Master of Public Health - MPH / This study aimed to identify barriers to the availability of essential drugs at health facilities, to identify implementable solutions to those barriers, to develop a monitoring system for tracking implementation of solutions and for tracking drug supply. / South Africa

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: OBJECTIVE The aim of this study is to establish the frequency of unlicensed and off label drug use in infants admitted to the neonatal intensive care unit (NICU) in Tygerberg Hospital. METHOD This was a prospective descriptive survey conducted over 3 consecutive months (September 2011-November 2011) of all medicine charts of neonates admitted during this time period to the NICU. Data collected included demography, diagnoses, medicines prescribed according to dose, frequency, route of administration and indication. Medicine use was defined as unlicensed, licensed or off label use according to the latest South African Medicines Formulary (2012) and the manufacturer’s package insert. Unlicensed drug use is per definition a drug not registered with South African Medicine Control Council (SA MCC) for children and off label drug use is where the use is outside of its authorized license with SA MCC. RESULTS There were 112 neonates enrolled in the study, of whom 51% were preterm and 49% term infants. The most common diagnoses on admission for the preterm babies were hyaline membrane disease (33%) and sepsis (21%), while it was hypoxic ischemic encephalopathy (42%) and post-operative care (22%) for term infants. There were 759 drug events of which 37% were licensed and followed all the licensing terms, 51% were prescribed in an off label manner and the remaining 12% were of unlicensed drugs. The most common reasons off label drug use were for weight (74%), followed by age (44%), frequency (44%), indication (21%), or a route not described in the licensing terms (13%). There was a lack of pediatric data for 9% of the drugs prescribed. In 203 drug events (27%) a drug was used in an off label manner for more than one reason. Sixty one percent of the drugs used had no information on the use of the drug in neonates. CONCLUSION This is the first study conducted in an African NICU, according to our knowledge and the results are similar to studies conducted in Europe and America. Neonates are exposed to a significant proportion of unlicensed and off label drugs. Neonatal clinical trials should be conducted to address the need for proven safe and efficacious treatment for neonates.

<p>This study aimed to identify barriers to the availability of essential drugs at health facilities, to identify implementable solutions to those barriers, to develop a monitoring system for tracking implementation of solutions and for tracking drug supply.</p>

<p>This study aimed to identify barriers to the availability of essential drugs at health facilities, to identify implementable solutions to those barriers, to develop a monitoring system for tracking implementation of solutions and for tracking drug supply.</p>

Thesis (M. Tech.) -- Central University of Technology, Free State, 2007 / Multi-agent systems (MAS) consist of a number of autonomous agents that communicate among themselves to coordinate their activities in order to solve collectively a complex problem that cannot be tackled by any agent individually. These kinds of systems are appropriate in many domains where problems that are complex, distributed and heterogeneous require communication and coordination between separate autonomous agents, which may be running on different machines distributed over the Internet and are located in many different places. In the health care domain, MAS have been used for distributed patient scheduling, organ and tissue transplant management, community care, decision support, training and so on. One other promising area of application is in the prescription of antiretroviral and antiTB drugs. The drugs used to treat the two diseases have many and similar side effects that complicate the prescription process. These factors have to be considered when prescribing medication to a person coinfected with HIV and tuberculosis. This is usually done manually using drug recommendation tables, which are complicated to use and require a great deal of decisionmaking. The design and implementation of a multiagent system that assists health care staff in carrying out the complex task of combining antiretroviral and antiTB drugs in an efficient way is described. The system consists of a number of collaborating agents requiring the communication of complex and diverse forms of information between a variety of clinical and other settings, as well as the coordination between groups of health care professionals (doctors, nurses, counsellors, etcetera.) with very different skills and roles. The agents in the system include: patient agents, nurse agents, lab agents, medication agents and physician agents. The agents may be hosted on different machines, located in many different places distributed over the Internet. The system saves time, minimises decision errors and increases the standard of health care provided to patients.