tilekeeva
Ulangul, head of the BCPD of the Kyrgyz State
Medical Academy, and Professor Zurdinova
Aida, head of BCPD at the Kyrgyz Russian
Slavic University, participated in the 2nd
International Conference QIQUM or Quality
Information for Quality Use of Medicines (http://
The conference was held in Kazan, Russian
Federation. More than 300 specialists from 9
countries took active part in this event. Five years
have passed since the first QIQUM conference.
According to the organizing committees welcome message, pharmacological, pharmaceutical,
and epidemiological studies aimed at improving
pharmacotherapy and individualized drug treatment and personalized medicine have markedly
advanced during this period. Delivering
independent comparative information on
the effects of pharmaceutical interventions
has become more important. Analysis of
the results of randomized, controlled trials;
pharmacoepidemiology studies; and the
practicality of these achievements are being
broadly and critically discussed.

INRUD News, January 2011

An arsenal of new knowledge on misleading

pharmaceutical information and its deleterious
effects on prescribing practices has been
accumulated. The concept of evidence-based
medicineclinical epidemiologyhas influenced
and changed the science and practice of modern
health. The search for and development of new
approaches and new information technologies to
enable the improvement of selection for essential
medicines lists and standard treatments guidelines
is on-going.
New technologies for managing pharmaceutical
knowledge for health practitioners and delivering
health and medicine information to the public are
urgently needed. Information, from basic drug
research to drug effects, safety, and public health
value must find its way to those who need it.
All of these issues of new medicine knowledge
management for the health and welfare of the
people were discussed at the 2nd International
Conference QIQUM.

Professor Tilekeeva Ulangul (right) talks with a

colleague at the QIQUM conference in October

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Moldova Core Group

Dr. Natalia Cebotarenco

Beyond Awareness: Consolidating

Actions for AMR Containment
The antimicrobial resistance (AMR) workshop,
Beyond Awareness: Consolidating Actions for
AMR Containment, was a session for sharing
progress on AMR activities and interventions from
prior workshops and to make further plans for
addressing advocacy and containment issues. The
workshop was attended by 19 participants from
15 countries and took place in Nairobi, Kenya, at
the Heron Hotel, May 57, 2010. The facilitators
were Donna Kusemererwa and Anke Meiburg
from the Ecumenical Pharmaceutical Network
(EPN) and Terry Green from Strengthening
Pharmaceutical Systems (SPS). The workshop
included presentations on AMR, tools, workplan
progress reports, development of new workplans,
and revision of EPN tools.
Workshop objectives
Share experiences and accomplishments since
the November 2008 Moshi workshop, evaluate
progress made, and discuss how to strengthen
Review the approaches and tools established
by EPN and SPS and other EPN partners
Develop approaches and interventions to
galvanize greater action for AMR containment
within the church health system
Develop plans for the secretariat and members
to continue advocacy and containment
Natalia Cebotarenco gave a presentation about the
work of the Coalition for Rational and Safe Use
of Medicines (CoRSUM) in the field of AMR and
the rational use of antibiotics. AMR activities in
CoRSUM are based on World Health Assembly
resolution 58.27 that calls for the containment
of AMR and the promotion of rational use of
antimicrobial agents as a means to improve global

INRUD News, January 2011

health security as well as a recommendation from

the ICIUM conference in 2004 that advocated
the use of children as change agents in improving
community medicine.
Some of the AMR challenges faced in the
CoRSUM network countries include the lack of
both infection control committees and a national
strategy on containment of AMR; counterfeit
medicines; the widespread availability and
inappropriate use of antibiotics by patients and
health care providers; and the widespread use of
antibiotics in veterinary health and agriculture.
In addition, in many countries, little information
exists about the nature of the AMR problem
in their specific context; when information is
available, it is not widely shared and discussed
among stakeholders. The main interventions by
CoRSUM have included school-based projects to
decrease inappropriate antibiotic use and Drugs
and Therapeutics Committee (DTC) training in
Moldova and other newly independent states for
establishing DTCs at health facilities. CoRSUM
is also responsible for translating AMR advocacy
material into Russian.
Lessons learned from the work in Zambia,
Ethiopia, and other countries of Africa
Frame AMR advocacy and containment
as value added in the context of existing
program priorities rather than presenting it
as a separate, vertical, and competing activity
Focus initial information gathering on
identifying key issues and stakeholders to
provide the basis for quickly starting the
national-level process for AMR containment
Identify and work with a suitable local
champion group that can lead the in-country
process and ensure that the champion group
o Includes respected opinion leaders to
legitimize activities and change agents to
carry them out
o Clearly articulates its objectives from the


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o Plays the role of a catalyzing body rather
than being the one and only action body
Use advocacy as a central strategy, but ensure
that it supports the objectives rather than being
an end in itself
Emphasize the continuous nature of the
national AMR containment process
Given the complexity of the AMR problem and
the many interventions that can be implemented, it
is very difficult to determine the best interventions
to use at the country, regional, and local levels.
As many stakeholders as possible need to be
involvedone organization or group cannot take
on this enormous problem alone. Efforts must
be synergized to maximize the effectiveness
of all available resources. Key points for AMR
advocacy and containment programs and
interventions include
Developing a coalition of experts at the local
and regional levels to catalyze the process to
develop successful AMR interventions
Mobilizing local stakeholders around
the common issue of drug resistance for
coordinated and collaborative action and
success of the initiative
Emphasizing that much is already known
about the causes of AMR and what can be
done to contain and prevent it and that there
is no need to wait for more information to act
Focusing on realistic local strategies that
capitalize on existing initiatives and catalyzing
new ones
Emphasizing that the containment and
prevention of AMR adds value to existing
health programs, such as malaria, HIV/AIDS,
and tuberculosis, and is not a competing
vertical program
Participants were equipped with tools for AMR
containment such as Building Local Coalitions
for Containing Drug Resistance: A Guide
(February 2008) published by Management

INRUD News, January 2011

Sciences for Health with support from the US

Agency for International Development. This
guide can help AMR stakeholders organize
a collaborative effort to locally address drug
resistance. The priority interventions outlined in
the World Health Organizations Global Strategy
are coupled with advocacy efforts to achieve the
critical mass of activity needed for a coordinated,
multidisciplinary, coalition-based approach to
containing drug resistance.

Participants of the international workshop

Beyond Awareness: Consolidating Actions for
AMR Containment, Nairobi, Africa, May 5-7, 2010.

Capacity Building Initiative on

Antibiotic Use in Moldova
INRUD/Moldova/CoRSUM continues their work
in the containment of AMR; 2010 activities were
supported by EPN and React.
INRUD/Moldova is a core group of CoRSUM
that links a wide range of health care providers,
medicine policy makers, public interest
nongovernmental and faith-based organizations,
consumers, and networks mainly in Armenia,
Uzbekistan, Moldova, Kazakhstan, Tajikistan,
Ukraine, and Russia to improve the quality of
health, increase access, and improve the rational
and safe use of essential medicines.
Building on early work since 1995 as individual
organizations led to the establishment in 2005


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of the CoRSUM network in recognition of the
key role that collaboration plays when based
on mutual interests and common positions to
improve public health.

Hospital; 22 family doctors, pharmacists, and

district hospital specialists participated. The four
principal facilitators were Dr. N. Cebotarenco,
PhD; Dr. I. Jacobet, MD; Dr. V. Guzun, chief
of the Telenesti District Hospital; and Dr. M.
Cetulean, chief of the Tuberculosis Municipal
Hospital from Chisinau, the capital of Moldova.
The participants decided that the following issues
must be addressed to contain AMR

The brochure Call for Action (by the Ecumenical
Pharmaceutical Network) is available in English,
Russian, French, and Spanish.

Conducted a media campaign

Translated Call to Action: Fight AMR! Save
medicines for our children and Infection
Control Advocacy Tool into Russian and
English and disseminated it to physicians,
pharmacists, medical students, journalists, and
consumers in Moldova and newly independent
Wrote and distributed the pamphlet Antibiotic
Resistance is Threatening our Future
Shared AMR information via a mailing
Conducted a capacity-building workshop
The main objectives of the workshop were to
empower the DTCs in Moldova to play a role in
the rational use of antibiotics and in containing
AMR at the district level and to upgrade the
knowledge and skills of health care workers.
The workshop was successfully conducted
on September, 17, 2010, in Telenesti District

INRUD News, January 2011

The low level of awareness about AMR and

infection control among health care workers
and patients
Poor infection control practices in health
Inappropriate use of antimicrobials in health
Insufficient coverage about AMR in the
national and regional scientific press
They concluded that DTCs should play a key role
in containing AMR.
Conducted an AMR kickoff meeting for
The meeting took place in Chisinau at the Alumni
Centre of the US Embassy on October, 14, 2010.
The meeting was linked via video conference to
Dr. Elena Stepkina at the Public Health School of
Kazakhstan and to Dr. Anahit Ayvazian and Dr.
Lilit Ghazaryan of the Department of Rational Use
of Drugs, Monitoring of Adverse Drug Reactions
and Professional Information Scientific Centre of
Drug and Medical Technology of the Republic of
Armenia. We were very lucky to have two keynote
speakers from the Ukraine, Dr. Andrey Boyko and
Dr. Ekaterina Pushak, Assistant Professors from
the Pharmaceutical Department of the Medical
and Pharmacy University in Lviv.
A major part of the meeting included presentations
from those with experiences at the global and
regional levelsBender, Telenesti, Tiraspol,
Bassarabeasca, Strefan Voda, Causeni District


group reports
Hospital, and the Tuberculosis Municipal
Hospital. The presenters shared information about
antibiotic use at the hospital and ambulatory
levels, including problems such as overuse of
antibiotics, lack of antibiotics sensitivity tests,
insufficient capacity of microbiology labs, and
the lack of collaboration between the Ministry
of Agriculture and the Ministry of Health.
The meeting concentrated on how to involve
different stakeholders, such as representatives
of the Ministry of Agriculture, the Ministry of
Education, and the mass media, in the discussion
on the design of the national plan on AMR.

Participants of the Contain Antimicrobial Resistance

meeting from Moldova, Ukraine, Armenia, and
Tiraspol held October 14, 2010, at the Alumni
Centre at the US Embassy, Chisinau, Moldova.

Participants underscored that the instability of the

political situation in Moldova threatens to disrupt
the efforts to establish the national committee on
the containment of AMR. Therefore, the activity
should be continued with hospitals, DTCs, and
Centers for Disease Control and Prevention at the
regional level.
Supported European Antibiotic Awareness
Day, November 18, 2010
Recognizing the importance of infection control
and the contributions to AMR in hospitals,
CoRSUM carried out a campaign to increase
awareness about proper infection control and
antibiotic use within hospitals in Moldova and
other newly independent states as part of the
European Antibiotic Awareness Day activities.

INRUD News, January 2011

Text from the Pamphlet Entitled Antibiotic

Resistance is Threatening Our Future
In the 1940s, the widespread availability of
penicillin and the subsequent discovery of
streptomycin led to a dramatic reduction in illness
and death from infectious diseases. However,
germs have a remarkable ability to mutate and
acquire resistance genes from other organisms and
thereby develop resistance to antimicrobial drugs.
When an antimicrobial drug is used, the selective
pressure exerted by the drug favors the growth
of organisms that are resistant to the drugs
action. Drug-resistant pathogens are a growing
menace to all people, regardless of age, gender, or
socioeconomic background. They endanger people
in affluent, industrial societies, as well as in less
developed nations such as Moldova. In developing
countries, relatively high levels of availability
and consumption have led to disproportionately
higher incidence of inappropriate use and greater
levels of resistance compared to developed
countries (Global Tuberculosis Control 2009:
Epidemiology, Strategy, Financing [WHO Report
2009 WHO/HTM/TB/2009.411]).
Antibiotic resistance creates a threat to global
health, because humanity loses effective antibiotics. Todays reality is that the introduction of
new antibiotics is lagging behind the emergence
of resistance, increasing the risk of serious health
implications. In some cases there are practically
no alternatives when it comes to treatment of
severe infections caused by certain strains of
multi-drug resistant bacteria.
Antimicrobial resistance is rapidly reducing the
effectiveness of these life-saving medicines. This
impacts all infectious diseases including HIV, TB,
malaria and pneumonia. According to new data
from the Fourth Global Report Anti-Tuberculosis
Drug Resistance in the World (WHO/HTM/
TB/2008.394, Geneva, 2008), among new cases
of tuberculosis, the prevalence of resistance to


group reports
any anti-TB drug is higher than 40 percent in
Moldova. Multidrug-resistant TB prevalence is
19.4 percent. Furthermore, it is known that the
incentives are weak to develop new antibiotics
to address the global problem of drug resistance.
Despite the urgent need for new anti-TB drugs,
according to the Stop TB Partnerships Global
Plan to Stop TB 20062015, the first new anti-TB
drug is not expected until 2015.

coherent policy framework that will address the

recent challenges to health and health equity and
develop cost-effective policies and strategies to
respond to them in an effective way.
Some of the most pressing priorities addressed at
this meeting

