Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic diseases of lifestyle (CDL) are on a raising trend in the world regardless of age,economic class or geographical location of a population. The mortality rate associated with CDL is alarmingly among the highest globally. Tanzania is not exempted from this development.Literature indicates that physical activity is a health practice that can prevent CDL. It is recommended that medical practitioners should hold the responsibility of counselling patients on physical activity. Some studies outside Africa found an association between doctors’ physical activity patterns and their counselling practices on the same. This study therefore sought to establish whether physical inactivity among medical doctors in Tanzania significantly influenced their counselling practices on physical activity. A cross sectional quantitative survey at the Muhimbili National Hospital and Muhimbili Orthopedic Institute was conducted to derive the required information. A self administered structured questionnaire was voluntarily answered by 144 medical doctors. The Statistical Package for Social Sciences (SPSS) version 17 was used for data capturing and analysis. Descriptive statistics were employed to summarize data and was expressed as means, standard deviation, frequencies and percentages. The students’t-test was used to compare mean physical activity between different groups. Furthermore students’t-test and analysis of variance tests were used to examine association between different variables. Chisquare tests were used to test for associations between categorical variables. Alpha level was set at p< 0.05. Most of the participants in this study were sedentary in their leisure time and only active at work. When their quality of physical activity counselling was assessed, the majority of them were found to be poor physical activity counsellors. A significant association was found between physical activity and age, as well as physical activity and counselling practice (p<0.05).Participants mostly informed their patients about the intensity and duration of exercising more than any other idea of physical activity such as types of exercises, issuing of a written prescription and planning for a follow up. Lack of knowledge and experience about details of physical activity were reasons offered for failure to counsel. Participants also reported the inconvenience of physical activity facility’s schedules, fatigue and tiredness to be their barriers to physical activity participation. Doctors in Tanzania lacked personal initiative to participate in physical activity and consequently lacked the motivation to counsel. Measures around enhancing this health practice should be enhanced by all stakeholders including medical doctors,physiotherapists and patients. The need for short term and long term training in matters related to physical activity are therefore necessary among the practicing doctors and those undergoing training in medical schools. Physiotherapists who are trained in movement science can offer valuable advice/information to medical doctors to ensure that medical doctors acquire physical activity prescription and counselling knowledge. Collaboration between stakeholders in campaigning against sedentary lifestyles should be enhanced. Further reasons for failure to counsel, hindrances to physical activity participation and modern approaches to counselling should be explored.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Chronic non-communicable diseases, including cardio-vascular diseases and stroke, cancer, type 2 diabetes and chronic pulmonary disorders, are rapidly emerging as leading causes of morbidity and premature mortalities globally. The majority of the populations worldwide have experienced major transformations in disease profiles and health status characterized by a shift from infectious diseases and nutritional deficiencies to a predominance of chronic diseases of lifestyle. This epidemiological transition is regarded as an outcome of the environmental and socioeconomic changes following urbanization.Common behavioral health risk factors, such as smoking, risky alcohol consumption,sedentarism, overweigh/obesity and hypertension, have consistently been attributed to the development of chronic non-communicable diseases among populations.This thesis seeks to describe the epidemiology of the major common risk factors for noncommunicable diseases among people living in Mombasa, Kenya. The study responds to the WHO’S recommendations on comprehensive and continuous risk factor surveillance as an essential component of the public health information system and a vital health promoting strategy in the control and prevention of non-communicable diseases.A cross-sectional study design using the WHO STEPwise protocol was employed.Convenient stratification of the Mombasa population was done according to gender, age and setting categories. Using the Yamane formula n = N/1+ N(e²), a sample of 500 participants aged 15 to 70 years was arrived at. The researcher then conveniently selected public high schools, tertiary institutions, workplaces and a marketplace as the study settings.The WHO STEPS instrument (Core and Expanded Version 1.4) was used for data collection. Step 1 involved gathering information on socio-demographic characteristics and health-related behaviors of the participants using close-ended structured questions. Step involved the taking of simple anthropometrical measurements pertaining to height, weight, waist circumference, blood pressure and pulse rate.Data were captured, cleaned and analyzed using the Statistical Analysis System (SAS) and SPSS version 16.0. Chi-square and Spearman correlation tests were used to determine associations between socio-demographic variables and behavioral health risk factors.The results indicated that 61% of the study participants possessed at least one of the investigated risk factors. 17% of the participants had a multiple risk factor profile, with 54% more females having a higher mean risk factor score compared to 46% of their male counterparts.Physical inactivity, hypertension and overweight/obesity were the most common registered risk factors, accounting respectively for 42%, 24% and 11%. Physical inactivity and hypertension formed the commonest cluster of multiple risk factor patterns; they co-occurred in 68% of the participants with a multiple risk factor profile.Increasing age, female gender and a low level of educational attainment were factors seen to be significantly associated with the development of risk factors for non-communicable diseases among the participants. It was observed that the burden of risk factors was unequally distributed among Mombasa residents; intervention programs based on our findings should therefore be used to ensure effectiveness. Future studies using nationally representative samples are further suggested to provide a more comprehensive analysis of a national risk factor profile.

