Browsing by Author "Amien, Feroza"

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    Assessing and improving care for patients with TB/HIV/STIs in a rural district in KwaZulu-Natal South Africa
    (Health and Medical Publishing Group (HMPG), 2011) Loveday, Marion; Scott, Vera; McLaughlin, Jennifer; Amien, Feroza; Virgina, Zweigenthal
    Setting: Despite the prioritisation of TB, HIV and STI programmes in South Africa, service targets are not achieved, have had little effect, and the magnitude of the epidemics continues to escalate. Objective. To report on a participatory quality improvement intervention designed to evaluate these priority programmes in primary health care (PHC) clinics in a rural district in KwaZulu-Natal. Methods: A participatory quality improvement intervention with district health managers, PHC supervisors and researchers was used to modify a TB/HIV/STI audit tool for use in a rural area, conduct a district-wide clinic audit, assess performance, set targets and develop plans to address the problems identified. Results: We highlight weaknesses in training and support of staff at PHC clinics, pharmaceutical and laboratory failures, and inadequate monitoring of patients as contributing to poor TB, HIV and STI service implementation. In the 25 facilities audited, 71% of the clinical staff had received no training in TB diagnosis and management, and 46% of the facilities were visited monthly by a PHC supervisor. Eighty per cent of the facilities experienced non-availability of essential drugs and supplies; polymerase chain reaction (PCR) results were not documented for 54% of specimens assessed, and the mean length of time between eligibility for ART and starting treatment was 47 days. Conclusion: Through a participatory approach, a TB/HIV/STI audit tool was successfully adapted and implemented in a rural district. It yielded information enabling managers to identify obstacles to TB, HIV and STI service implementation and develop plans to address these. The audit can be used by the district to monitor priority services at a primary level.
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    Location of community pharmacies and prevalence of oral conditions in the Western Cape Province
    (Elsevier, 2013) Amien, Feroza; Myburgh, Neil G.; Butler, Nadine
    Community pharmacists are approached regularly for oral health advice; most commonly for ulcers which could be indicative of oral cancer, HIV, and various systemic diseases. Community pharmacists should know how to manage these conditions yet they have very limited training to manage these conditions appropriately. The area location and socioeconomic status (SES) of the pharmacy should be considered as it may influence patient management. A study of this nature has not yet been conducted in the Western Cape Province of South Africa. To determine the prevalence and frequency of oral complaints at community pharmacies and if these parameters differ by metropolitan location and SES. A cross-sectional survey of 162 randomlyselected private sector pharmacies was conducted. The sample (n = 121) was stratified by SES and metropolitan location. An open-ended structured questionnaire was faxed to pharmacists. A telephonic interview was conducted a day later. Community pharmacists were asked about the frequency and type of oral health problems they encountered. Most pharmacists (91%) dealt with oral health problems frequently, most commonly for ulcers (55.8%), thrush (49.2%), and toothache (33.3%). The results did not differ by metropolitan location and SES (Chi-squared, Fisher’s Exact, p > 0.05), with the exception of toothache and mouth sores. Community pharmacists are an important part of an interdisciplinary team, and play a definite role in the early detection of oral health conditions, namely, caries, HIV and oral cancer. Training on common oral health conditions should be included in undergraduate pharmacy curricula and continuous professional development courses.
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    Management of oral ulcers and oral thrush by Community Pharmacists.
    (University of the Western Cape, 2009) Amien, Feroza; Myburgh, N.G.; Butler, Nadine; Faculty of Dentistry
    Oral ulcers and oral thrush could be indicative of serious illnesses such as oral cancer, HIV and other sexually transmitted infections (STIs), among others. There are many different health care workers that can be approached for advice and/or treatment for oral ulcers and oral thrush (sometimes referred to as mouth sores by patients), including pharmacists. In fact, the mild and intermittent nature of oral ulcers and oral thrush may most likely lead the patient to present to a pharmacist for immediate treatment. In addition, certain aspects of access are exempt at a pharmacy such as long queues and waiting times, the need to make an appointment and the cost for consultation. Thus pharmacies may serve as a reservoir of undetected cases of oral cancer, HIV and other STIs. Aim: To determine how community pharmacists in the Western Cape manage oral ulcers and oral thrush. Objectives: The data set included the prevalence of oral complaints confronted by pharmacists, how they manage oral ulcers, oral thrush and mouth sores, their knowledge about these conditions, and the influence of socio-economic status (SES) and metropolitan location (metro or non-metro) on recognition and management of the lesions. Method: A cross-sectional survey of community pharmacists in the Western Cape was conducted. A random sample of pharmacies was stratified by SES (high and low), and metropolitan location. A structured questionnaire was used to conduct a telephonic interview. The questionnaire was faxed to pharmacists 24 hours prior to the interview. Pharmacists were also telephoned 24 hours prior to the interview, but after the questionnaire was faxed, in order to gain informed consent for participation in the study, and to confirm a convenient time to conduct the interview. Results: Two thirds (63%) of pharmacists managed oral problems nearly everyday, and 30% managed these more than once a week. More pharmacists in high SES (73%) areas managed oral problems nearly everyday (Fisher Exact, p=0.0005). Just over half (56%) and 49.2% of pharmacists said that ulcers and thrush, respectively, was the most common oral problem that they encounter. The prevalence of oral thrush was significantly higher in non-metro areas (58%) (RR=0.7 (0.5-1.0) ChiSquared=4.0, p=0.04), and it was also significantly lower in low SES areas (RR=1.6 (1.1-2.4), Chi Squared=6.5, p=0.01). Half the pharmacists reported that they would manage the patient comprehensively. Most would take a history but the quality of the history is poor, thereby compromising their ability to manage these cases appropriately. Only a third would refer a simple oral ulcer, thrush or mouth sore to a doctor/dentist but all pharmacists would have referred a longstanding ulcer to a doctor/dentist. In terms of knowledge, only 33% of pharmacists were aware that oral ulcers and thrush could be indicative of HIV infection, and only 8% linked oral ulcers with oral cancer. There was no discernable pattern of management of oral ulcers and thrush, or of knowledge of the link between these lesions with underlying diseases, by SES and metropolitan locations (Chi Squared, Fisher Exact, p>0.05). Conclusion: The result of this study strengthens the current view of pharmacists as oral health advisors as they encounter oral problems regularly, most commonly oral ulcers and oral thrush. Therefore, the pharmacist can play an important role in the early detection of HIV and oral cancer. However many pharmacists fail to refer these cases to a dentist. Most pharmacists lacked specific knowledge about the relationship of oral ulcers and thrush with underlying conditions, which may explain why many pharmacists are not managing these cases correctly. There is a definite need to train pharmacists at both an under- and post-graduate level with specific emphasis on the proper management of oral ulcers, oral thrush and mouth sores, as well as comprehensive training that outlines why vigilant management of oral ulcers and oral thrush is necessary.