The European region has been polio-free since

2002, but in April 2010,171 cases of acute
flaccid paralysis were reported by the Ministry
The problem of antibiotic resistance is threatening
of Health of the Republic of Tajikistan; 32 of
our future. The current generation has the ethical
these cases were confirmed as wild poliovirus
obligation to reverse this process. Concrete actions
type 1 and results are pending for the rest.
on combating AMR require the commitment of
There have been 12 deaths.
governments and politicians to changes in social
Multidrug-resistant and extensively drugand individual behaviors.
resistant tuberculosis (M/XDR-TB) is a global
health threat in Europe. Out of the 27 highParticipation in the 60th Session of the
burden MDR-TB countries that collectively
WHO Regional Committee for Europe
account for 85 percent of the cases globally,
the first 15 are in the European region.
The 60th session of WHOs Regional Committee
WHO Euro is in the process of preparing a
for Europe was held in Moscow, Russian
comprehensive action plan to fight M/XDRFederation, September 1316, 2010, with
TB in 20102015.
representatives from 52 countries participating.
Antimicrobial resistance (AMR) is another
Also present were representatives of the Joint
global threat and will be the topic of the next
United Nations (UN) Programme on HIV/AIDS,
World Health Day in 2011. The European
the UN Childrens Fund, the UN Development
region has started to
Programme, the
prepare a regional AMR
UN Economic
It is not difficult to make microbes resistant to
strategy. A coordinated
Commission for
penicillin...The time may come when penicillin can
be bought by anyone in the shops. Then there is the and strong international
Europe, the UN
danger that the ignorant man may easily under dose response in surveillance
himself and by exposing his microbes to non-lethal
and research, the
Programme, the UN
quantities of the drug make them resistant.
prudent use of
Population Fund,
antibiotics, and effective
Alexander Flemings
the World Bank, the
programs against
Council of Europe,
the European Union,
infections are needed.
the Organisation for Economic Co-operation

major public
and Development, and other nongovernmental
health challenge, with rapidly increasing
transmission in many European countries.
Health 2020, a new European health policy, will
Eastern Europe now has the fastest-growing
be developed through a participatory process
HIV epidemic in the world and is the only
involving member states and other partners. The
region where the annual number of reported
objective is to ensure an evidence-based and
cases of HIV is still increasing.
INRUD News, January 2011


group reports
At the round table, Dr. N. Cebotarenco, on
behalf of the World Council of Churches, made
the presentation The Role of NGOs, FaithBased, and Other Civil Society Organizations in
Support of the Global Strategy for Womens and
Childrens Health. TheGlobal Strategy setsout
key areas in which urgent action is needed to
address maternal andinfant mortality and improve
the health of women and children. The Global
Strategys objectives, guiding principles, and
recommendations provide a good starting point
around whichcivil society organizationscan
be mobilized to press for stronger action on
womens and childrens health issues and to meet
or exceed the minimum targets established by the
Millennium Development framework.

Participants of the 60th Session of the WHO

Regional Committee for Europe held September
13-16, 2010, at Moscow, Russia.

INRUD News, January 2011

Nepal Core Group

Professor Kumud K. Kafle

INRUD/Nepal conducted training of trainers
for Monitoring and Supervision for Drug
Use and Management, organized by the
Department of Health Services, Ministry of
Health, for health workers of all 75 districts of
Nepal in April 2010
Participated in the first district-level peergroup discussion in the Kailali district in May
2010 that consisted of presentations on the
prescribing practices and availability of drugs;
presentations were made by those in charge
of the health facilities, and the discussion was
conducted by the district health officer
In October 2010, participated in the workshop
Dashboard to Decision Making on distribution of
long-lasting insecticide nets and behavior-change
communication in the districts with malaria
programs supported by The Global Fund to Fight
AIDS, Tuberculosis and Malaria.
Member Achievements
Dr. K. K. Kafle presented a protocol entitled
Rational Use of Medicines: Protocol for
Situation Analysis at National, Institutional, and
Community Levels at the intercountry meeting
Promoting Rational Use of Medicines (SouthEast Asia Regional Office/WHO, July 2010)
Dr. K. K. Kafle gave a talk entitled Pharmacovigilance in Nepal: the Past, the Present, and
the Future at the Indo-Nepal Symposium on
Synergising Pharmacovigilance in South Asian
Countries (B. P. Koirala Institute of Health
Sciences, Dharan, Nepal, September 2010)


group reports
Impact of INRUD/Nepal

Nigeria Core Group

INRUD/Nepal is a partner for the program

Monitoring and Supervision for Drug Use and
Management organized by the Management
Division, Department of Health Services,
Ministry of Health
INRUD/Nepal conducted a training course for
drug sellers on malaria prevention, diagnosis,
and treatment for two years (2009 and 2010)
as a sub-recipient of The Global Fund

Professor A. F. B. Mabadeje

The general meeting of INRUD Nigeria took

place in Lagos on September 29, 2010, and was
well attended by members from various parts of
the country. The meeting was chaired by Professor
A. O. Isah, who discussed plans for ICIUM 2011
to ensure effective participation from Nigeria.
Professor Isah also discussed implementation
strategies for INRUD Nigeria activities for 2011.
Dr. Oreagba and his team are carrying out
active surveillance of antiretrovirals at the
Lagos University Teaching Hospital HIV Clinic,
which is a follow up to an earlier retrospective
pharmacoepidemiological study of antiretrovirals
in the same clinic.
Mrs. Lawal, chairperson of the Drug Information
Centre of the Association of Community
Pharmacists of Nigeria, conducted atraining
program to acquaint secondary school students of
Trinity International College, Ofada, Ogun State,
Southwest Nigeria, on the rational use of medicines.
Dr. Akoria conducted a city-wide survey of
randomly selected households in Benin City, in
addition to a survey of the antenatal clinics of the
state-run Central Hospital and the University of
Benin Teaching Hospital. The aim was to assess
the uptake of insecticide-treated bed nets for
the prevention of malaria and artemisinin-based
combination therapies for the treatment of malaria
among household members, children under age
five, and pregnant women. The study began in
December 2009 and was completed in June 2010.
Conferences and Workshops
Dr. Aina attended the 8th Annual Conference for
the International Society for the Prevention of

INRUD News, January 2011


group reports
Tobacco-Induced Diseases in Boston, MA, USA,
September 29 to October 1, 2010. She presented
a papertitled Knowledge of Tobacco Policy and
Willingness to be Involved in Tobacco Cessation
Among Pharmacy Students at Niger Delta
University, South, South Nigeria.

Uzochukwu, B. S. C.; Onwujekwe, O. E.; Uguru,

N. P.; Ughasoro, M.D.; Ezeoke, O. P. (2010);
Willingness to Pay for Rapid Diagnostic Tests
for the Diagnosis and Treatment of Malaria
in Southeast Nigeria: Ex Post and Ex Ante.
International Journal for Equity in Health, 9:1

Professor Isah and a team of INRUD members

(Drs. Oreagba, Olowofela, Ogunleye, Ogundele,
Enwere, Pharm Adekoya, Garnet, Umar, and
others) attended the 16th World Congress of Basic
and Clinical Pharmacology held in Copenhagen,
Denmark, July 1723, 2010. Professor Isah
chaired a session and presented a paper titled
Specific Features of Medicines Safety and
Pharmacovigilance in Africa.

Oreagba, I. A.; Ogunleye, O. J.; Olayemi, S. O.

(2010); The Knowledge, Perceptions, and Practice
of Pharmacovigilance amongst Community
Pharmacists in Lagos State, Southwest Nigeria.
Pharmacoepidemiology and Drug Safety.
September 15 2010 (online early view).

Drs. Akoria and Oreagba attended the 26th

International Conference on Pharmacoepidemiology and Therapeutic Risk Management in
Brighton, UK, August 1922, 2010. The posters
they presented were titled Effects of an Educational
Intervention on the Prescribing of Antimalarial
Medicines in a Nigerian Teaching Hospital (Dr.
Akoria) and Pharmacoepidemiological Study
of Antiretrovirals in Lagos University Teaching
Hospital South West Nigeria (Dr. Oreagba).
Drs. Opara, Aina, and Oreagba served as resource
persons at the West African Postgraduate College
of Pharmacists Update lectures, which took place
October 58, 2010.
Recent Publications
Uzochukwu, B. S. C.; Chiegboka, L. O.;
Enwereuzo, C.; Nwosu, U.; Okorafor, D.;
Onwujekwe, O. E.; Uguru, N. P.; Sibeudu, F. T.;
Ezeoke, O. P. (2010); Examining Appropriate
Diagnosis and Treatment of Malaria: Availability
and Use of Rapid Diagnostic Tests and
Artemisinin-Based Combination Therapy in
Public and Private Health Facilities in Southeast
Nigeria. BMC Public Health, 10:486

INRUD News, January 2011

Busari, A.; Olayemi, S.; Oreagba, I.; Alabidun,

A. (2010); Educational Intervention as a Strategy
for Improving Blood Pressure Status of Market
Women in Lagos, Nigeria. The Internet Journal of
Health, 11(1)
Appointments and Awards
Professor John Ohaju-Obodo has been elected
Provost of the College of Medical Sciences, Delta
State University, Abraka.
Dr. S. O. Olayemi was appointed Acting Head
of the Department of Pharmacology University of
Lagos, Lagos.
Dr. O. A. Abosede was appointed Chairman of the
Lagos State Primary Health Care Board, Lagos.
Dr. Bukky Dada successfully defended her PhD
thesis titled Access, Quality, and Use of Generic
Drugs in Health Facilities in Lagos State in
September 2010.
The members of INRUD Nigeria sympathize with
Dr. Ogori Taylor and family on the death of her


group reports
Improving quality of malaria
treatment services: assessing
inequities in consumers
perceptions and providers
behaviour in Nigeria
*Obinna Onwujekwe1,2, Eric Obikeze1,2, Benjamin
Uzochukwu1,2,3, Ijeoma Okoronkwo1,4 and
Ogochukwu C. Onwujekwe5

Department of Health Administration and

Management; 2Health Policy Research Group,
Department of Pharmacology and Therapeutics;
Department of Community Medicine; and
Department of Nursing Sciences, College of
Medicine, University of Nigeria, Enugu-Campus,
Nigeria; and 5Department of Pharmacy, University
of Nigeria Teaching Hospital, Ituku-Ozalla,
Enugu, Nigeria

International Journal for Equity in Health 2010,

The electronic version of this article is the
complete one and can be found online at
2010 Onwujekwe et al; licensee BioMed Central
Ltd. This is an Open Access article distributed
under the terms of the Creative Commons
Attribution License which permits unrestricted
use, distribution, and reproduction in any medium,
provided the original work is properly cited. (http://

Methods: Questionnaire was used to interview

randomly selected health care providers
about the technical quality of their malaria
treatment services. Exit polls were used to
obtain information about perceived quality from
consumers. A socio-economic status (SES) index
and comparison of data between urban and rural
areas was used to examine socio-economic status
and geographic differences in quality of services.
Results: The lowest technical quality of services
was found from patent medicine dealers. Conversely, public and private hospitals as well as
primary health care centres had the highest quality
of services. Householders were least satisfied with
quality of services of patent medicine dealers and
pharmacy shops and were mostly satisfied with
services rendered by public and private hospitals.
The urbanites were more satisfied with the overall
quality of services than the rural dwellers.
Conclusion: These findings provide areas for
interventions to equitably improve the quality
of malaria treatment services, especially for
patent medicine dealers and pharmacy shops,
that are two of the most common providers of
malaria treatment especially with the current
change of first line drugs from the relatively
inexpensive drugs to the expensive artemisininbased combination therapy, so as to decrease
inappropriate drug prescribing, use, costs and
resistance to artemisinin-based combination

Background: Information about quality of
malaria treatment services of different health care
providers is needed to know how to improve the
treatment of malaria since inappropriate service
provision leads to increased burden of malaria.
Hence, the study determined the technical and
perceived quality of malaria treatment services
of different types of providers in three urban and
three rural areas in southeast Nigeria.

INRUD News, January 2011


group reports
Most Mothers Lack the Knowledge
on How to Prepare and Give Doses
of Ampicillin-Cloxacillin Dry Syrup
to their Babies
Moses Iorngurum

Pediatric researchers at the University of

Lagos, Nigeria, have observed for the first time
(worldwide) that too few mothers in an urban
setting demonstrated a real capacity to correctly
reconstitute and accurately measure doses of
ampicillin-cloxacillin dry syrup for their babies
without assistance. They investigated mothers
knowledge and practice of reconstitution, storage,
measurement of the dose, and use of the broadspectrum antibiotic formulation often used to
treat common bacterial infections in children for
decades in many countries.

mothers to administer an increasing number of

pediatric oral suspensions to their children.
Moses Iorngurum was the principal investigator
and is a pioneer in neonatal and pediatric
clinical pharmacy in Nigeria. He is one of the
lead consultants to the Ministry of Health for
development of a pharmacovigilance policy for
Nigeria. He worked with O. Ogunbanjo (one of
his students) and with Prof. Mrs. Edna Iroha,
consultant pediatrician and neonatologist. This
research was presented at the 14th Annual
Neonatal and Paediatric Pharmacists Group
( in Birmingham,
UK, in 2008 (Arch. Dis. Child. 2009, 94:e2;

The 107 mothers were provided ampicillincloxacillin dry syrup and all other requirements
for reconstitution including a suitable work area
at no cost. Their knowledge and skills were
simultaneously assessed and corrected while
they each reconstituted the syrup and measured
one dose the way they would normally do at
home. Only 22 (20.5 percent) knew the crucial
importance of viewing the lower meniscus of
water at eye level to obtain the correct volumes
of their babies syrup. Before administering the
reconstituted syrup to their babies, 24 (22.4 percent) did not shake the bottle immediately before
measuring the dose volumes, which implied that
their doses would be incorrect. These and other
findings in the study have serious implications for
rational use of medicines in children, particularly
the development of bacterial resistance to
commonly used antibiotics.
Our findings will have far-reaching impact on
health care practice in general and pediatric
formulations and pharmacotherapy around the
world, particularly in health care systems that
absolutely rely on the abilities of uneducated

INRUD News, January 2011


comments on Recent articles

Retail pharmacies and their role in Tanzanias malaria control
program. Soft targets or partners in health?