Aim: The overall aim of this thesis, using a salutogenic framework, was to develop knowledge about experiences and perceptions of living with recessive limb-girdle muscular dystrophy and its influences on health, from the affected young adults’ and their parents’ perspectives. Methods: A qualitative explorative and descriptive study design was used. Semi-structured interviews were held with 14 young adults diagnosed with recessive limb-girdle muscular dystrophy, aged 20–0 years, and 19 parents. Data analyses were conducted using content analysis (I, II, III) and phenomenography (IV). In order to mirror the interview data, the participants also answered the 13-item sense of coherence questionnaire. Findings: Recessive limb-girdle muscular dystrophy has a major impact on the affected young adults’ and their parents’ lives as the disease progresses. Health described in terms of well-being was thus perceived to be influenced, not only by physical, emotional and social consequences due to the disease and worry about disease progression but also by external factors, such as accessibility to support provided by society and other people’s attitudes. There was, however, a determination among the participants to try to make the best of the situation. The importance of being able to mobilize internal resources, having social support, meaningful daily activities, adapted environment, the young adult being seen as a person and having support from concerned professionals, including personal assistance when needed, was thereby described. Self-rated sense of coherence scores varied. Those who scored above or the same as median among the young adults (≥56) and the parents (≥68) expressed greater extent satisfaction regarding social relations, daily activities and external support than those who scored less than median. Conclusion: This thesis highlights the importance of early identification of personal perceptions and needs to enable timely health-promoting interventions. Through dialogue, not only support needed for the person to comprehend, manage and find meaning in everyday life can be identified, but also internal and external resources available to enhance health and well-being, taking into account the person’s social context as well as medical aspects.

Family history (FH) is a risk factor for many diseases. Disease guidelines often include family history as important in assessing chronic disease risks, but the empirical evidence base to inform the routine use of family history in primary care in practice appears largely lacking. An environmental scan of how family history is represented in prevention guidelines for five conditions showed that, while family history is often included in guidelines, there is variation in the definition used, recommendation given and evidence cited. A dataset on cardiovascular health in women was analyzed to examine whether family history offers useful discrimination value above standard risk factors. Regression results showed that family history is an independent risk predictor for coronary heart disease which improves discrimination beyond classical clinical factors. However, the absolute amount of discriminatory ability alone or with other factors is moderate at best, raising issues regarding clinical utility.

