Orientadores: Carmenlucia Santos Giordano Penteado, Cassiana Maria Reganhan Coneglian / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Tecnologia / Made available in DSpace on 2018-08-22T13:15:30Z (GMT). No. of bitstreams: 1 Teodoro_IzabelaFreire_M.pdf: 5510567 bytes, checksum: 19941a37c1df07cbe5d4a51961f72209 (MD5) Previous issue date: 2013 / Resumo: Os produtos farmacêuticos têm sido amplamente utilizados na medicina humana, veterinária, como cosméticos e produtos de higiene pessoal, sendo caracterizados como substâncias emergentes e de caráter poluidor. O aporte dessas substâncias nos corpos hídricos suscita riscos para o meio ambiente e saúde pública. Atualmente existe a preocupação principalmente no que se diz respeito ao descarte de medicamentos de uso domiciliar, pois não existem regulamentos específicos para tal no Brasil. O equacionamento do problema envolve a proposição de medidas conjuntas, com a participação dos consumidores, fabricantes, distribuidores de medicamentos, e o poder público. Esta pesquisa visou levantar dados e informações junto às farmácias e drogarias, unidades básicas de saúde (UBS) e população, bem como propor diretrizes para a implantação de programas de gestão e gerenciamento de resíduos de medicamentos de uso domiciliar no município de Limeira - SP. Nas entrevistas realizadas junto às 92 farmácias e drogarias de Limeira, conveniadas a AFAL - Associação de Farmácias de Limeira, e nas 14 Unidades Básicas de Saúde do município, identificou-se que os programas de coleta de medicamentos de uso domiciliar existentes não são eficazes e possuem abrangência limitada. As entrevistas realizadas junto à população do município identificaram os hábitos relacionados ao consumo, armazenamento e descarte de medicamentos, assim como a conscientização e sensibilização da população a cerca dos impactos do descarte inadequado destes resíduos. Em relação à forma de descarte dos medicamentos de uso domiciliar observou-se que dos 437 indivíduos entrevistados 1,5% retornam seus medicamentos vencidos nas farmácias; 12% retornam a alguma UBS; 6% armazenam, uma vez que não sabem como descartar; 68% descartam no lixo; 10% descartam no vaso sanitário ou na pia; e 2,5% queimam. Observou-se ainda que cerca de 40% dos indivíduos entrevistados não tem consciência dos impactos decorrentes do descarte inadequado e mais de 70% nunca receberam orientações sobre o descarte adequado. Os resultados indicam a necessidade da implantação de diretrizes consolidadas para elaboração de um plano de gestão e gerenciamento no município, embasados na logística reversa e responsabilidade compartilhada dos atores envolvidos na gestão dos resíduos de medicamentos de uso domiciliar. Com base nos dados levantados nesta pesquisa, foram formuladas diretrizes para a gestão e o gerenciamento destes resíduos e proposto um modelo de logística reversa para os mesmos, no âmbito municipal / Abstract: The pharmaceutical products have been widely used in human medicine, veterinary medicine, such as cosmetics and personal care products, being characterized as emerging substances and character polluter. The intake of these substances in water bodies raises risks for the environment and public health. Currently there is a concern especially in respect to the discarding of medicinal products for home, as there are no specific regulations for such in Brazil. The solving the problem involves the proposition of joint measures, with the participation of consumers, manufacturers, distributors of medicines, and the public power. This research took as case study of the municipality of Limeira, SP aiming at getting data and information from pharmacies and drugstores, basic health units and population, and propose guidelines for the implementation of programs of management and waste management of medicines household in the city. In the interviews with the 92 pharmacies and drugstores of Limeira, those affiliated the AFAL - Association of Pharmacies of Limeira, and in the 14 Basic Health Units of the municipality, it is identified that the collection programs of medicines to use existing home are not effective and have limited scope. The interviews conducted with the population of the municipality identified the habits related to consumption, storage and disposal of drugs, as well as the understanding and awareness of the population to some of the impacts of improper disposal of residues of medicinal products. In relation to the form of discarding of medicinal products for use at home it was observed that the 437 individuals interviewed 