University of British Columbia, Department of

Anthropology, 2319-6303 North West Marine
Drive, Vancouver, British Columbia, Canada
V6T1Z1; 2University of Dodoma, Dodoma, United
Republic of Tanzania


Social Science and Medicine 2010; 71(3):626-633


The retail sector has been at the center of recent

policy debates concerning its role in malaria
control programs in Africa. This article closely
examines the perspectives of owners and
managers of retail pharmacies and drug shops
in Dar es Salaam toward the dominant public
health discourse and practices surrounding the
deployment of artemisinin-based combination
therapy (ACT) as a way forward in malaria
control. Drawing on fieldwork conducted between
MayAugust 2007, and JulyAugust 2009
involving in-depth interviews and participant
observation in pharmacies and drug shops in Dar
es Salaam, the article describes the social realities
facing people who manage retail pharmacies,

INRUD News, January 2011

the nature of their interactions with customers,

the kinds of antimalarials they sell, and their
perspective on how the new malaria treatment
guidelines have affected their business. Findings
suggest that for most pharmacy owners and
managers, it is business as usual concerning the
sale of conventional antimalarials, with a majority
reporting that the introduction of ACT in public
health facilities had not negatively affected their
business. Implications of the research findings are
examined in the context of proposed interventions
to make pharmacy owners and managers more
socially responsible and adhere to government
health regulations. The article makes a case for
actively involving pharmacy owners and managers
in decision making processes surrounding the
implementation of new treatment guidelines and
training programs that have an impact on their
business, social responsibility, and community
health. In considering regulatory interventions,
health planners must explicitly address the concern
that retail pharmacies fill an important role in the
countrys health care system and that the complex
nexus that drives the global pharmaceutical market
often governs their operations at the local level.


Comments on Recent articles

Pharmacies and drug shops play a key role in the delivery of health care and access to medicines in lowresource settings. The authors of this article argue that the commonly held stereotype of the African drug
shop owner as a greedy profit maximizer who flaunts government regulations and provides illicit access to
prescription-only medications may be too simplistic. The perspectives of this important group of care providers
must be better understood if they are to play a meaningful role in public health, as they are expected to do
in supporting the replacement of malaria monotherapy with ACTs. Using structured in-depth interviews with
80 pharmacists/shop owners in one district in Dar es Salaam and participant observations in 6 shops, the
authors explore the practices of shop owners in stocking antimalarials, servicing the customers who purchase
them, the challenges in maintaining their business, and attitudes towards the government policy shift to ACTs.
The picture they paint is of an environment characterized by a scarcity of jobs, low pay, minimum training,
and high competition for customers. A large percentage of customers come for treatment of fever, often with a
prescription. Although 85 percent of shops did not stock ACTs at the time of the survey, respondents reported
receiving requests for ACTs by customers, usually ones with prescriptions. However, over-the-counter sales
of ACTs were very uncommon, in part due to the low cost, wide availability, and established trust of older
products, and the volume of sales of older therapies had not been affected by the change in the governments
treatment policy. Although ACTs are freely available in government facilities, many customers are reported
to prefer the convenience, choice, and social environment of the drug shop. The authors contend that in the
current economic environment, it is unrealistic to expect shop owners to undergo extensive formal training
before they can manage a retail pharmacy when the rewards are so meager. They argue that regulatory
programs to change retail practices have been ineffective, and that programs to train shop attendants about
malaria guidelines must be tailored to the background characteristics of retailers, their formal training, work
experience, and motivation to continue with their present job given its low compensation. While true, it is
difficult to imagine how any programs to encourage use of ACTs for malaria can be effective without eliciting
corresponding changes in awareness and preference among consumers.

INRUD News, January 2011


Comments on Recent articles

Practical knowledge and perceptions of antibiotics and antibiotic

resistance among drugsellers in Tanzanian private drugstores

BMC Infectious Disease 2010; 10:270


Background: Studies indicate that antibiotics are

sold against regulations and without prescriptions
in private drugstores in rural Tanzania. The
objective of the study was to explore and describe
antibiotics sales and dispensing practices and link
them to drugseller knowledge and perceptions of
antibiotics and antibiotic resistance.
Methods: Exit customers of private drugstores
in eight districts were interviewed about the
drugstore encounter and drugs bought. Drugsellers
filled in a questionnaire with closed- and openended questions about antibiotics and resistance.
Data were analyzed using mixed quantitative and
qualitative methods.
Results: Of 350 interviewed exit customers, 24
percent had bought antibiotics. Thirty percent had
seen a health worker before coming and almost
all of these had a prescription. Antibiotics were
dispensed mainly for cough, stomachache, genital
complaints, and diarrhea but not for malaria or
headache. Dispensed drugs were assessed as
relevant for the symptoms or disease presented
in 83 percent of all cases and 51 percent for
antibiotics specifically. Nonprescribed drugs were

INRUD News, January 2011

assessed as more relevant than prescribed. The

knowledge level of the drugseller was ranked as
high or very high by 75 percent of the respondents.
Seventy-five drugsellers from three districts
participated. Seventy-nine percent stated that
diseases caused by bacteria can be treated with
antibiotics but 24 percent of these also said that
antibiotics can be used for treating viral disease.
Most (85 percent) said that sexually transmitted
infections can be treated with antibiotics while 1
percent said the same about headache, 4 percent
general weakness, and 3 percent all diseases.
Seventy-two percent had heard of antibiotic
resistance. When describing what an antibiotic
is, the respondents used six different kinds
of keywords. Descriptions of what antibiotic
resistance is and how it occurs were quite rational
from a biomedical point of view with some
exceptions. They gave rise to five categories and
one theme: perceiving antibiotic resistance based
on practical experience.
Conclusions: The drugsellers have considerable
practical knowledge of antibiotics and a
perception of antibiotic resistance based on
practical experience. In the process of upgrading
private drugstores and formalizing the sale
of antibiotics from these outlets in resourceconstrained settings, their practical knowledge as
well as their perceptions must be taken into account
in order to attain rational dispensing practices.


Comments on Recent articles

Rather than focusing on failure to comply with government regulation, this article focuses on potential
strengths in retail drug shops in rural Tanzania. Using material from closed-ended questionnaires and openended interviews of licensed drug shop attendants and customers in eight districts, the authors provide
a window into the perceptions and expectations about antibiotic treatment and the problem of antibiotic
resistance in these settings. One interesting finding, which has also been reported in other settings, is that
the drugs dispensed for the two-thirds of customers who did not have a prescription were judged to be
more relevant to the clinical condition for which they were purchased than the ones that were dispensed on
prescription. Consumer self-choice or shop attendant recommendations are often more conservative and less
expensive that private practitioners. However, nearly one in four customers purchased antibiotics and these
purchases were assessed to be less clinically relevant. Despite this, drug sellers displayed a relatively high
level of knowledge about the indications for antibiotics and also about potential problems in their use. This
suggests that there may bein the words of the authorsa practical knowledge base upon which to build
in these shops. Because antibiotics are likely to continue to be dispensed without prescription in drug shops
in rural Tanzania and many other resource-constrained settings, programs to improve provider and consumer
knowledge about when antibiotics are needed and especially about their dangers may help to improve
appropriate use. Although some small-scale interventions in drug shops have been shown to be successful
(see next abstract), their effectiveness should be tested in large-scale programs implemented by ministries of
health or pharmacy associations.

INRUD News, January 2011


Comments on Recent articles

Are interventions for improving the quality of services provided

by specialized drug shops effective in sub-Saharan Africa?
A systematic review of the literature.

International Journal of Quality in Health Care

2010; 22(4):316-323

Purpose: We set out to determine effectiveness of

interventions for improving the quality of services
provided by specialized drug shops in sub-Saharan
Data sources: We searched PubMed, CAB
Abstracts, Web of Science, PsycINFO, and Eldis
databases and websites for organizations such
as WHO and Management Sciences for Health.
Finally, we searched manually through the
references of retrieved articles.

Results of data synthesis: We obtained 10 studies,

all implementing educational interventions. Outcome measures were heterogeneous and included
knowledge, communication, and dispensing
practices. Education improved knowledge across
studies, but gave mixed results on communication
between sellers and clients, dispensing of
appropriate treatments, and referring of patients
to health facilities. Profit incentives appeared to
constrain behavior change in certain instances,
although cases of shops adopting practices at the
expense of sales revenue were also reported.

Conclusion: Evidence suggests that knowledge

and practices of pharmacies and drug shops can be
improved across a range of diseases and countries/
regions, although variations were reported across
studies. Profit incentives appear to bear some
influence on the level of success of interventions.
Study selection: Our search strategy included
More work is required to extend the geographical
randomized trials, time-series studies, and before
base of evidence, investigate cost-effectiveness,
and after studies evaluating six interventions
education, peer review, reorganizing administrative and evaluate sustainability of interventions over
periods longer than one year.
structures, incentives, regulation, and legislation.
Data extraction: We extracted information on
design features, participants, interventions, and
outcomes assessed studies for methodological
quality and extracted results, all using uniform

INRUD News, January 2011


Comments on Recent articles

The authors systematically searched for studies examining the effects of a range of different types of
interventions in African retail pharmacy settings; but despite identifying over 500 candidate articles, only
10 met study inclusion criteria. This indicates a critical gap in knowledge about strategies to improve the
quality of dispensing in this important health care setting, which provides access to essential medicines for
a large proportion of Africas population. Furthermore, all 10 studies examined educational interventions
directed primarily at owners and shop attendants (although a few studies included supportive patientoriented materials). First, although it is encouraging that the studies found that education can be effective in
improving knowledge and dispensing practices for several health conditions, the efficacy in these settings
of other intervention approaches included in the authors typology (e.g., feedback, peer support, regulatory
enforcement) must be explored. Some of these have been studied to a limited extent in other regions, but
whether these approaches would be successful in Africa is an open question. Second, given that the decision
to seek care in retail shops lies primarily with consumers and that much of what transpires in the sales
encounter is heavily influenced by consumer preference and choice, the efficacy of different approaches to
educate consumers about appropriate purchasing of medicines also needs to be examined. This is certainly
relevant as governments try to shift the treatment of choice for malaria to ACT or in national efforts to reduce
antibiotic use and resistance. Until consumers can use their feet and their purchasing power to leverage
practice, the extent of long-term improvements in retail drug dispensing in Africa is likely to be limited by the
economic forces that currently drive behavior in these settings.

INRUD News, January 2011


Comments on Recent articles

Balancing medicine prices and business sustainability: Analyses

of pharmacy costs, revenues, and profit shed light on retail
medicine mark-ups in rural Kyrgyzstan
resource-sharing. The network operated at
Department of Family Medicine, Boston University break-even profit, leaving little room to lower
medicine prices and mark-ups. Medicine markSchool of Medicine, One Boston Medical Center
ups needed for sustainability were greater than
Place, Dowling 5 South, Boston, MA 02118, USA.
originally envisioned by network administration.
In 2005, 55 percent, 35 percent, and 10 percent
of the networks top 50 products revealed markups of less than 50 percent, 5099 percent, and
BMC Health Services Research 2010; 10:205.
greater than 100 percent, respectively. Annual
mark-ups increased dramatically each year to
Background: Numerous not-for-profit pharmacies cover increasing recurrent costs. By 2007, only
19 percent and 46 percent of products revealed
have been created to improve access to medicines
mark-ups of less than 50 percent and 5099
for the poor, but many have failed due to
percent, respectively, and 35 percent of products
insufficient financial planning and management.
revealed mark-ups greater than 100 percent. In
These pharmacies are not well described in health
2007, medicine mark-ups varied substantially
services literature, despite strong demand from
across these products, ranging from 32 percent to
policy makers, implementers, and researchers.
244 percent. Mark-ups needed to sustain private
Surveys reporting unaffordable medicine prices
pharmacies would be even higher in the absence of
and high mark-ups have spurred efforts to
government subsidies.
reduce medicine prices, but price reduction goals
are arbitrary in the absence of information on
Conclusion: Pharmacy networks can be
pharmacy costs, revenues, and profit structures.
established in hard-to-reach regions with little
Health services research is needed to develop
funding by using publicprivate partnerships and
sustainable and reasonable medicine price goals resource-sharing models. Medicine prices and
and strategic initiatives to reach them.
mark-ups must be interpreted with consideration

Methods: We utilized cost accounting methods

on inventory and financial information obtained
from a not-for-profit rural pharmacy network
in mountainous Kyrgyzstan to quantify costs,
revenues, profits, and medicine mark-ups during
establishment and maintenance periods (October
2004 December 2007).
Results: Twelve pharmacies and one warehouse
were established in remote Kyrgyzstan with less
than 25,000 USD on the basis of governmental

INRUD News, January 2011

for regional costs of business. Mark-ups vary

dramatically across medicines. Some mark-ups
appear excessive, but are likely necessary for
pharmacy viability. Pharmacy financial data is
available in remote settings and can be used
towards determination of reasonable medicine price
goals. Health systems researchers must document
the positive and negative financial experiences of
pharmacy initiatives to inform future projects and
advance access to medicines goals.