Orientadores: Tirza Aidar, Emerson Soares dos Santos / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciências Humanas / Made available in DSpace on 2018-08-27T09:09:58Z (GMT). No. of bitstreams: 1 Alencar_LeilaAuxiliadoradeArruda_D.pdf: 4236140 bytes, checksum: 3af39c092380f145f777f7e09be929ac (MD5) Previous issue date: 2014 / Resumo: Objetivo do presente estudo foi identificar as desigualdades socioespaciais refletidas na saúde da população idosa residente na cidade de Cuiabá. Trata-se de estudo ecológico descritivo com um componente temporal e outro espacial que analisou dados sobre população e da mortalidade aos 60 anos e mais de idade de residentes em Cuiabá. Informações sobre população e variáveis ambientais e econômicas foram obtidas dos censos demográficos de 2000 e 2010 do IBGE. Informações sobre óbitos foram extraídas da base municipal do Sistema de Informações de Mortalidade da Secretaria Municipal de Saúde de Cuiabá, georefenciados segundo bairros de residência no município. Procedeu-se a análise fatorial que possibilitou formar grupos de bairros homogêneos (clusters) segundo características ambientais e socioeconômicas. A distribuição geográfica das taxas de mortalidade pelas principais causas nos agrupamentos de bairros de Cuiabá mostrou que clusters mais ricos e desenvolvidos socioeconomicamente apresentaram menores taxas de mortalidade por doenças circulatórias e respiratórias e maiores taxas de mortalidade por neoplasias. Idosos de 60 a 69 anos são os mais vulneráveis às piores condições de vida do cluster, quando comparados aos mais idosos. Ou seja, os riscos para esse grupo etário residente nos clusters com piores indicadores sobre condição de vida foram maiores quando comparados aos demais. As mulheres sofrem mais ação das condições sociais dos clusters que os homens. Ficou evidenciada a importância das condições socioeconômicas e a heterogeneidade como estas mortes acontecem nos diferentes espaços físicos e sociais da cidade / Abstract: This study aims at identifying the socio spatial inequalities reflected in the health of the elderly population that lives in the city of Cuiabá. It is a descriptive ecological study with a temporal and spatial component which analyzed data about the population and mortality of people living in Cuiabá aged 60 and over. Data on the population and environmental and economic variables were obtained from the demographic censuses of 2000 and 2010 of the IBGE. Data on deaths were drawn from the municipal base of the Mortality Information System of the Municipal Health Office of Cuiabá, according to the neighborhoods of the municipality. Factorial analysis was done in order to form groups of homogeneous neighborhood (clusters) according to environmental and socioeconomic characteristics. The geographic distribution of mortality rates due to the main causes in the neighborhood clusters of Cuiabá showed that richer and socioeconomically developed clusters presented lower mortality rates due to circulatory and respiratory diseases and higher mortality rates due to neoplasias. Elderly aged 60 to 69 are the most vulnerable to the worst cluster living conditions than those above that age. That is, the risks for this age group that lives in the clusters with the worst indicators on life condition were higher when compared to the others. Women suffer more actions from the social conditions of the clusters than men. The study revealed the importance of the socio economic conditions and heterogeneity as these deaths occur in the different physical and social spaces of the city / Doutorado / Demografia / Doutora em Demografia