1.5 % return their medicines accrued in pharmacies; 12% are returning to some health unit; 6% store, since it does not know how discard; 68% are discarding in the trash; 10% are discarding the toilet or in the sink; and 2.5 % burn the medicines. It was observed that about 40% of the individuals interviewed are not aware of the impacts arising from the discard inappropriate and more than 70% never received guidelines about proper disposal. The results indicate the need for the deployment of consolidated guidelines for preparation of a management plan and management in the municipality, based in reverse logistics and shared responsibility of the actors involved in the management of waste medicines for use at home. Based on data gathered in this survey, were formulated guidelines for the management and management of the waste of medicines for use at home and was proposed a model of reverse logistics for the same, at the municipal level / Mestrado / Tecnologia e Inovação / Mestra em Tecnologia

Orientadores: Osvaldir Pereira Taranto, Marcello Nitz / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Química / Made available in DSpace on 2018-08-19T18:12:35Z (GMT). No. of bitstreams: 1 Albanez_Roberta_M.pdf: 3222892 bytes, checksum: 3764421c1c9d6cfda6a9a56e6ed056e4 (MD5) Previous issue date: 2011 / Resumo: Os pellets apresentam muitas vantagens biofarmacêuticas e são ideais para aplicação de recobrimento. Quando o recobrimento é funcional, um dos principais objetivos é formação de uma barreira que modifique o perfil de liberação da droga (liberação controlada ou gastrorresistente). Neste trabalho pellets de diclofenaco de sódio foram produzidos por extrusão/esferonização e, em seguida, foram recobertos em leito fluidizado tipo Wurster. Esse tipo de leito é um dos sistemas mais adequados para o recobrimento de partículas. Dentre suas vantagens destaca-se a não formação de zonas mortas. Este trabalho teve como objetivo estudar o recobrimento dos pellets produzidos com duas suspensões poliméricas aquosas comerciais entéricas, Advantia® Performance e Acryl-Eze® MP. O estudo do processo de recobrimento foi realizado por meio de um planejamento experimental 2³. As variáveis estudadas foram: temperatura do ar de entrada, vazão da suspensão e polímero de recobrimento. As variáveis de resposta foram: eficiência do processo, resultados acima de 78,2%, e fração de aglomerados, resultados inferiores a 8%. O efeito do tipo de polímero de recobrimento foi o que mais influenciou as variáveis de resposta, sendo que o Advantia® Performance resultou numa maior eficiência e uma maior fração de aglomerados. Determinou-se também o ganho de massa mínimo para atingir a gastrorresistência - Acryl-Eze® MP: 9,7% e Advantia® Performance: 8,6%. Os pellets revestidos passaram por testes de teor, dissolução e estabilidade. No teste de estabilidade os pellets recobertos com Advantia® Performance mantiveram seu perfil gastrorresistente. Porém, os pellets recobertos com Acryl-Eze® MP apresentaram um aumento da gastrorresistência após a exposição às condições de estabilidade, o que pode indicar que a coalescência das partículas do polímero aconteceu durante a estocagem. As suspensões foram caracterizadas quanto à sua reologia e ângulo de contato. O tempo de instantaneização do pó polimérico também foi testado / Abstract: Pellets have many biopharmaceutical advantages and are suitable for coating. When the coating is performed for functional purpose, one of the major goal is to form a barrier that modifies the drug release profile (controlled or enteric release). In this work, diclofenac sodium pellets were produced by the extrusion / spheronisation process and then coated in a fluidized bed coater column with a Wurster insert. This type of bed is one of the best suited systems for the coating of particles. One of the main advantages is that it avoids dead zones. This work aimed to study the coating of pellets produced with two commercial aqueous enteric polymer suspensions, Advantia® Performance and Acryl-Eze® MP. The study of the coating process was accomplished through a 2³ experimental design. The variables studied were: inlet air temperature, suspension flow rate and coating polymer. The response variables were: process efficiency, results above 78.2%, and agglomeration fraction, values below 8%. The effect of polymer coating type was the variable that influenced the response variables the most. The polymer Advantia ® Performance resulted in a better efficiency and increased the agglomerate fraction. The minimum mass gain to achieve the enteric profile was also determined - Acryl-Eze® MP: 9.7% and Advantia® Performance: 8.6%. The coated pellets were tested for content, dissolution and stability. In the stability test, pellets coated with Advantia® Performance maintained the enteric profile. However, the pellets coated with Acryl-Eze® MP presented a better enteric profile after the exposure to conditions of stability, which may indicate that coalescence of the polymer particles occurred during storage. The suspensions were characterized by rheology and contact angle. The static wettability of the polymeric powder was also tested / Mestrado / Engenharia de Processos / Mestre em Engenharia Química