Comments on Recent articles

Although set in rural Kyrgyzstan rather than Africa, this insightful and revealing study sheds light on the
economic realities of running a sustainable retail operation in a very low-resource setting. Retail drug shop
owners are often accused of price gouging and profiteering. Mark-ups of 100 percent or more on sales of
essential medicines are seen as excessively high. This carefully conducted study demonstrates that in a
network of not-for-profit retail shops operating at a break-even level, 35 percent of the most commonly sold
medicines had mark-ups of 100 percent or more. The reasons for high mark-ups were twofoldlow customer
volume and high, fixed, recurrent costs (e.g., salaries, transport, and inventory). As the authors point out, if
these shops were run for profit, mark-ups would need to be even higher to make the operation sustainable,
because of the need to cover additional costs, including rent, overhead, and profit. Similar studies are urgently
needed in urban and rural Africa, where the factors that drive costs are likely to be quite different from those
in central Asia. Until we develop a deeper understanding of the economic realities of private retail drug shops,
efforts to increase affordability of essential medicines or improve their dispensing are likely to founder.

INRUD News, January 2011


Recent articles
Advances in Health Economics and Health
Services Research
Encinosa WE, Bernard D, Dor A. Does prescription
drug adherence reduce hospitalization and costs? The
case of diabetes. Adv Health Econ Health Serv Res
2010; 22:151-173.

American Journal of Emergency Medicine

Hill PM, Rothman R, Saheed M, Deruggiero K,
Hsieh YH, Kelen GD. A comprehensive approach
to achieving near 100% compliance with The Joint
Commission Core Measures for pneumonia antibiotic
timing. Am J Emerg Med 2010 Jul 14. [Epub ahead of

American Journal of Managed Care

Gibson TB, Song X, Alemayehu B, Wang SS, Waddell
JL, Bouchard JR, Forma F. Cost sharing, adherence,
and health outcomes in patients with diabetes. Am J
Manag Care 2010; 16(8):589-600.
Pittman DG, Tao Z, Chen W, Stettin GD.
Antihypertensive medication adherence and subsequent
health care utilization and costs. Am J Manag Care
2010; 16(8):568-576.
Patel H, Toe DC, Burke S, Rasu RS. Anticonvulsant
use after formulary status change for brand-name
second-generation anticonvulsants. Am J Manag Care
2010; 16(8):e197-e204.
Tjia J, Field TS, Garber LD, Donovan JL, Kanaan
AO, Raebel MA, Zhao Y, Fuller JC, Gagne SJ, Fischer
SH, and Gurwitz JH. Development and pilot testing
of guidelines to monitor high-risk medications in the
ambulatory setting. Am J Manag Care 2010; 16(7):489496.
Rosenzweig JL, Taitel MS, Norman GK, Moore TJ,
Turenne W, Tang P. Diabetes disease management in
Medicare Advantage reduces hospitalizations and costs.
Am J Manag Care 2010; 16(7):e157-e162.
Aubert RE, Yao J, Xia F, Garavaglia SB. Is there a
relationship between early statin compliance and a
reduction in health care utilization? Am J Manag Care
2010; 16(6):459-466.

INRUD News, January 2011

Margolis JM, Cao Z, Onukwugha E, Sanchez RJ,

Alvir J, Joshi AV, Mullins CD. Health care utilization
and cost effects of prior authorization for Pregabalin
in commercial health plans. Am J Manag Care 2010;
Orrico KB, Lin JK, Wei A, Yue H. Clinical
consequences of disseminating the rosiglitazone
FDA safety warning. Am J Manag Care 2010;

Annales de cardiologie et dangiologie

Ghozzi H, Kassis M, Hakim A, Sahnoun Z,
Abderrahmen A, Abbes R, Maalej S, Hammami S,
Hajkacem L, Zeghal K. [Medication adherence of
a sample of hypertensive patients in the region of
Sfax (Tunisia)]. Ann Cardiol Angeiol (Paris) 2010;

Annals of Family Medicine

Hartung DM, Evans D, Haxby DG, Kraemer DF,
Andeen G, Fagnan LJ. Effect of drug sample removal
on prescribing in a family practice clinic. Ann Fam
Med 2010; 8(5):402-409.

Annals of Pharmacotherapy
Manias E, Williams A. Medication adherence in people
of culturally and linguistically diverse backgrounds: a
meta-analysis. Ann Pharmacother 2010; 44(6):964-982.
Kane-Gill SL, Van Den Bos J, Handler SM. Adverse
drug reactions in hospital and ambulatory care settings
identified using a large administrative database. Ann
Pharmacother 2010; 44(6):983-993.
Mann DM, Woodward M, Muntner P, Falzon L,
Kronish I. Predictors of nonadherence to statins:
a systematic review and meta-analysis. Ann
Pharmacother 2010; 44(9):1410-1421.

Antimicrobial Agents and Chemotherapy

Willemsen I, Cooper B, van Buitenen C, Winters M,
Andriesse G, Kluytmans J. Improving quinolone use
in hospitals by using a bundle of interventions in an
interrupted time series analysis. Antimicrob Agents
Chemother 2010; 54(9):3763-3769.


Recent articles
Applied Health Economics and Health
Tetteh EK. Implementing differential pricing for
essential medicines via country-specific bilateral
negotiated discounts. Appl Health Econ Health Policy
2009; 7(2):71-89.
Marseille E, Kahn JG, Pitter C, Bunnell R, Epalatai
W, Jawe E, Were W, Mermin J. The cost effectiveness
of home-based provision of antiretroviral therapy in
rural Uganda. Appl Health Econ Health Policy 2009;

Archives of Internal Medicine

Strom BL, Schinnar R, Aberra F, Bilker W, Hennessy
S, Leonard CE, Pifer E. Unintended effects of a
computerized physician order entry nearly hard-stop
alert to prevent a drug interaction: a randomized
controlled trial. Arch Intern Med 2010; 170(17):15781583.
Tseng CW, Waitzfelder BE, Tierney EF, Gerzoff
RB, Marrero DG, Piette JD, Karter AJ, Curb JD,
Chung R, Mangione CM, Crosson JC, Dudley RA.
Patients willingness to discuss trade-offs to lower
their out-of-pocket drug costs. Arch Intern Med 2010;
Mattison ML, Afonso KA, Ngo LH, Mukamal KJ.
Preventing potentially inappropriate medication use
in hospitalized older patients with a computerized
provider order entry warning system. Arch Intern Med
2010; 170(15):1331-1336.
Millett C, Everett CJ, Matheson EM, Bindman AB,
Mainous AG, III. Impact of Medicare Part D on
seniors out-of-pocket expenditures on medications.
Arch Intern Med 2010; 170(15):1325-1330.
Winterstein AG, Linden S, Lee AE, Fernandez EM,
Kimberlin CL. Evaluation of consumer medication
information dispensed in retail pharmacies. Arch Intern
Med 2010; 170(15):1317-1324.
Zhang Y, Lee BY, Donohue JM. Ambulatory antibiotic
use and prescription drug coverage in older adults.
Arch Intern Med 2010; 170(15):1308-1314.

INRUD News, January 2011

Smeets HM, de Wit NJ, Zuithoff NP, van Dijk PC, van
der Lee AP, Hoes AW. A health insurance companyinitiated multifaceted intervention for optimizing
acid-suppressing drug prescriptions in primary care:
a randomized controlled trial. Arch Intern Med 2010;
Onder G, Petrovic M, Tangiisuran B, Meinardi
MC, Markito-Notenboom WP, Somers A, Somers
A, Rajkumar C, Bernabei R, van der Cammen TJ.
Development and validation of a score to assess risk of
adverse drug reactions among in-hospital patients 65
years or older: the GerontoNet ADR risk score. Arch
Intern Med 2010; 170(13):1142-1148.
Tamblyn R, Abrahamowicz M, Dauphinee D,
Wenghofer E, Jacques A, Klass D, Smee S, Eguale
T, Winslade N, Girard N, Bartman I, Buckeridge DL,
Hanley JA. Influence of physicians management and
communication ability on patients persistence with
antihypertensive medication. Arch Intern Med 2010;
Stafford RS, Bartholomew LK, Cushman WC, Cutler
JA, Davis BR, Dawson G, Einhorn PT, Furberg
CD, Piller LB, Pressel SL, Whelton PK; ALLHAT
Collaborative Research Group. Impact of the ALLHAT/
JNC7 Dissemination Project on thiazide-type diuretic
use. Arch Intern Med 2010; 170(10):851-858.

Beijing Da Xue Xue Bao

Yuan YL, Yu BZ, Jiang SW, Wang T, Lv J, Tao
QS. [Study of an adherence rating score system for
tuberculosis patients in China]. Beijing Da Xue Xue
Bao 2010; 42(3):299-303.

BMC Cardiovascular Disorders

van Mourik MS, Cameron A, Ewen M, Laing RO.
Availability, price and affordability of cardiovascular
medicines: a comparison across 36 countries using
WHO/HAI data. BMC Cardiovasc Disord 2010; 10:25.

BMC Clinical Pharmacology

Timonen J, Bengtstrom M, Karttunen P, Ahonen R.
The impact of generic substitution on the activities
of pharmaceutical companies - a survey from the
companies perspective one year and five years after the
introduction of generic substitution in Finland. BMC
Clin Pharmacol 2010; 10(1):15.


Recent articles
BMC Health Services Research
Freund T, Kayling F, Miksch A, Szecsenyi J,
Wensing M. Effectiveness and efficiency of primary
care based case management for chronic diseases:
rationale and design of a systematic review and metaanalysis of randomized and non-randomized trials
[CRD32009100316]. BMC Health Serv Res 2010;
Kuo RN, Lai MS. Comparison of Rx-defined morbidity
groups and diagnosis- based risk adjusters for
predicting health care costs in Taiwan. BMC Health
Serv Res 2010; 10:126.
Wettermark B, Persson ME, Wilking N, Kalin M,
Korkmaz S, Hjemdahl P, Godman B, Petzold M,
Gustafsson LL; Regional Drug Expert Consortium in
Stockholm County Council.
Forecasting drug utilization and expenditure in a
metropolitan health region. BMC Health Serv Res
2010; 10:128.
Martirosyan L, Arah OA, Haaijer-Ruskamp FM,
Braspenning J, Denig P. Methods to identify the
target population: implications for prescribing quality
indicators. BMC Health Serv Res 2010; 10:137.
Paniz VM, Fassa AG, Maia MF, Domingues MR,
Bertoldi AD. Measuring access to medicines: a review
of quantitative methods used in household surveys.
BMC Health Serv Res 2010; 10:146.
Soufi G, Belayachi J, Himmich S, Ahid S, Soufi M,
Zekraoui A, Abouqal A. Patient satisfaction in an acute
medicine department in Morocco. BMC Health Serv
Res 2010; 10:149.
Adamski J, Godman B, Ofierska-Sujkowska G,
Osinska B, Herholz H, Wendykowska K, Laius O,
Jan S, Sermet C, Zara C, Kalaba M, Gustafsson R,
Garuolien K, Haycox A, Garattini S, Gustafsson
LL. Risk sharing arrangements for pharmaceuticals:
potential considerations and recommendations for
European payers. BMC Health Serv Res 2010; 10:153.

INRUD News, January 2011

Schmittdiel JA, Steers N, Duru OK, Ettner SL, Brown

AF, Fung V, Ettner SL, Brown AF, Fung V, Hsu J,
Quiter E, Tseng CW, Mangione CM. Patient-provider
communication regarding drug costs in Medicare Part
D beneficiaries with diabetes: a TRIAD Study. BMC
Health Serv Res 2010; 10:164.
Sauceda-Valenzuela AL, Wirtz VJ, Santa-AnaTellez Y, de la Luz Kageyama-Escobar. Ambulatory
health service users experience of waiting time and
expenditure and factors associated with the perception
of low quality of care in Mexico. BMC Health Serv
Res 2010; 10:178.
Waning B, Maddix J, Soucy L. Balancing medicine
prices and business sustainability: analyses of
pharmacy costs, revenues and profit shed light on retail
medicine mark-ups in rural Kyrgyzstan. BMC Health
Serv Res 2010; 10:205.
Sunaert P, Bastiaens H, Nobels F, Feyen L, Verbeke
G, Vermeire E, De Maeseneer J, Willems S, De Sutter
A. Effectiveness of the introduction of a Chronic Care
Model-based program for type 2 diabetes in Belgium.
BMC Health Serv Res 2010; 10:207.
Chen W, Tang S, Sun J, Ross-Degnan D, Wagner AK.
Availability and use of essential medicines in China:
manufacturing, supply, and prescribing in Shandong
and Gansu provinces. BMC Health Serv Res 2010;
Sychareun V, Phongsavan K, Hansana V, Phengsavanh
A. Policy maker and provider knowledge and attitudes
regarding the provision of emergency contraceptive
pills within Lao PDR. BMC Health Serv Res 2010;
Hsiao FY, Tsai YW, Huang WF. Price regulation, new
entry, and information shock on pharmaceutical market
in Taiwan: a nationwide data-based study from 2001 to
2004. BMC Health Serv Res 2010; 10:218.
Wang W, Fu C, Zhuo H, Luo J, Xu B. Factors affecting
costs and utilization of type 2 diabetes health care: a
cross-sectional survey among 15 hospitals in urban
China. BMC Health Serv Res 2010; 10:244.