Avec le vieillissement de la population et les progrès médicaux, le nombre de patients souffrant d’une maladie chronique et devant prendre chaque jour un ou plusieurs médicaments est en augmentation. La non-observance, définie comme l’absence de concordance entre les comportements des patients et les prescriptions médicales, pose de nombreux défis aux cliniciens et aux chercheurs par sa complexité et son caractère dynamique au cours du temps.Dans un premier temps, nous avons développé un outil de mesure de l’observance médicamenteuse chez les patients prenant un traitement au long cours, en prenant en compte les différents types de comportements de non observance, médicament par médicament. La validité et fiabilité de cet instrument ont été évaluées en France, auprès de 243 patients. Dans un deuxième temps, nous avons réalisé une étude auprès de 128 binômes médecin-patient qui a mis en évidence une discordance entre l’observance médicamenteuse déclarée par les patients et l’importance des médicaments selon leur médecin traitant. Certains médicaments considérés comme importants par les médecins n’étaient pas correctement pris (situation potentiellement à risque) ; à l’inverse, certains médicaments de moindre importance étaient pris scrupuleusement, posant alors la question d’un fardeau évitable ou d’une potentielle surprescription. Dans un troisième temps, nous avons développé un outil collaboratif en ligne permettant à 544 médecins d’évaluer le seuil de non observance à partir duquel le risque encouru par le patient était inacceptable selon eux, en fonction du comportement de non observance (oubli ponctuel ou pause de plusieurs jours), et du médicament. Les estimations des médecins étaient très variables en fonction des médicaments, suggérant que les médicaments n’ont pas tous la même « tolérance à l’oubli » selon les médecins. Nos travaux ont permis de confirmer la complexité de l’observance qui ne se résume pas à une caractérisation binaire « bonne observance » ou « mauvaise observance ». Les perspectives de ces travaux seront le développement d’un outil de mesure en ligne inspiré de notre premier travail, ainsi que la comparaison des données de notre troisième travail avec des données d’observance. Une réflexion pour favoriser la discussion entre médecins et patients reste nécessaire, avec pour objectif une observance « optimale » et non forcément « parfaite », tenant compte des difficultés rencontrées par les patients. / Against the backdrop of population ageing and medical progress, the prevalence of long-term disorders is rising worldwide. As a consequence, an increasing number of patients need to take medications daily. Medication adherence, which can be defined as the extent to which patients’ medication-taking behaviors coincides with medical prescriptions, may become ever harder to achieve. Non-adherence is a main challenge for physicians and for researchers, especially given its complexity and its dynamic evolution over time. First, we developed a new instrument to assess medication adherence to each individual medication taken by patients undergoing long-term treatment, taking into account different types of medication-taking behavior. We assessed the instrument’s validity and reliability among 243 outpatients and inpatients taking 961 medications, in France. Second, we focused on the discordance between medication adherence as reported by patients and drug importance as reported by their physicians. We compared the opinions of 128 patients and physicians and showed that some drugs considered important by the physicians were not correctly taken by patients, a situation that may lead to potential severe consequences. On the contrary, some drugs considered less important by physicians were correctly taken by physicians, which may lead to potential overprescription and avoidable burden of treatment. Third, we used a crowd sourcing approach to assess physicians’ estimation of the threshold for unacceptable risk of non-adherence, for two distinct types of behavior (episodic missing doses and drug holidays) for the most prescribed drugs in France. Physicians’ estimations varied considerably according to the drugs assessed, suggesting that according to physicians, some drugs are “more forgiving” than others. Our findings confirm that medication adherence is a complex phenomenon that should not be simply dichotomized into « good adherence » and « bad adherence ». Future work will consist in developing and validating a new online tool inspired from our first study. We will try to sharpen our understanding of the results in our third study by comparing physicians’ estimations to patients’ adherence data. Future interventions are still needed to improve patient-physician discussion about medications in order to reach an “optimal adherence” rather than a "perfect adherence", taking into account patients’ perspectives.