Submitted by Biblioteca da Faculdade de Farmácia (bff@ndc.uff.br) on 2017-03-20T17:05:56Z No. of bitstreams: 1 Hofer, Ana Paula Barroso [Dissertação, 2015].pdf: 1799140 bytes, checksum: 36e28677babd928285b73b45ed328c2e (MD5) / Made available in DSpace on 2017-03-20T17:05:56Z (GMT). No. of bitstreams: 1 Hofer, Ana Paula Barroso [Dissertação, 2015].pdf: 1799140 bytes, checksum: 36e28677babd928285b73b45ed328c2e (MD5) / A lista de medicamentos essenciais é um instrumento de orientação das condutas clínicas e administrativas para medicamentos em determinada organização. Uma lista com medicamentos adequadamente selecionados favorece a sua utilização racional e os demais processos da assistência farmacêutica; sendo a adesão dos médicos prescritores às listas um indicador de sua qualidade. O objetivo do trabalho foi avaliar a adesão dos prescritores à lista de padronização de medicamentos de um hospital terciário do Estado do Rio de Janeiro, através da aplicação de um questionário aos prescritores, além da avaliação de prescrições médicas. O modelo de investigação se caracterizou como descritivo com delineamento transversal, sendo analisadas 1108 prescrições dos pacientes internados e aplicados 31 questionários aos médicos prescritores do hospital de estudo. Foram verificadas características das prescrições médicas e dos prescritores, além de condutas diante dos fatores relacionados à adesão à lista de padronização de medicamentos da instituição. A incidência de medicamentos não padronizados solicitados foi conferida e classificada de acordo com a Anatomical Therapeutic Chemical Classification (ATC) e quanto ao grau de recomendação para utilização em suas principais indicações. O indicador de prescrição médica proposto pela OMS referente à porcentagem de medicamentos prescritos que pertencem à lista de medicamentos essenciais (lista de medicamentos padronizados pela instituição) foi determinado, resultando no valor de 98,25%, referente à taxa de adesão dos prescritores à lista. Entre os medicamentos prescritos ou solicitados não incluídos na lista, aproximadamente 30% fazem parte da classe do sistema cardiovascular, sendo a valsartana, o mais frequente. Os resultados obtidos através da análise das prescrições médicas demonstraram que a adesão à lista ocorre de maneira expressiva, entretanto, foi verificado pelos questionários aplicados que uma grande parte dos médicos desconhece a lista. Desta maneira, a adesão à lista pode ser proveniente do fato do medicamento estar disponível para prescrever, ou ainda, pela grande variedade de itens presentes na lista. Esse desconhecimento da lista de medicamentos por parte dos prescritores parece compartilhado por outras instituições no país, devido a outros hábitos de prescrição, preconceito ou eventualmente pela falta de compromisso dos profissionais / The list of essential drugs is a policy instrument of clinical and administrative managements for drugs in a given organization. A list of properly selected medicines promotes the rational use of them, as well as organizes other pharmaceutical assistance processes. The adherence of prescribers to the lists is an indicator of its quality. The objective of this study was to evaluate the adherence of prescribing the medicine standardization list of a tertiary hospital in the state of Rio de Janeiro, through the analysis of a questionnaire to the prescribers. We also evaluated if the medical prescriptions are compliant with the list of properly selected medicines. It is a descriptive cross-sectional study. We analyzed 1108 prescriptions of patients admitted and applied the questionnaire to 31 medical doctors of the hospital. Were recorded characteristics of medical prescriptions and prescribers factors possibly related to the adherence to the list of properly selected medicines. It was given the incidence of non-standardized medications ordered, classifying