Recent articles
Mc Namara KP, George J, OReilly SL, Jackson SL,
Peterson GM, Howarth H, Bailey MJ, Duncan G,
Trinder P, Morabito E, Finch J, Bunker S, Janus E,
Emery J, Dunbar JA.
Engaging community pharmacists in the primary
prevention of cardiovascular disease: protocol for
the Pharmacist Assessment of Adherence, Risk and
Treatment in Cardiovascular Disease (PAART CVD)
pilot study. BMC Health Serv Res 2010; 10:264.
Stepurko T, Pavlova M, Gryga I, Groot W. Empirical
studies on informal patient payments for health care
services: a systematic and critical review of research
methods and instruments. BMC Health Serv Res 2010;
Phuong HL, Nga TT, Giao PT, Hung lQ, Binh TQ, Nam
NV, Nagelkerke N, de Vries PJ.
Randomised primary health center based interventions
to improve the diagnosis and treatment of
undifferentiated fever and dengue in Vietnam. BMC
Health Serv Res 2010; 10:275.

BMC Infectious Diseases

Hadi U, van den Broek P, Kolopaking EP, Zairina
N, Gardjito W, Gyssens IC. Cross-sectional study of
availability and pharmaceutical quality of antibiotics
requested with or without prescription (Over The
Counter) in Surabaya, Indonesia. BMC Infect Dis 2010;
Viberg N, Kalala W, Mujinja P, Tomson G, Lundborg
CS. Practical knowledge and perceptions of
antibiotics and antibiotic resistance among drugsellers
in Tanzanian private drugstores. BMC Infect Dis 2010;

BMC International Health and Human

Sakisaka K, Jimba M, Hanada K. Changing poor
mothers care-seeking behaviors in response to
childhood illness: findings from a cross-sectional study
in Granada, Nicaragua. BMC Int Health Hum Rights
2010; 10:10.

INRUD News, January 2011

BMC Medical Informatics and Decision

Ko GT, So WY, Tong PC, Le Coguiec F, Kerr D,
Lyubomirsky G, Tamesis B, Wolthers T, Nan J, Chan J.
From design to implementation--the Joint Asia Diabetes
Evaluation (JADE) program: a descriptive report of an
electronic web-based diabetes management program.
BMC Med Inform Decis Mak 2010; 10:26.
Lamy JB, Ebrahiminia V, Riou C, Seroussi B, Bouaud
J, Simon C, Dubois S, Butti A, Simon G, Favre M,
Falcoff H, Venot A. How to translate therapeutic
recommendations in clinical practice guidelines into
rules for critiquing physician prescriptions? Methods
and application to five guidelines. BMC Med Inform
Decis Mak 2010; 10:31.

BMC Pediatrics
Waning B, Diedrichsen E, Jambert E, Barnighausen
T, Li Y, Pouw M, Moon S. The global pediatric
antiretroviral market: analyses of product availability
and utilization reveal challenges for development of
pediatric formulations and HIV/AIDS treatment in
children. BMC Pediatr 2010; 10(1):74.

BMC Public Health

Maher D. Re-thinking global health sector efforts for
HIV and tuberculosis epidemic control: promoting
integration of programme activities within a
strengthened health system. BMC Public Health 2010;
Asante KP, Abokyi L, Zandoh C, Owusu R, Awini E,
Sulemana A, Amenga-Etego S, Adda R, Boahen O,
Segbaya S, Mahama E, Bart-Plange C, Chandramohan
D, Owusu-Agyei S. Community perceptions of malaria
and malaria treatment behaviour in a rural district
of Ghana: implications for artemisinin combination
therapy. BMC Public Health 2010; 10:409.
Uzochukwu BS, Chiegboka LO, Enwereuzo C, Nwosu
U, Okorafor D, Onwujekwe OE, Uguru NP, Sibeudu
FT, Ezeoke OP. Examining appropriate diagnosis and
treatment of malaria: availability and use of rapid
diagnostic tests and artemisinin-based combination
therapy in public and private health facilities in south
east Nigeria. BMC Public Health 2010; 10:486.


Recent articles
Bird D, Oldenburg B, Cassimatis M, Russell A, Ash
S, Courtney MD, Scuffham PA, Stewart I, Wootton
R, Friedman RH. Randomised controlled trial of
an automated, interactive telephone intervention to
improve type 2 diabetes self-management (TelephoneLinked Care Diabetes Project): study protocol. BMC
Public Health 2010; 10(1):599.
Sapkota AR, Coker ME, Rosenberg Goldstein RE,
Atkinson NL, Sweet SJ, Sopeju PO, Ojo MT, Otivhia
E, Ayepola OO, Olajuyigbe OO, Shireman L, Pottinger
PS, Ojo KK. Self-medication with antibiotics for the
treatment of menstrual symptoms in southwest Nigeria:
a cross-sectional study. BMC Public Health 2010;

British Journal of Clinical Pharmacology

Rawlins M, Barnett D, Stevens A. Pharmacoeconomics:
NICEs approach to decision-making. Br J Clin
Pharmacol 2010; 70(3):346-349.
Edlin R, Round J, Hulme C, McCabe C. Costeffectiveness analysis and efficient use of the
pharmaceutical budget: the key role of clinical
pharmacologists. Br J Clin Pharmacol 2010; 70(3):350355.
Stewart D, Cunningham IT, Hansford D, John D,
McCaig D, McLay J. General practitioners views
and experiences of over-the-counter simvastatin in
Scotland. Br J Clin Pharmacol 2010; 70(3):356-359.
Towse A. Value based pricing, research and
development, and patient access schemes. Will the
United Kingdom get it right or wrong? Br J Clin
Pharmacol 2010; 70(3):360-366.

British Journal of Psychiatry

Siskind D, Araya R, Kim J. Cost-effectiveness of
improved primary care treatment of depression in
women in Chile. Br J Psychiatry 2010; 197(4):291-296.

British Medical Journal

Lester H, Schmittdiel J, Selby J, Fireman B, Campbell
S, Lee J, Whippy A, Madvig P. The impact of removing
financial incentives from clinical quality indicators:
longitudinal analysis of four Kaiser Permanente
indicators. BMJ 2010; 340:c1898.

INRUD News, January 2011

Costelloe C, Metcalfe C, Lovering A, Mant D, Hay

AD. Effect of antibiotic prescribing in primary care
on antimicrobial resistance in individual patients:
systematic review and meta-analysis. BMJ 2010;
Cumming J, Mays N, Daube J. How New Zealand has
contained expenditure on drugs. BMJ 2010; 340:c2441.
Ferner RE, Lenney W, Marriott JF. Controversy over
generic substitution. BMJ 2010; 340:c2548.
Kinra S, Bowen LJ, Lyngdoh T, Prabhakaran D, Reddy
KS, Ramakrishnan L, Gupta R, Bharathi AV, Vaz M,
Kurpad AV, Smith GD, Ben-Shlomo Y, Ebrahim S.
Sociodemographic patterning of non-communicable
disease risk factors in rural India: a cross sectional
study. BMJ 2010; 341:c4974.
So A, Furlong M, Heddini A. Globalisation and
antibiotic resistance. BMJ 2010; 341:c5116.

Bulletin of The World Health Organization

Mendis S, Johnston SC, Fan W, Oladapo O, Cameron
A, Faramawi MF. Cardiovascular risk management and
its impact on hypertension control in primary care in
low-resource settings: a cluster-randomized trial. Bull
World Health Organ 2010; 88(6):412-419.
Greene JA. When did medicines become essential?
Bull World Health Organ 2010; 88(7):483.

Cadernos de sade pblica

Dal Pizzol Tda S, Trevisol DJ, Heineck I, Flores LM,
Camargo AL, Kenig A, Torres IL, Kadri MC, Monreal
MT, Melo AM, Ferreira MB. [Adherence to essential
medicines in cities from three Brazilian states]. Cad
Saude Publica 2010; 26(4):827-836.

Cincia y sade coletiva

Naves Jde O, Castro LL, Carvalho CM, MerchanHamann E. [Self-medication: a qualitative approach
of its motivations]. Cien Saude Colet 2010; 15 Suppl


Recent articles
Clinical Infectious Diseases

Drugs and Aging

dAcremont V, Malila A, Swai N, Tillya R, KahamaMaro J, Lengeler C, Genton B. Withholding

antimalarials in febrile children who have a negative
result for a rapid diagnostic test. Clin Infect Dis 2010;

Lampela P, Hartikainen S, Lavikainen P, Sulkava R,

Huupponen R. Effects of medication assessment as part
of a comprehensive geriatric assessment on drug use
over a 1-year period: a population-based intervention
study. Drugs Aging 2010; 27(6):507-521.

Clinical Research in Cardiology

East African Journal of Public Health

Wong MC, Jiang JY, Su X, Wang H, Tang JL, Griffiths

SM. Individuals at risk of beta-blocker discontinuation:
a cohort study in 19,177 Chinese patients. Clin Res
Cardiol 2010; 99(5):277-284.

Ajayi IO, Falade CO, Kale OO. An assessment of

accuracy of mothers presumptive diagnosis of fever
at home in southwest Nigeria: evidence for switch to
parasite-based diagnostic test. East Afr J Public Health
2009; 6(3):229-234.

Current Drug Safety

Talevi A. The new patient and responsible selfmedication practices: a critical review. Curr Drug Saf
2010; 5(4):342-353.

Current Medical Research and Opinion

Shi L, Zhao Y, Fonseca V, Ascher-Svanum H, Chiang
YJ, Winstead D. Health care resource utilization,
adherence and persistence with antipsychotic therapy
among schizophrenia patients with vs. without preexisting metabolic syndrome. Curr Med Res Opin
2010; 26(10):2499-2506.
Nichols GA, Conner C, Brown JB. Initial
nonadherence, primary failure and therapeutic success
of metformin monotherapy in clinical practice. Curr
Med Res Opin 2010; 26(9):2127-2135.
Yang W, Chang J, Kahler KH, Fellers T, Orloff J, Wu
EQ, Bensimon AG. Evaluation of compliance and
health care utilization in patients treated with single pill
vs. free combination antihypertensives. Curr Med Res
Opin 2010; 26(9):2065-2076.

Diabetes Research and Clinical Practice

Al-Qazaz HK, Hassali MA, Shafie AA, Sulaiman SA,
Sundram S, Morisky DE. The eight-item Morisky
Medication Adherence Scale MMAS: Translation and
validation of the Malaysian version. Diabetes Res Clin
Pract 2010.

INRUD News, January 2011

Eastern Mediterranean Health Journal

Bashrahil KA. Indicators of rational drug use and
health services in Hadramout, Yemen. East Mediterr
Health J 2010; 16(2):151-155.

European Journal of Clinical

Cereza G, Agusti A, Pedros C, Vallano A, Aguilera C,
Danes I, Vidal X, Arnau JM. Effect of an intervention
on the features of adverse drug reactions spontaneously
reported in a hospital. Eur J Clin Pharmacol 2010;
Porta A, Esposito S, Menson E, Spyridis N, Tsolia
M, Sharland M, Principi N. Off-label antibiotic use
in children in three European countries. Eur J Clin
Pharmacol 2010; 66(9):919-927.
Gjerden P, Slordal L, Bramness JG. Prescription
persistence and safety of antipsychotic medication: a
national registry-based 3-year follow-up. Eur J Clin
Pharmacol 2010; 66(9):911-917.
Latry P, Molimard M, Begaud B, Martin-Latry K. How
reimbursement databases can be used to support drug
utilisation studies: example using the main French
national health insurance system database. Eur J Clin
Pharmacol 2010; 66(7):743-748.


Recent articles
Tobaiqy M, Stewart D, Helms PJ, Bond C, Lee AJ,
Bateman N, McCaig D, McLay J. A pilot study to
evaluate a community pharmacy-based monitoring
system to identify adverse drug reactions associated
with paediatric medicines use. Eur J Clin Pharmacol
2010; 66(6):627-632.

European Journal of Pediatrics

Maor Y, Raz M, Rubinstein E, Derazne E, Ringel S,
Roizin H, Rahav G, Regev-Yochay G; for the Israeli
Judicious Antibiotic Prescription (IJAP) study group.
Changing parents opinions regarding antibiotic use in
primary care. Eur J Pediatr 2010.