Thesis (M.A. Pharm. (Pharmacy Practice) -- University of Limpopo, 2020 / Background: Non-communicable chronic disease contributes to premature mortality in SA, threatening the socio-economic development of the country. The efficient management of essential medicines supply at the clinic level is vital as stock-outs of the medicines increase morbidity and mortality. Objectives: The study aimed to identify and determine the challenges in the inventory management of medicine for the treatment of non-communicable chronic diseases at public health clinics in the Dikgale community of Limpopo province. Methods: The study used a cross-sectional quantitative research design; the purposive sampling technique was used, as it requires people with specific skills, knowledge, and expertise. A Pre-validated questionnaire was used to collect data from pharmacists, professional nurses, and transport personnel. Stock card utilization review and checklist were used to verify the answers obtained from the participants. Descriptive and inferential statistics were used to analyse the data collected. All these processes ensure that stock is always available and at optimal levels. The availability of stock at optimal levels is dependent on the personnel following SOPs. Results: In total, 40% of pharmacists indicated to have never trained nursing personnel on stock management, and 66.7% which, is the majority of nursing personnel, reported they have never been trained on stock management. Only 26.67% of medicines used for NCDs did not have stock cards. The study further found that the stock-card was not used every time a transaction was made. Thirty-nine (39%) percent of the respondents did not know how to quantify order quantities; this factor contributes to stock-outs experienced at clinics. All the clinics did not have a secure dedicated area. Deliveries are offloaded outside the medicine room. Conclusions: There is a training gap that needs to be closed to meet the minimum requirements as per GPP guidelines and also help to reduce medicine stock-outs as personnel will be well equipped to handle stock. In terms of inventory management and stock control systems, all primary healthcare sectors used a manual/paper-based inventory management system. Stock control systems are in place but were not always utilised and, processes are not consistent among staff members across clinics. With distribution, it would work better if nursing personnel dedicated a person to place and receive orders as discrepancies will be picked up sooner, and quantities will be sufficient to last until the next ordering date. None of the clinics complied with “Ideal Clinic” standards for infrastructure, storage, and inventory management. / VLIR

En France, depuis de nombreuses années nous assistons à des transformations diverses telles que la hausse des maladies chroniques, l’augmentation de l’espérance de vie mais également l’évolution des technologies de l’information et de la communication. Les maladies chroniques correspondent à la première cause de décès dans le monde. Elles coûtent cher à notre système de santé car elles impliquent plus de dépenses sur une période de vie davantage longue. La communication est au cœur des organisations. De plus en plus, on fait appel aux outils informatiques pour mieux communiquer, améliorer les processus et la qualité, pour accompagner les patients également. Nous remarquons pourtant de nombreuses difficultés dans la mise en œuvre de ces outils. La communication sur ces derniers étant soit insuffisante soit inappropriée. Cela rend alors les changements de pratiques difficiles. Nous essaierons de nous appuyer sur des études de cas et des observations de diverses natures afin de comprendre les facteurs de succès et les facteurs bloquants. Nous visiterons les pratiques, les perceptions et les représentations sociales autour de l’utilisation des technologies de l’information et de la communication, de plus en plus présentes dans la sphère médicale et médico-sociale.L’intérêt de cette thèse est donc d’essayer d’apporter un regard neutre sur les comportements des acteurs de santé, professionnels et patients face à un secteur de la santé faisant appel aux technologies de l’information dans un contexte économique contraignant. Les travaux de recherche se situent à l’interface des domaines de la communication et de la gestion. La thèse réalisée s’appuie sur des travaux de terrain tels que des audits cliniques, des auto-évaluations, des observations et des entretiens dans le secteur médico-social et le secteur du sanitaire.Nous nous demandons comment concilier maîtrise des dépenses, évolution technologique et accompagnement des équipes de soins et des patients. Nous interrogeons le vécu des personnes et essayons de proposer des axes d’amélioration. Pour ce faire, notre thèse a évolué grâce à la contribution de plusieurs structures d’accueil sur lesquelles reposent différentes études de cas. La première a lieu au sein d’un établissement médico-social assurant la prévention et les soins relatifs aux troubles addictifs. Cette étude de cas est mise en perspective avec une enquête comparative effectuée au sein d’un hôpital seine-et-marnais. Nous avons mis en place des interviews auprès des professionnels de santé et des managers des deux établissements, ainsi qu’une enquête sur le changement.La deuxième étude de cas se déroule dans le cadre d’audits cliniques ciblés de deux EHPAD de Franche-Comté. Notre rôle a été d’auditer les pratiques des professionnels de santé, sur la base d’observations et d’entretiens. Nous avons élaboré en équipe des préconisations et organisé des sessions de formation avec les managers de proximité et les professionnels de santé volontaires. La