them according to the Anatomical Therapeutic Chemical Classification (ATC) and the degree of recommendation for use in its main indications. The indicator, proposed by the WHO, i.e.; the percentage of prescription drugs that belong to the list of medicines essential (list of standardized medicines by the institution) was determined, 98.25% were adherent to the list. Among the medications prescribed or ordered not included in the list, about 30% are part of the cardiovascular system class, and valsartan, the most frequent. The results obtained by analyzing medical prescriptions showed that joining the list occurs more significantly, however, through the questionnaire to the prescribers, we verified that part of them is unaware of the list. Consequently, the adherence to the list is due to the several items available to the prescribers, even if they do not know its existence. The lack of knowledge of the list of drugs by prescribers is observed in other institutions in the country, we believe it was observed due to ancient prescription habits, prejudice or eventually by the lack of commitment of the professionals

Le Gentiopicroside (GPS) est un secoiridoïde isolé de Gentiana lutea qui est appelé Qin Jiao en chinois. C'est l'une des plantes médicinales les plus couramment utilisée en Chine. Le GPS a des activités biologiques et pharmacologiques allant des propriétés antiviral, anti-inflammatoire, analgésique, anti-hépatotoxique et cholérétiques. Toutefois, la modification structurelle et la synthèse totale du GPS est toujours un défi pour les chimistes organiciens.Dans ce mémoire, nous avons traité la conception, la synthèse et l'évaluation pharmacologique d'une série de composés dérivés du GPS comme inhibiteurs potentiels du virus de l'hépatite C (HCV). Certaines fonctions communes dans la conception de médicaments, tels que des halogènes, du soufre, de l'azoture et un groupe amino, ont été introduites au fragment sucre du GPS. Dans le même temps, nous avons étudié trois approches pour synthétiser la partie aglycone du GPS, deux d'entre elles sont basées sur des cycloadditions [3+3] inter- ou intramoléculaire organocatalyzées à partir des aldéhydes insaturés B et D. La troisième est basée sur le réarrangement d'énol-esters α,β-insaturés F, catalysé par un N-hétérocyclique carbène (NHC). L'intermédiaire commun pour ces approches est un ester insaturé A qui a été préparé en quatre étapes à partir de D-(-)-mannitol et de méthylcrotonate commerciaux. La cycloaddition [3+3] entre l'énal 54 et l'énol stabilisé 59 ne fournit pas le cyclo-adduit attendu même si sur un modèle de réaction les 3,4-dihydropyranne 68 et pyranone 69 ont été formées. Le traitement de l'énol-ester 77 avec un NHC donne un accès à un précurseur potentiel dans la synthèse totale du GPS. / Gentiopicroside (GPS) is a secoiridoid compound isolated from Gentiana lutea which is called Qin Jiao in Chinese. It is one of the most common herbal medicines used in China. The biological and pharmacological activities of GPS contain antiviral, anti-inflammatory, analgesia, antihepatotoxic and choleretic activities. GPS is involved in ongoing phase III clinical trials as the first class new drug. However, the structural modifications and total synthesis of GPS is still a challenge for organic chemists.In this thesis we have processed the design, synthesis and pharmacological evaluation of a series of GPS derivatives as potential hepatitis C virus (HCV) entry inhibitors. Some common functional elements in drug design, such as halogen, sulfur, azide and amino group, have been successfully introduced on the sugar moiety of GPS. In the mean time, we studied three approaches to synthesize the aglycone part of GPS. Two of them are based on organocatalyzed inter- or intramolecular [3+3] cycloadditions from unsaturated aldehydes B and D. The third one was based on an NHC-catalysed rearrangement of α,β-unsaturated enol-esters F. The common key intermediate for these approaches was the unsaturated ester A which was prepared in four steps from commercially available D-(-)-manitol and methylcrotonate. The formal [3+3] cycloaddition between enal 54 and the stabilized enol 59 did not provide the expected cyclo-adduct even if on a model reaction 3,4-dihydropyran 68 and pyranone 69 were formed. The α-substituted position of enal 54 could explain this default in reactivity under proline organocatalysis. The treatment of enol-ester 77 with N-Heterocyclic-Carbene gave an access to the advanced precursor 78 potentially useful in the total synthesis of GPS.