Evidence-Based Mental Health

Campbell LA, Kisely S. Prescribing preferred
medications improves adherence in people with
severe mental illness. Evid Based Ment Health 2010

Expert Opinion on Pharmacotherapy

Fontoura MS, Araujo-Neto CA, Andrade SC, Brim RV,
Matutino AR, Silva CC, Santana MC, Nobre-Bastos M,
Oliveira F, Barreto BB, Santos PM, Noblat L, Cardoso
MR, Nascimento-Carvalho CM; PNEUMOPACEfficacy Study Group. Clinical failure among children
with nonsevere community-acquired pneumonia treated
with amoxicillin. Expert Opin Pharmacother 2010;

Family Practice
Dong L, Yan H, Wang D. Drug prescribing indicators
in village health clinics across 10 provinces of Western
China. Fam Pract 2010 Sep 27. [Epub ahead of print].
Kotwani A, Wattal C, Katewa S, Joshi PC, Holloway K.
Antibiotic use in the community: what factors influence
primary care physicians to prescribe antibiotics in
Delhi, India? Fam Pract 2010 Jul 26. [Epub ahead of
Pickin M, OCathain A, Sampson F, Salisbury C,
Nicholl J. The impact of Advanced Access on antibiotic
prescribing: a controlled before and after study. Fam
Pract 2010; 27(5):554-555.

INRUD News, January 2011

Globalization and Health

Waning B, Kyle M, Diedrichsen E, Soucy L, Hochstadt
J, Barnighausen T, Moon S. Intervening in global
markets to improve access to HIV/AIDS treatment: an
analysis of international policies and the dynamics of
global antiretroviral medicines markets. Global Health
2010; 6:9.

Health Affairs (Millwood)

Kesselheim AS, Outterson K. Fighting antibiotic
resistance: marrying new financial incentives to
meeting public health goals. Health Aff (Millwood)
2010; 29(9):1689-1696.
Shrank WH, Choudhry NK, Agnew-Blais J, Federman
AD, Liberman JN, Liu J, Kesselheim AS, Brookhart
MA, Fischer MA. State generic substitution laws
can lower drug outlays under Medicaid. Health Aff
(Millwood) 2010; 29(7):1383-1390.
Jacobson M, Earle CC, Price M, Newhouse JP. How
Medicares payment cuts for cancer chemotherapy
drugs changed patterns of treatment. Health Aff
(Millwood) 2010; 29(7):1391-1399.
Davidoff AJ, Stuart B, Shaffer T, Shoemaker JS, Kim
M, Zacker C. Lessons learned: who didnt enroll in
Medicare drug coverage in 2006, and why? Health Aff
(Millwood) 2010; 29(6):1255-1263.

Health Care Management Science

Gonul FF, Carter FJ. Impact of e-detailing on the
number of new prescriptions. Health Care Manag Sci
2010; 13(2):101-111.

Health and Human Rights

Mok EA. International assistance and cooperation for
access to essential medicines. Health Hum Rights 2010;

Health Policy
Yu X, Li C, Shi Y, Yu M. Pharmaceutical supply chain
in China: current issues and implications for health
system reform. Health Policy 2010; 97(1):8-15.


Recent articles
Carlson JJ, Sullivan SD, Garrison LP, Neumann PJ,
Veenstra DL. Linking payment to health outcomes:
a taxonomy and examination of performance-based
reimbursement schemes between health care payers and
manufacturers. Health Policy 2010; 96(3):179-190.
Ahmed HM, Mitchell M, Hedt B. National
implementation of Integrated Management of
Childhood Illness (IMCI): policy constraints and
strategies. Health Policy 2010; 96(2):128-133.
Lockhart M, Babar ZU, Garg S. Evaluation of policies
to support drug development in New Zealand. Health
Policy 2010; 96(2):108-117.
Hiligsmann M, Rabenda V, Bruyere O, Reginster JY.
The clinical and economic burden of non-adherence
with oral bisphosphonates in osteoporotic patients.
Health Policy 2010; 96(2):170-177.
Onwujekwe O, Dike N, Uzochukwu B, Ezeoke
O. Informal payments for health care: differences
in expenditures from consumers and providers
perspectives for treatment of malaria in Nigeria. Health
Policy 2010; 96(1):72-79.

Health Policy and Planning

Riyarto S, Hidayat B, Johns B, Probandari A,
Mahendradhata Y, Utarini A, Trisnantoro L,
Flessenkaemper S. The financial burden of HIV care,
including antiretroviral therapy, on patients in three
sites in Indonesia. Health Policy Plan 2010; 25(4):272282.

Health Services Research

Karaca-Mandic P, Joyce GF, Goldman DP, Laouri M.
Cost sharing, family health care burden, and the use of
specialty drugs for rheumatoid arthritis. Health Serv
Res 2010; 45(5 Pt 1):1227-1250.
Zhang Y, Donohue JM, Lave JR, Gellad WF. The
impact of Medicare Part D on medication treatment
of hypertension. Health Serv Res 2010 Sep 28 [Epub
ahead of print].

INRUD News, January 2011

Chen TT, Chung KP, Lin IC, Lai MS. The unintended
consequence of diabetes mellitus Pay-for-Performance
(P4P) Program in Taiwan: Are patients with more
comorbidities or more severe conditions likely to be
excluded from the P4P Program? Health Serv Res 2010
Sep 28 [Epub ahead of print].
Fagan PJ, Schuster AB, Boyd C, Marsteller JA,
Griswold M, Murphy SM, Dunbar L, Forrest CB.
Chronic care improvement in primary care: evaluation
of an integrated pay-for-performance and practicebased care coordination program among elderly
patients with diabetes. Health Serv Res 2010 Sep 17.
[Epub ahead of print].
Wang J, Mullins CD, Brown LM, Shih YC, DagogoJack S, Hong SH, Cushman WC. Disparity implications
of Medicare eligibility criteria for medication
therapy management services. Health Serv Res 2010;

Implementation Science
Luitjes SH, Wouters MG, Franx A, Scheepers HC,
Coupe VM, Wollersheim H, Steegers EA, Heringa MP,
Hermens RP, van Tulder MW. Study protocol: Cost
effectiveness of two strategies to implement the NVOG
guidelines on hypertension in pregnancy: An innovative
strategy including a computerised decision support
system compared to a common strategy of professional
audit and feedback, a randomized controlled trial.
Implement Sci 2010; 5:68.

Indian Journal of Community Medicine

Sodani PR, Kumar RK, Srivastava J, Sharma L.
Measuring patient satisfaction: a case study to improve
quality of care at public health facilities. Indian J
Community Med 2010; 35(1):52-56.

Indian Journal of Pharmacology

Kotwani A. Access to essential medicines and standard
treatment for chronic diseases. Indian J Pharmacol
2010; 42(3):127-128.


Recent articles
Infection Control and Hospital

International Journal of Evidence-Based

Health care

Apisarnthanarak A, Yatrasert A, Mundy LM. Impact of

education and an antifungal stewardship program for
candidiasis at a Thai tertiary care center. Infect Control
Hosp Epidemiol 2010; 31(7):722-727.

Medves J, Godfrey C, Turner C, Paterson M, Harrison

M, Mackenzie L, Durando P. Systematic review of
practice guideline dissemination and implementation
strategies for health care teams and team-based
practice. Int J Evid Based Healthc 2010; 8(2):79-89.

International Journal of Clinical

Pharmacology and Therapeutics
Olanrewaju TO, Aderibigbe A, Busari OA, Sanya
EO. Antihypertensive drug utilization and conformity
to guidelines in a sub-Saharan African hypertensive
population. Int J Clin Pharmacol Ther 2010; 48(1):6875.

International Journal of Circumpolar

Bhattacharyya O, Harris S, Zwarenstein M, Barnsley
J. Controlled trial of an intervention to improve
cholesterol management in diabetes patients in remote
Aboriginal communities. Int J Circumpolar Health
2010; 69(4):333-343.

International Journal of Diabetes in

Developing Countries
Morowatisharifabad MA, Mahmoodabad SS,
Baghianimoghadam MH, Tonekaboni NR.
Relationships between locus of control and adherence
to diabetes regimen in a sample of Iranians. Int J
Diabetes Dev Ctries 2010; 30(1):27-32.
Salam A. Educational program for patients with type1 diabetes mellitus receiving free monthly supplies
of insulin improves knowledge and attitude, but not
adherence. Int J Diabetes Dev Ctries 2010; 30(2):105.

International Journal for Equity in Health

Onwujekwe O, Obikeze E, Uzochukwu B, Okoronkwo
I, Onwujekwe OC. Improving quality of malaria
treatment services: assessing inequities in consumers
perceptions and providers behaviour in Nigeria. Int J
Equity Health 2010; 9:22.

INRUD News, January 2011

International Journal of Infectious

Bigogo G, Audi A, Aura B, Aol G, Breiman RF, Feikin
DR. Health-seeking patterns among participants of
population-based morbidity surveillance in rural
western Kenya: implications for calculating disease
rates. Int J Infect Dis 2010.

International Journal of Nursing Studies

Chiu CW, Wong FK. Effects of 8 weeks sustained
follow-up after a nurse consultation on hypertension:
a randomised trial. Int J Nurs Stud 2010; 47(11):13741382.

International Journal of Pharmacy Practice

James KL, Barlow D, McArtney R, Hiom S, Roberts D,
Whittlesea C. Incidence, type and causes of dispensing
errors: a review of the literature. Int J Pharm Pract
2009; 17(1):9-30.

International Psychogeriatrics
Rodriguez E, Marquett R, Hinton L, McBride M,
Gallagher-Thompson D. The impact of education on
care practices: an exploratory study of the influence of
action plans on the behavior of health professionals.
Int Psychogeriatr 2010; 22(6):897-908.

International Journal for Quality in Health

Linder JA, Schnipper JL, Tsurikova R, Volk LA,
Middleton B. Self-reported familiarity with acute
respiratory infection guidelines and antibiotic
prescribing in primary care. Int J Qual Health Care
2010 Oct 8. [Epub ahead of print].


Recent articles
Chiu YW, Weng YH, Lo HL, Shih YH, Hsu CC, Kuo
KN. Impact of a nationwide outreach program on the
diffusion of evidence-based practice in Taiwan. Int J
Qual Health Care 2010; 22(5):430-436.
Wafula FN, Goodman CA. Are interventions for
improving the quality of services provided by
specialized drug shops effective in sub-Saharan Africa?
A systematic review of the literature. Int J Qual Health
Care 2010; 22(4):316-323.

Journal of the American Medical

informatics Association
Palchuk MB, Fang EA, Cygielnik JM, Labreche M,
Shubina M, Ramelson HZ, Hamann C, Broverman C,
Einbinder JS, Turchin A. An unintended consequence
of electronic prescriptions: prevalence and impact of
internal discrepancies. J Am Med Inform Assoc 2010;

Snyder RA, Fields W. A model for medication

safety event detection. Int J Qual Health Care 2010;

Magrabi F, Li SY, Day RO, Coiera E. Errors and

electronic prescribing: a controlled laboratory study to
examine task complexity and interruption effects. J Am
Med Inform Assoc 2010; 17(5):575-583.

Journal of the American Academy of Nurse


Journal of the American Pharmacists


Landers TF, Ferng YH, McLoughlin JW, Barrett AE,

Larson E. Antibiotic identification, use, and selfmedication for respiratory illnesses among urban
Latinos. J Am Acad Nurse Pract 2010; 22(9):488-495.

Nichol MB, Knight TK, Priest JL, Wu J, Cantrell

CR. Nonadherence to clinical practice guidelines
and medications for multiple chronic conditions in a
California Medicaid population. J Am Pharm Assoc
(2003) 2010; 50(4):496-507.

Journal of the American Geriatrics Society

Polinski JM, Kilabuk E, Schneeweiss S, Brennan T,
Shrank WH. Changes in drug use and out-of-pocket
costs associated with Medicare Part D implementation:
a systematic review. J Am Geriatr Soc 2010;

Journal of the American Medical

Powell LH, Calvin JE, Jr., Richardson D, Janssen
I, Mendes de Leon CF, Flynn KJ, Grady KL,
Rucker-Whitaker CS, Eaton C, Avery E; HART
Investigators. Self-management counseling in patients
with heart failure: the heart failure adherence and
retention randomized behavioral trial. JAMA 2010;
Holmes CB, Coggin W, Jamieson D, Mihm H, Granich
R, Savio P, Hope M, Ryan C, Moloney-Kitts M,
Goosby EP, Dybul M. Use of generic antiretroviral
agents and cost savings in PEPFAR treatment
programs. JAMA 2010; 304(3):313-320.

INRUD News, January 2011

Journal of Antimicrobial Chemotherapy

Butler CC, Hood K, Kelly MJ, Goossens H, Verheij
T, Little P, Melbye H, Torres A, Mlstad S, GodyckiCwirko M, Almirall J, Blasi F, Schaberg T, Edwards P,
Rautakorpi UM, Hupkova H, Wood J, Nuttall J, Coenen
S. Treatment of acute cough/lower respiratory tract
infection by antibiotic class and associated outcomes:
a 13 European country observational study in primary
care. J Antimicrob Chemother 2010; 65(11):2472-2478.
McNulty CA, Francis NA. Optimizing antibiotic
prescribing in primary care settings in the UK: findings
of a BSAC multi-disciplinary workshop 2009. J
Antimicrob Chemother 2010; 65(11):2278-2284.