troisième étude de cas, quant à elle, a lieu au sein d’un groupement de coopération sanitaire spécialisé dans la filière diabète et maladies chroniques, le GCS Diapason. Ce dernier regroupe plusieurs structures et nous avons particulièrement porté nos regards sur un des établissements hospitaliers. / In recent years we have observed an increase in chronic illnesses in French soil, resulting in a significant growth in health expenses. In fact, such chronic diseases often lead to degradation in the quality of life of patients and necessitate longer treatment times. Some even face treatment for life. Chronic illnesses are "long-term illnesses that, as a general rule, develop slowly. Causing 63% of deaths, chronic illnesses (congenital heart diseases, strokes, cancer, Chronic respiratory diseases, diabetes...) are the number one cause of mortality in the world. Out of the 36 million people who died from chronic illnesses in 2008, 29% were less than 60 years old and half were women" (World Health Organization).We consider communication to be at the heart of human social life, and we begin with the assumption that it is thanks to communication that changes occur. If communication is effective, then the change that is undertaken has more chances of success. The concept of communication is understood here in the general sense as the sharing of information. Hence, communication constitutes the zone of sharing that exists between two human beings. In other words, it is the combination of messages that are shared between people. We think that these messages can be conscious or unconscious. Since the latter plays a higher role, it is without a doubt what makes human relationships more complex, particularly those relationships in the professional realm. We will thus attempt to illustrate in this dissertation the different aspects of communication through case studies.We also think that there is no societal life without communication. The exchange of information is therefore necessary. For the individual, communication has two main goals: on the one hand to obtain something from the other and on the other hand to be known or even to be recognized as a being.Therefore, the interest of this paper is to shed a neutral perspective on the behavior of participants in health services, including professionals and patients, in the face of a health sector that appeals to information technologies within economic constraints. The research work will be based at once on scientific data from the fields of communication and management, as well as on clinical audits, auto-evaluations, observations and interviews in the medical-social sector and the public health sector. Our thesis has evolved thanks to the contribution of several facilities on which different case studies are based. The first one is situated within the institution témoin 1, a medical-social institution that provides services for the prevention and treatment of addiction. This case study is carried out through a comparative survey conducted in a hospital in Seine-et-Marne, described under the name of institution témoin 3. We set up interviews with the healthcare professionals and managers of two institutions, as well as a survey on the changes. The second case study takes place in the context of clinical audits at two retirement homes in Franche-Comté, referred to here as EHPAD 1 and EHPAD 2. Our role was to audit the practices of healthcare professionals, on the basis of observations and interviews. We developed recommendations as a group and organized training sessions with local managers and volunteer healthcare professionals. As for the third case study, it takes place within a « groupement de coopération sanitaire » specialized in the field of diabetes and chronic illnesses, the GCS Diapason. The latter brings together several organizations and we examined in particular a hospital facility named here as témoin 2.

Coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving and is a serious public health threat worldwide. Timely and effective control of the pandemic is highly dependent on preventive approaches. Perception of risk is a major determinant of health behavior. The current study explores the association between actual risk and perceived risk for one’s self, family/friends and friends, and community. A questionnaire was administered to participants in Central Appalachia (n = 102). The actual risk was based on the number of chronic conditions of the following conditions: hypertension, heart disease, cancer, diabetes, and chronic obstructive pulmonary disease. Participants were also queried about their perception of risk for COVID-19. Generalized Linear Models were used to independently evaluate the likelihood of perceived risk for one’s: self, family/friends, and community, based on actual risk. Actual risk for COVID-19 was significantly associated with higher likelihood of higher perception of risk for one’s self (b = 0.24; p = 0.04), but not with one’s family/friends (b = 0.05; p = 0.68), or one’s community (b = 0.14; p = 0.16). No health insurance was negatively associated with perception of risk for self (b = −0.59; p = 0.04) and family/friends (b = −0.92; p < 0.001). Male gender (b = −0.47; p = 0.01) was also negatively associated with perception of risk for family/friends. In conclusion, individuals’ actual risk for COVID-19 is associated with their own perception of risk. This indicates that one’s perception of risk for COVID-19 is greater for their own health compared to their family/friends or the community. Therefore, monitoring and following up with chronic disease patients and addressing their lack of awareness of risk to others is needed to prevent and curtail the spread of COVID-19.