>Magister Scientiae - MSc / Research into traditional medicines is often conducted in a multidisciplinary approach as motivated by a desire to understand them in as complete a manner as possible,realizing their chemistry, biology and pharmacology. One biological approach involves monitoring the cytotoxicity of the extracts of subfractions against the nauplii,Artemia salina (brine shrimp). Organic and aqueous extracts of seven South African medicinal plants was investigated for biological activity. Selected plant extracts was also evaluated for AChE inhibitory activity. The objectives of this study was to look for any correlation between known biological activities of the investigated plants and BSLT lethality data and also to look for any correlation between AChEI activity and BSLT lethality data for selected plant extracts. The most active of the plants was the n-hex extract of T.alliacea, followed by the aqueous extract of C.mellei and the MeOH extract of C.quadrifidus; the MeOH and the DCM extracts of A.afra; the DCM extract of P.undulatum and the EtOAc extract of A.annua. The results from this study show a good correlation with antitumor, antimicrobial and anti-trypanocidal activity.The various plants extracts investigated showed good inhibitory activity towards AChE using the TLC bioautography method. The results obtained from this study indicate that this type of activity is not only subject to plants containing alkaloids, but rather a diverse class of compounds may exhibit this kind of activity. The extracts that showed good AChE inhibitory activity also showed good cytotoxicity towards brine shrimp nauplii.

Magister Pharmaceuticae - MPharm / Syzygium cordatum is a medicinal plant indigenous to South Africa and Mozambique, commonly used to treat stomach aches, diabetes, respiratory problems and tuberculosis. In spite of the folklore use, adequate scientific data to credit its widespread traditional use is lacking. The objectives of this study were: to evaluate and validate scientifically the successful therapeutic claims by traditional medicine practitioners that Syzygium cordatum is effective in treating diarrhoea and diabetes; to determine the effects of the plant extract on gastrointestinal transit of a charcoal meal in mice; to determine the effects on castor oilinduced intestinal fluid accumulation; to determine the safety profile of the plant by carrying out acute toxicology study and to carry out preliminary screening of the active compounds present in the plant using standard phytochemical analytical procedures. The aqueous leaf extract of Syzygium cordatum (3.125 -50mg/kg, p.o) significantly reduced the faecal output caused by castor oil (0.7ml). All the doses used, reduced faecal output from 100% produced by castor oil to between 40 and 61%. S.cordatum (6.25 – 50mg/kg, p.o) significantly and in a dose dependent manner, delayed the onset of castor oil-induced diarrhoea. / South Africa

Magister Public Health - MPH / Irrational use of medicines is a global health problem. The World Health Organization has reported that more than 50% of all medicines are prescribed, dispensed and sold inappropriately, and that more than 50% of patients fail to take their medicines correctly (Holloway, 2006). The rational use of medicines is one of the core components of the National Strategic Plan for the Implementation of a Pharmaceutical Policy in Cameroon (MOH, 2000). In Cameroon, it has been noted that instead of going to the hospital when they fall sick, consumers prefer to self-medicate or visit a street vendor, traditional or faith healer or quack doctor (World Bank, 1995) and that they adjust the quantity of medicines they take based on their ability to pay for them (van der Geest, 1991). Aim and Objectives This study described the factors influencing the use of medicines by consumers in Tiko sub-division at household level, community level, health institutions level, and national level. Study Design This study used a qualitative study design to explore the factors influencing the use of medicines by consumers in Tiko-subdivision, Cameroon. Study Population and Sampling Six focus group discussions with consumers representing the different socio-economic and educational levels of Tiko sub-division were conducted. Two focus groups with members of each of the following organizations - Plantain Traders Association, Township Taxi Drivers Association and Teachers of Tiko High School. Six in-depth interviews with key informants were carried out, three with workers that sell medicines in community pharmacies and three with workers that sell medicines in the informal sector. Data Collection and Analysis Notes and observations were taken during the focus groups and key informant interviews. In addition, the proceedings were audio taped and the recordings were used to expand and clarify the notes. The data obtained was analyzed to identify recurring themes from the various influences of medicine use on consumers. Results Factors that influenced consumers’ use of medicines were categorized into household, community, health institutional and national levels. At the household level key influences were the consumers’ perceived need for medicines, the cost of medicines, the purchasing habits of consumers, the literacy level and consumers’ idea about efficacy and power of medicine, together with polypharmacy and polytherapy. At the community level, the medicine use culture, medicine supply channels and the sources of information of medicines influenced consumers’ use of medicines. At the health institutional level the influences reported were the quality of services, the cost of medicines, availability of medicines and consulting health worker. At the national level factors included, the media, lack of medicines regulation and control and medicines financing mechanisms. Discussion The study found that medicines use in Tiko sub-division was affected by a number of key factors. A number of cross-cutting themes were identified which had a critical impact on the rational use of medicines by this community. These themes were categorized as: sociocultural, economic and regulatory .Amongst the sociocultural factors was the way consumers perceived their need for medicines, their ideas about efficacy and the power of medicine and their perception of medicines as a commodity. Economic factors included user charges for health care - including medicines, and the high cost of medicines, while regulatory factors emanated from the illicit trade in pharmaceuticals, poor regulatory control and the lack of a national drug policy. Recommendations Proposals to improve the rational use of medicines by consumers in Tiko sub-division were identified to remove the sociocultural, economic and regulatory barriers to appropriate medicines use. Sociocultural strategies should focus on public education on medicines through role plays and audiovisual communication tools increase knowledge about medicines and to ensure behaviour change. Economic strategies should include the elimination of user charges and health financing strategies. Regulatory strategies proposed include amongst others, implementation of a national medicines policy and the setting up of a multisectoral task force to control sales of medicines.