Journal of Biosocial Science

Okeke TA. Improving malaria recognition, treatment
and referral practices by training caretakers in rural
Nigeria. J Biosoc Sci 2010; 42(3):325-339.


Recent articles
Journal of Clinical Hypertension

Journal of Critical Care

Martin MY, Kohler C, Kim YI, Kratt P, Schoenberger

YM, Litaker MS, Prayor-Patterson HM, Clarke SJ,
Andrews S, Pisu M. Taking less than prescribed:
medication nonadherence and provider-patient
relationships in lower-income, rural minority adults
with hypertension. J Clin Hypertens (Greenwich) 2010;

Amado VM, Vilela GP, Queiroz A, Jr., Amaral AC.

Effect of a quality improvement intervention to
decrease delays in antibiotic delivery in pediatric
febrile neutropenia: A pilot study. J Crit Care 2010 Jul
7. [Epub ahead of print].

Journal of Clinical Nursing

Bhogal SK, McGillivray D, Bourbeau J, Plotnick LH,

Bartlett SJ, Benedetti A, Ducharme FM. Focusing the
focus group: impact of the awareness of major factors
contributing to non-adherence to acute paediatric
asthma guidelines. J Eval Clin Pract 2010 Sep 22.
[Epub ahead of print].

Maa SH, Chang YC, Chou CL, Ho SC, Sheng

TF, Macdonald K, Wang Y, Shen YM, Abraham I.
Evaluation of the feasibility of a school-based asthma
management programme in Taiwan. J Clin Nurs 2010;

Journal of Clinical Pharmacology

Wong MC, Jiang JY, Griffiths SM. Antihypertensive
drug adherence among 6408 Chinese patients on
angiotensin-converting enzyme inhibitors in Hong
Kong: a cohort study. J Clin Pharmacol 2010;

Journal of Clinical Pharmacy and

Tsuji K, Tsutani K. Approval of new drugs 1999-2007:
comparison of the US, the EU and Japan situations. J
Clin Pharm Ther 2010; 35(3):289-301.
Sultana G, Kapur P, Aqil M, Alam MS, Pillai KK. Drug
utilization of oral hypoglycemic agents in a university
teaching hospital in India. J Clin Pharm Ther 2010;

Journal of Community Health

Silver A, Figge J, Haskin DL, Pryor V, Fuller K,
Lemme T, Li N, OBrien MJ. An Asthma and Diabetes
Quality Improvement Project: Enhancing Care in
Clinics and Community Health Centers. J Community
Health 2010 Jul 29. [Epub ahead of print].

Journal of Evaluation in Clinical Practice

Fokkens AS, Wiegersma PA, Reijneveld SA.

Organization of diabetes primary care: a review of
interventions that delegate general practitioner tasks to
a nurse. J Eval Clin Pract 2010 Aug 26. [Epub ahead of
Chen CC, Wu LC, Li CY, Liu CK, Woung LC, Ko MC.
Non-adherence to antibiotic prescription guidelines
in treating urinary tract infection of children: a
population-based study in Taiwan. J Eval Clin Pract
2010 Aug 24. [Epub ahead of print].
Barry AR, Loewen PS, de Lemos J, Lee KG.
Reasons for non-use of proven pharmacotherapeutic
interventions: systematic review and framework
development. J Eval Clin Pract 2010 Aug 24. [Epub
ahead of print].
Lin YC, Lin HC, Lin HC. Doctor characteristics and
prescribing antibiotics for urinary tract infections: the
experience of an Asian country. J Eval Clin Pract 2010
Aug 15. [Epub ahead of print].
Millar A, Cauch-Dudek K, Shah BR. The impact of
diabetes education on blood glucose self-monitoring
among older adults. J Eval Clin Pract 2010; 16(4):790793.
Doubova SV, Mino-Leon D, Reyes-Morales H, FloresHernandez S, Torres-Arreola LP, Perez-Cuevas R.
Effects of two educational programmes aimed at
improving the utilization of non-opioid analgesics in
family medicine clinics in Mexico. J Eval Clin Pract
2010; 16(4):716-723.

INRUD News, January 2011


Recent articles
Siriwardena AN, Apekey T, Tilling M, Dyas JV,
Middleton H, Orner R. General practitioners
preferences for managing insomnia and opportunities
for reducing hypnotic prescribing. J Eval Clin Pract
2010; 16(4):731-737.
Kyle GJ, Nissen L, Tett S. Community pharmacy
dispensing of prescription medicine sample packs:
changing the business of medicine initiation? J Eval
Clin Pract 2010 Jul 29. [Epub ahead of print].

Journal of General Internal Medicine

Pinckney RG, Helminski AS, Kennedy AG, Maclean
CD, Hurowitz L, Cote E. The Effect of Medication
Samples on Self-Reported Prescribing Practices: A
Statewide, Cross-Sectional Survey. J Gen Intern Med
2010 Aug 31. [Epub ahead of print].

Journal of Health Economics

Bardey D, Bommier A, Jullien B. Retail price
regulation and innovation: reference pricing in
the pharmaceutical industry. J Health Econ 2010;

Journal of Health Services Research and

Atkins S, Biles D, Lewin S, Ringsberg K, Thorson
A. Patients experiences of an intervention to support
tuberculosis treatment adherence in South Africa. J
Health Serv Res Policy 2010; 15(3):163-170.

Journal of Infection
Joung MK, Kwon KT, Kang CI, Cheong HS, Rhee
JY, Jung DS, Chung SM, Lee JA, Moon SY, Ko KS,
Chung DR, Lee NY, Song JH, Peck KR. Impact of
inappropriate antimicrobial therapy on outcome in
patients with hospital-acquired pneumonia caused by
Acinetobacter baumannii. J Infect 2010; 61(3):212-218.

Journal of Infection and Public Health

Dib JG, Al Tawfiq JA, Al Abdulmohsin S, Mohammed
K, Jenden PD. Improvement in vancomycin utilization
in adults in a Saudi Arabian Medical Center using
the Hospital Infection Control Practices Advisory
Committee guidelines and simple educational activity. J
Infect Public Health 2009; 2(3):141-146.

INRUD News, January 2011

Scicluna EA, Borg MA, Gur D, Rasslan O, Taher I,

Redjeb SB, Elnassar Z, Bagatzouni DP, Daoud Z. Selfmedication with antibiotics in the ambulatory care
setting within the Euro-Mediterranean region; results
from the ARMed project. J Infect Public Health 2009;

Journal of the International AIDS Society

Waning B, Diedrichsen E, Moon S. A lifeline to
treatment: the role of Indian generic manufacturers
in supplying antiretroviral medicines to developing
countries. J Int AIDS Soc 2010; 13:35.

Journal of Managed Care Pharmacy

Bhargava V, Greg ME, Shields MC. Addition of generic
medication vouchers to a pharmacist academic detailing
program: effects on the generic dispensing ratio in a
physician-hospital organization. J Manag Care Pharm
2010; 16(6):384-392.
Linton A, Bacon TA, Trice S, Devine J, Cottrell L,
McGinnis TJ, McAllister EB. Results from a mailed
promotion of medication reviews among department
of defense beneficiaries receiving 10 or more chronic
medications. J Manag Care Pharm 2010; 16(8):578592.

Journal of Medical Economics

Yu AP, Xie J, Bensimon A, Parikh K, Wu EQ, Ben
Hamadi R, Blum S, Haim Erder M. Economic
consequence of switching to citalopram after its
generic entry for adult patients with major depressive
disorder (MDD) treated with escitalopram: a 6-month
retrospective study. J Med Econ 2010 Sep 29. [Epub
ahead of print].

Journal of Medical Systems

Chuang MH, Wang YF, Chen M, Cham TM.
Effectiveness of implementation of a new drug storage
label and error-reducing process on the accuracy of
drug dispensing. J Med Syst 2010 Oct 15. [Epub ahead
of print].


Recent articles
Journal of Rheumatology

Medical Care

Lineker SC, Husted JA. Educational interventions for

implementation of arthritis clinical practice guidelines
in primary care: effects on health professional behavior.
J Rheumatol 2010; 37(8):1562-1569.

Alexander JA, Hearld LR. The science of quality

improvement implementation: developing capacity to
make a difference. Med Care 2010 Sep 8. [Epub ahead
of print].

Journal of Tropical Pediatrics

Ostini R, Jackson C, Hegney D, Tett SE. How is

medication prescribing ceased?: a systematic review.
Med Care 2010 Oct 18. [Epub ahead of print].

Chen R, Chen Y, Black S, Hao CL, Ding YF, Zhang

T, Zhao GM. Antibiotic resistance patterns and
serotype distribution in Streptococcus pneumoniae
from hospitalized pediatric patients with respiratory
infections in Suzhou, China. J Trop Pediatr 2010;

Fang G, Brooks JM, Chrischilles EA. A new method

to isolate local-area practice styles in prescription use
as the basis for instrumental variables in comparative
effectiveness research. Med Care 2010; 48(8):710-717.

Journal of Vector Borne Diseases

Medical Care Research and Review

Adedotun AA, Morenikeji OA, Odaibo AB.

Knowledge, attitudes and practices about malaria in an
urban community in south-western Nigeria. J Vector
Borne Dis 2010; 47(3):155-159.

Baig AA, Wilkes AE, Davis AM, Peek ME, Huang ES,
Bell DS, Chin MH. The use of quality improvement
and health information technology approaches to
improve diabetes outcomes in African American and
Hispanic patients. Med Care Res Rev 2010; 67(5

Ridley DB, Sanchez AC. Introduction of European
priority review vouchers to encourage development of
new medicines for neglected diseases. Lancet 2010;
Adeyi O, Atun R. Universal access to malaria
medicines: innovation in financing and delivery. Lancet
2010 Oct 10. [Epub ahead of print].

Malaria Journal
Alba S, Hetzel MW, Goodman C, Dillip A, Liana
J, Mshinda H, Lengeler C. Improvements in access
to malaria treatment in Tanzania after switch to
artemisinin combination therapy and the introduction
of accredited drug dispensing outlets - a provider
perspective. Malar J 2010; 9:164.
Kyabayinze DJ, Asiimwe C, Nakanjako D, Nabakooza
J, Counihan H, Tibenderana JK. Use of RDTs to
improve malaria diagnosis and fever case management
at primary health care facilities in Uganda. Malar J
2010; 9:200.

INRUD News, January 2011

Mdecine et maladies infectieuses

Hounsa A, Kouadio L, De Mol P. [Self-medication
with antibiotics obtained from private pharmacies
in Abidjan, Ivory Coast]. Med Mal Infect 2010;

Medical Principles and Practices

Saad H, Sawan S, Rashed W, Zubaid M. Influence of
diabetes on the outcome of acute coronary syndrome in
Kuwait. Med Princ Pract 2010; 19(2):113-117.
Ayyad S, Al Owaisheer A, Al Banwan F, Al Mejalli
A, Shukkur M, Thalib L. Evidence-based practice in
the use of antibiotics for respiratory tract infections
in primary health centers in Kuwait. Med Princ Pract
2010; 19(5):339-343.

Mdicine Tropicale
Maiga D, Maiga S, Maiga MD. [Mechanism and
implication of regulation of the pricing of essential
medicines in the private pharmaceutical sector in Mali].
Med Trop 2010; 70(2):184-188.


Recent articles
Nepal Medical College Journal

Pharmacy World and Science

Kafle KK, Bhuju GB, Karkee SB, Prasad RR, Shrestha

N, Shrestha AD, Das PL, Chataut BD, Daud M. An
intervention improving prescribing practices and
monitoring drugs availability in a district. Nepal Med
Coll J 2009; 11(4):217-221.

Babar ZU, Stewart J, Reddy S, Alzaher W, Vareed

P, Yacoub N, Dhroptee B, Rew A. An evaluation of
consumers knowledge, perceptions and attitudes
regarding generic medicines in Auckland. Pharm World
Sci 2010; 32(4):440-448.

Nigeria Quarterly Journal of Hospital



Aina BA, Tayo F, Taylor O, Eniojukan JF. Antimalarial

prescribing patterns in state hospitals and selected
parastatal hospitals in Lagos, Nigeria. Nig Q J Hosp
Med 2009; 19(1):20-26.

Patient Preference and Adherence

Wilbur K, Salam SE, Mohammadi E. Patient
perceptions of pharmacist roles in guiding selfmedication of over-the-counter therapy in Qatar. Patient
Prefer Adherence 2010; 4:87-93.

Pharmacoepidemiology and Drug Safety

Qato DM, Lindau ST, Conti RM, Schumm LP,
Alexander GC. Racial and ethnic disparities in
cardiovascular medication use among older adults in
the United States. Pharmacoepidemiol Drug Saf 2010;
Hansen RA, Cornell PY, Ryan PB, Williams CE,
Pierson S, Greene SB. Patterns in nursing home
medication errors: disproportionality analysis as
a novel method to identify quality improvement
opportunities. Pharmacoepidemiol Drug Saf 2010;
Carrasco-Garrido P, Hernndez-Barrera V, Lpez
de Andrs A, Jimnez-Trujillo I, Jimnez-Garca
R.Sex-Differences on self-medication in Spain.
Pharmacoepidemiol Drug Saf 2010 Sep 24. [Epub
ahead of print].
Oreagba IA, Ogunleye OJ, Olayemi SO.
The knowledge, perceptions and practice of
pharmacovigilance amongst community pharmacists
in Lagos state, south west Nigeria. Pharmacoepidemiol
Drug Saf 2010 Sep 15. [Epub ahead of print].