Background: Tertiary hospitals have multiple specialist outpatient clinics attended by patients suffering from various comorbid diseases. This results in individuals attending more than one clinic per month, since dedicated clinic days are seldom on the same day. As patients attend discrete clinics, they have separate encounters with various prescribers, increasing the potential for irrational drug use. In addition, multiple clinic visits have a negative socio-economic impact on health care users from poorer communities where financial resources are limited due to transport expenses and days of work missed. The aim of this study was to determine the prescribing pattern of drugs to chronic disease outpatients, and find possible solutions to provide a system that would reduce overprescribing of chronic medication at Steve Biko Academic Hospital (SBAH) in one measure namely drug duplication. Methods: A retrospective descriptive cross-sectional study with the use of convenience sampling was employed to determine the medication prescribing practises to comorbid chronic disease patients attending multiple specialist clinics at SBAH from February 1, 2018-May 31, 2018. Participants were selected according to their appearance in the hospital records, with sample saturation reached when each participant had visited all the different clinics. Chronic disease outpatients attending the SBAH clinics had reviews every three months. The reviews were controlled by issuing patients with medication for a three-month period, where after a follow up visit was mandatory in order to ensure prescription and medication renewal. Therefore, each patient visited all the clinics rendering a service relating to a specific chronic condition within a four-month period that determined the study period chosen. Hospital records of patients attending the most frequently visited clinics as reported by the SBAH Pharmacy and Therapeutics committee (PTC) were evaluated. These clinics included outpatient departments of diabetes, haematology, internal medicine, neurology, oncology and psychiatry. Each drug prescription observed was evaluated using guidelines of World Health Organization (WHO) titled, “How to investigate drug use in health facilities: selected drug use indicators.” Prescribing indicators relevant to this study were used from the WHO guidelines. Results: One hundred and six patients were multiple clinic-attendees during the study period. Of the 106 patients retained, 103 (97.17%) patients attended two clinics and three (2.83%) patients attended three clinics. Regarding the WHO prescribing indicators, the average number of visits to SBAH by the comorbid chronic disease outpatients observed was 3.03 visits during the four-month study period. Prescription analysis included 80 (75.47%) patients out of 106 patients attending multiple clinics at the same time. The average number of drugs prescribed per encounter was 4.97. The results also showed that 45.45% of the 187 prescriptions observed contained five or more drugs. Most frequently prescribed drugs were tramadol 51 (5.49%), followed by simvastatin 48 (5.17%) and enalapril 45 (4.84%). Drug duplication occurred in 68 individual cases in the 80 patients observed. In total, drug duplication affected 39 patients (48.75%) [95% CI = 37.80%: 59.70%]. The most duplicated drug classes were analgesics 18 (26.47%), followed by anti-depressants 14 (20.59%) cases recorded. Conclusion: The results from this study support findings from similar studies at different institutions. The study confirmed multiple clinic visits are prevalent in the medical disciplines, often prescribing drugs from the same class. Clinical implications from these frequent and separate encounters may result in irrational prescribing, adverse drug events, drug-drug interactions and polypharmacy. The establishment of polypharmacy to comorbid chronic disease patients indicates the high risk of drug-drug interactions and adverse drug events. A prospective study would have provided more data for analysis to determine the level of polypharmacy and drug duplication. Thus, supplementation of this study with further studies could provide conclusions on whether the patients suffered from problematic or had appropriate polypharmacy. Physicians treating multiple clinicattendees should be equipped to monitor rationality of prescribing encounters. Installation of an advanced electronic Hospital Information System (HIS) could aid in improving drug prescribing in tertiary hospitals. Use of electronic prescribing tools as shown in previous studies is a requirement to improve tertiary hospitals in developing countries such as SBAH. The incidence of drug duplication at SBAH builds on existing evidence of unnecessary healthcare costs because of medication errors. / Dissertation (MSc)--University of Pretoria, 2020. / Pharmacology / MSc (Pharmacology) / Unrestricted