Magister Public Health - MPH / Background: A growing concern about possible age-related inequities in health care access has emerged in the increasing debate on the challenges of population ageing and health in sub-Saharan Africa. Older persons may experience systematic exclusion from health services. Viewed as one of the poorest, most marginalized groups in SSA societies, older people are deemed to lack access to even basic, adequate health care. There is an assumption, furthermore, that older persons have less access to required health services than do younger age-groups. This suggests an element of age-related inequity. One possible indicator of age-related inequity may be found through measuring the relative availability of essential medicines for chronic non-communicable diseases (NCD), relative to the availability of medicines for communicable diseases (CD). Aim and objectives: The aim of the study was to compare the availability of essential medicines for NCD and CD in Kenya, as an indicator of age-related inequities in access to health care in Kenya. The three study objectives were as follows, in public and mission facilities in Kenya: 1. To assess the availability of medicines for the following CD: diarrhoea, HIV, malaria, pneumonia and other infections 2. To assess the availability of medicines for the following NCD common in older populations: arthritis, diabetes, glaucoma, gout, heart disease, hypertension and Parkinson’s disease 3. To compare the availability of medicines for CD and NCD and draw conclusions on possible age-related inequities in access. Study design: Using an adapted version of the HAI / WHO methodology, a cross sectional descriptive survey of medicines availability was conducted. HAI and WHO collaboratively developed a standardized and validated methodology for comprehensively measuring medicines availability, as well as prices, affordability and price components. The survey manual, launched in 2003 and revised in 2008, is available to the public. The methodology involves collecting data on the availability and price of medicines found in a sample of health facilities across sectors of interest within national health systems. If the specific medicine, dose and form being surveyed is available on the day of the survey, then the medicine is documented as being available. Methods: Random sampling was carried out in six of Kenya’s eight provinces, targetting ten facilities per province. Data on availability of the targeted medicines was collected by trained data collectors on pilot-tested data collection forms adapted from the standardized WHO / HAI methodology. The list of medicines included sixteen for communicable diseases to treat infections such as diarrhoea, HIV, malaria, and pneumonia and twelve medicines used to treat non-communicable diseases such as diabetes, arthritis, hypertension, gout, glaucoma, stroke and Parkinson’s disease. Availability of medicines was noted by physical observation by a data collector, and calculated as the percentage of facilities where a medicine was found on the day of data collection. The availability of brands and generics was not distinguished and were combined to establish availability of each medicine. Overall availability of all CD and NCD medicines was compared, and within each category between rural and urban areas and between mission and public facilities. The Ministry of Health was informed of the survey and provided the data collectors with an MOH endorsement letter. The names of facilities participating in the study were recorded on the data collection forms, but not reported. No data on individual patients was collected, and no patients were interviewed for this survey. Data were entered into an Excel file and exported to and analyzed with SPSS. Results: A total of 56 facilities were surveyed: 49 in the public sector and 7 in the mission sector, giving a facility response rate of 93%. Thirty facilities were located in rural settings and 26 were in urban settings. More CD medicines were available than medicines for NCD. Of a total of 896 individual observations of CD medicines, 632 (70.5%) were recorded as available on the day of visit, compared to 306 (45.5%) of 672 possible individual observations of NCD medicines. These differences were highly significant statistically (chi-square=98.8, p<0.001). Furthermore, comparison of availability between urban and rural areas showed statistically significant differences for NCD medicines (40.6% vs. 51.3%, p=0.007), but not CD medicines (72.5% vs. 68.3%, p=0.190). There were no significant differences in availability of medicines in mission compared to public facilities. Conclusions: This study reveals the low relative availability of medicines for NCDs in Kenya’s public and mission sector. Medicines for NCDs were less available in rural vs. urban facilities, but there was no rural vs. urban difference in medicines for CDs. While more research should be carried out to understand the reasons behind these findings, immediate attention to the supply and financing of medicines for NCDs is urgently needed. The relatively lower availability of medicines for NCDs than for CDs may be an indicator of age-related inequities in access to health care in Kenya and calls for more investigations on equity and access to health for older people in Kenya.