INRUD News, January 2011

Weissenfeld J, Stock S, Lngen M, Gerber A. The

nocebo effect: a reason for patients non-adherence to
generic substitution? Pharmazie 2010; 65(7):451-456.

PLoS Medicine
Niens LM, Cameron A, Van de PE, Ewen M, Brouwer
WB, Laing R. Quantifying the impoverishing effects of
purchasing medicines: a cross-country comparison of
the affordability of medicines in the developing world.
PLoS Med 2010; 7(8) pii: e1000333.

PLoS Neglected Tropical Diseases

Cavalli A, Bamba SI, Traore MN, Boelaert M,
Coulibaly Y, Polman K, Pirard M, Van Dormael M.
Interactions between Global Health Initiatives and
country health systems: the case of a neglected tropical
diseases control program in Mali. PLoS Negl Trop Dis
2010; 4(8):e798

Plos One
Udwadia ZF, Pinto LM, Uplekar MW. Tuberculosis
management by private practitioners in Mumbai, India:
has anything changed in two decades? PLoS ONE
2010; 5(8):e12023.

Population Health Management

Nair KV, Miller K, Park J, Allen RR, Saseen JJ, Biddle
V. Prescription co-pay reduction program for diabetic
employees. Popul Health Manag 2010; 13(5):235-245.
Patel UB, Ni Q, Clayton C, Lam P, Parks J. An attempt
to improve antipsychotic medication adherence by
feedback of medication possession ratio scores to
prescribers. Popul Health Manag 2010; 13(5):269-274.


Recent articles
Psychiatric Services

Singapore Medical Journal

Robst JM, Constantine R, Boaz T, Andel R, Teague G,

Becker M, Howe A. Short-term impact of preferred
drug list changes on health care use and Medicaid
costs: injectable risperidone. Psychiatr Serv 2010;

Shankar PR, Upadhyay DK, Subish P, Bhandari RB,

Das B. Drug utilisation among older inpatients in a
teaching hospital in Western Nepal. Singapore Med J
2010; 51(1):28-34.

Quality and Safety in Health Care

Wilczynski NL, Haynes RB. Optimal search filters for
detecting quality improvement studies in Medline. Qual
Saf Health Care 2010 Jul 29. [Epub ahead of print].

Research in Social and Administrative

Goedken AM, Urmie JM, Farris KB, Doucette WR.
Impact of cost sharing on prescription drugs used by
Medicare beneficiaries. Res Social Adm Pharm 2010;

Revista de sade pblica

Lopes LC, Barberato-Filho S, Costa AC, Osorio-deCastro CG. Rational use of anticancer drugs and patient
lawsuits in the state of Sao Paulo, Southeastern Brazil.
Rev Saude Publica 2010; 44(4):620-628.

Revista panamericana de salud pblica

Madden JM, Meza E, Ewen M, Laing RO, Stephens
P, Ross-Degnan D. Measuring medicine prices in
Peru: validation of key aspects of WHO/HAI survey
methodology. Rev Panam Salud Publica 2010;

Sexually Transmitted Diseases

Corbell C, Stergachis A, Ndowa F, Ndase P, Barnes
L, Celum C. Genital ulcer disease treatment policies
and access to acyclovir in eight sub-Saharan African
countries. Sex Transm Dis 2010; 37(8):488-493.

Sexually Transmitted Infections

Gomez GB, Campos PE, Buendia C, Carcamo CP,
Garcia PJ, Segura P, Whittington WL, Hughes JP,
Ward H, Garnett GP, Holmes KK.. Studying complex
interactions among determinants of health care-seeking
behaviours: self-medication for sexually transmitted
infection symptoms in female sex workers. Sex Transm
Infect 2010; 86(4):285-291.

INRUD News, January 2011

Social Science and Medicine

Kamat VR, Nyato DJ. Soft targets or partners in health?
Retail pharmacies and their role in Tanzanias malaria
control program. Soc Sci Med 2010; 71(3):626-633.
Masiye F, Chitah BM, McIntyre D. From targeted
exemptions to user fee abolition in health care:
experience from rural Zambia. Soc Sci Med 2010;

Kao LS, Lew DF, Doyle PD, Carrick MM, Jordan VS,
Thomas EJ, Lally KP. A tale of 2 hospitals: a staggered
cohort study of targeted interventions to improve
compliance with antibiotic prophylaxis guidelines.
Surgery 2010; 148(2):255-262.

Teaching and Learning in Medicine

Naughton BJ, Singh R, Wisniewski AM, Singh G,
Anderson DR. Improving quality of NSAID prescribing
by internal medicine trainees with an educational
intervention. Teach Learn Med 2010; 22(4):287-292.

Evans CD, Eurich DT, Taylor JG, Remillard AJ,
Shevchuk YM, Blackburn DF. A pragmatic cluster
randomized trial evaluating the impact of a community
pharmacy intervention on statin adherence: rationale
and design of the Community Pharmacy Assisting in
Total Cardiovascular Health (CPATCH) study. Trials
2010; 11:76.
Brooker S, Okello G, Njagi K, Dubeck MM, Halliday
KE, Inyega H, Jukes MC. Improving educational
achievement and anaemia of school children: design
of a cluster randomised trial of school-based malaria
prevention and enhanced literacy instruction in Kenya.
Trials 2010; 11:93.


Recent articles
Tobacco Control
Smith MW, Chen S, Siroka AM, Hamlett-Berry K.
Using policy to increase prescribing of smoking
cessation medications in the VA health care system.
Tob Control 2010 Sep 24. [Epub ahead of print].

Tropical Medicine and International Health

Hasker E, Singh SP, Malaviya P, Singh RP, Shankar
R, Boelaert M, Sundar S. Management of visceral
leishmaniasis in rural primary health care services in
Bihar, India. Trop Med Int Health 2010; 15 Suppl 2:5562.
Bratt JH, Torpey K, Kabaso M, Gondwe Y. Costs
of HIV/AIDS outpatient services delivered through
Zambian public health facilities. Trop Med Int Health
2010 Oct 19. [Epub ahead of print].

Zeng F, An JJ, Scully R, Barrington C, Patel BV,

Nichol MB. The impact of value-based benefit design
on adherence to diabetes medications: a propensity
score-weighted difference in difference evaluation.
Value Health 2010 Sep;13(6):846-52.

Zhonghua Yi Xue Za Zhi

Cao B, Sun LY, Liu K, Li RS, Liu YM, Tong ZH, Li
WX, Pan SF, Yang Y, Huang KW, Li CS, Chen YY,
Wang HY, Li B, Hu YS, Hou SC, Wang C. [A hospitalwide intervention program to optimize the utilization
quality of carbapenems and glycopeptides]. Zhonghua
Yi Xue Za Zhi 2009; 89(36):2557-2560.

Harries AD, Zachariah R, Lawn SD, Rosen S.

Strategies to improve patient retention on antiretroviral
therapy in sub-Saharan Africa. Trop Med Int Health
2010; 15 Suppl 1:70-75.

Upsala Journal of Medical Sciences

Vgter K, Wahlstrm R, Wedel H, Svrdsudd K.
Effect of mailed feedback on drug prescribing profiles
in general practice: a seven-year longitudinal study in
Storstrm County, Denmark. Ups J Med Sci 2010.

Value in Health
Chapman RH, Kowal SL, Cherry SB, Ferrufino CP,
Roberts CS, Chen L. The modeled lifetime costeffectiveness of published adherence-improving
interventions for antihypertensive and lipid-lowering
medications. Value Health 2010 Sep;13(6):685-94.
Chabot I, Rocchi A. How do cost-effectiveness
analyses inform reimbursement decisions for oncology
medicines in Canada? The example of sunitinib for
first-line treatment of metastatic renal cell carcinoma.
Value Health 2010 Sep;13(6):837-45.
Barron TI, Bennett K, Feely J. A competing risks
prescription refill model of compliance and persistence.
Value Health 2010 Sep;13(6):796-804.

INRUD News, January 2011


Support for INRUD News

This newsletter was made possible

through support provided by the Swedish
International Development Cooperation
Agency. The opinions expressed herein are
those of the authors and do not necessarily
reflect the views of the Swedish International
Development Cooperation Agency.

For further information about INRUD or

INRUD News, please contact the INRUD
Coordinator at the following address
4301 North Fairfax Drive, Suite 400
Arlington, Virginia 22203-1627 USA
Tel: 703-524-6575
Fax: 703-524-7898

What Is INRUD?
The International Network for Rational Use of Drugs (INRUD) was established in 1989 with the goal of
promoting the rational use of pharmaceuticals. INRUDs strategy to achieve this includes

An interdisciplinary focus, linking clinical and social sciences

Activities originating from country-based core groups of individuals representing ministries of health,
universities, nongovernmental organizations, and private-sector institutions

Belief in the importance of sharing relevant experiences and in technical cooperation among participating

Emphasis on understanding behavioral aspects of drug use, particularly the beliefs and motivations of
providers and consumers

Promotion of well-designed research studies to understand these behavioral factors, leading to reproducible
interventions to improve drug use

Development of useful tools for research, including standard research methodologies, simplified sampling and
data collection strategies, and user-accessible computer software

INRUD News, January 2011


Ethiopia: Tenaw Andualem
P. O. Box 31540
Addis Ababa, Ethiopia
Fax: +251-162-63-10
E-mail: or
Ghana: Dr. David Ofori-Adjei
Centre for Tropical Clinical
University of Ghana Medical School
P.O. Box 4236
Accra, Ghana
or Daniel Arhinful at
Kenya: Prof. Bill Lore
Fax: +254-2-574108
Nigeria: Prof. Ambrose Isah
Unit of Clinical Pharmacology and Therapeutics
Department of Medicine, University of Benin
Benin City, Nigeria
Tanzania: Dr. Amos Massele
Dept. of Clinical Pharmacology
Muhimbili University College
Fax: +255-51-151596
Uganda: Dr. Paul Waako
Dept. of Pharmacology &
Makerere University Medical School
Fax: +256-41-532-947
Zimbabwe: Dr. C. E. Ndhlovu
Directorate of Pharmacy Services
Ministry of Health and Child Welfare
Fax: +263-4-730-970 or

Bangladesh: Prof. Azad Chowdhury
Dept. of Clinical Pharmacy & Pharmacology
University of Dhaka
Tel: +88-02-8625677
Cell No: +88-01713040361
E-mail:,, or duregstr@

INRUD News, January 2011

Cambodia: Dr. Chroeng Sokhan

Dept. of Drugs and Food
Fax: +855-23-88 06 96
China: Dr. Zongjiu Zhang
Dept. of Health Policy and
Peking University School of
Public Health
Fax: +8610-82801607
India/Delhi: Dr. Usha Gupta
Maulana Azad Medical College
Fax: +91-11-3235574
India/Karnataka: Dr. Gopal Dabade
Drug Action Forum Karnataka
57, Sony, Tejaswinagar, Dharwad
Karnataka, India
Tel: +91(0)836-2461722
Cell No: +91(0)9448862270
Fax: +91(0)836-2461722
India/Tamil Nadu: Dr. R. Murali
TamilNadu AIDS Control Society
Fax: +91-44-4983298
Indonesia: Dr. Sri Suryawati
Centre for Clinical Pharmacology
and Drug Policy Studies
Gadjah Mada University
Fax: +62-274-563-596
Kyrgyzstan: Prof. Zurdinov Ashirali
Tel: +312-54-58-53, 54-58-92
Nepal: Prof. Kumud K. Kafle
Head of Clinical Pharmacology
Tribhuvan University
Teaching Hospital
Fax: +977-1-4115515
Philippines: Dr. Roberto A. Rosadia
Program Management Technical
Advisors Team
Fax: +632-742-8107

Thailand: Dr. Chitr Sitthi-amorn

Director of Saint Louis Hospital
Bangkok, Thailand
Via Ratana Somrongthong
Vietnam: Dr. Pham Huy Dung
Vietnam Association of
Family Physicians

Karolinska Institutet: Dr. Gran Tomson
Division of International Health
Dept. of Public Health Sciences
Stockholm, Sweden
Fax: +46-8-311-590
Moldova: Dr. Natalia Cebotarenco
Tel/Fax: +3732-2-4505-94
World Health Organization:
Dr. Kathy Holloway
Department of Essential Medicines and
Pharmaceutical Policies
Geneva, Switzerland
Fax: +41-22-791-4167

Latin America
Peru: Dr. Ral Cruzado Ubills
Seguro Integral de SaludMinisterio de
Fax: +51-1-387-9244

North America
WHO Collaborating Center in
Pharmaceutical Policy and Drug Policy
Research Group: Dr. Dennis RossDegnan
Dept. of Ambulatory Care &
Harvard Medical School
Boston, MA, USA
Fax: +617-859-8112
INRUD Secretariat: Dr. John Chalker
Management Sciences for Health
Arlington, VA, USA
Fax: +703-524-7898