Master of Public Health - MPH / The World Health Organisation estimates that more than 50% of medicines are inappropriately used globally. The situation is worst in developing countries such as Nigeria, where irrational prescribing practices account for wastage of resources, catastrophic medicines costs and poor access to health services. In 2005, the Social Health Insurance Programme was launched as a financially sustainable model to achieve cost effective and affordable health care services including medicines. This study investigated prescribing practices and availability of medicines in the Social Health Insurance Programme in accredited public sector secondary hospitals in the Federal Capital Territory, Nigeria.Methodology:The study is a descriptive, cross-sectional and retrospective survey of prescriptions of insured outpatients in the Federal Capital Territory, Nigeria. Four hospitals were selected by stratification of thirteen (13) public secondary hospitals in the territory into urban/peri-urban areas, followed by random selection of two hospitals from each stratum.A total of seven hundred and twenty (720) retrospective prescription encounters of insured outpatients were systematically selected from encounters between July 2009 and June 2010 at the selected facilities. Data on prescribing practices and the extent to which prescribed medicines were provided were assessed with the use of modified WHO/INRUD indicators. Descriptive statistics were generated with Epi-info (version 3.4.3) and SPSS (version 17.0)Results: Out of the seven hundred and twenty (720) prescriptions that were assessed analgesics/NSAID, antibiotics, antimalarials and haematinics/vitamins collectively accounted for 67.4% of the medicines prescribed.A comparison of the results with WHO/Derived reference values showed that average number of medicines prescribed per prescription (3.5 ±1, p<0.001) and the rate of antibiotic prescribing (53.7%, p=0.009) were higher than the WHO recommended ranges of (1.6-1.8) and (20.0- 25.4%) respectively.The use of generic names in prescribing (50.9%, p<0.0009) and medicines prescribed from the Essential Medicine List (74.2%, p=0.05) were considerably lower than the standard (100%) However, the rate of injection prescribing (12.49%, p=0.4) was within the recommended range (10.1–17.0%).The study also found that 85.1%, (p=0.001) of prescribed medicines were dispensed, while 93.4% (p=0.256) of essential medicines were dispensed which was lower than the recommended standard (100%). Overall, only 58%,(p<0.0001) of patients had all prescribed medicines completely dispensed and this was significantly lower than the desired standard (100%.) in social health insurance programmes.Conclusions:The findings of this study show trends toward irrational prescribing practices as characterized by poly-pharmacy, overuse of antibiotics, sub-optimal generic prescribing, as well as poor adherence to the use of NHIS-Essential Medicine List. There was sub-optimal provision of prescribed medicines. These are potential threats to the scheme‟s goal of universal access to health care in the year 2015. Pragmatic multi-component interventions are recommended to promote rational prescribing and improve equity in access to essential medicines.

Magister Pharmaceuticae - MPharm / Diabetes Mellitus, one of the major diseases affecting human population all over the world has caused significant morbidity and mortality. The management of this condition has raised the demand of safe and cost effective remedial measures due to several side effects associated with the present use of modern medicines. Thus, it is crucial to explore other options for diabetes management such as the use of medical plants. Cnicus benedictus L. is one of the known plant species used by traditional medicine practitioners in South Africa for the treatment of various ailments including inflammatory conditions, pain and diabetes. Even though the plant species has been extensively studied, scientifically, no evidence exists in literature to corroborate the claim made by traditional medicine practitioners of its therapeutic success in the treatment of diabetes and pain. Therefore, the objectives of this present study were: to investigate the antidiabetic activity of C. benedictus using leaf methanol extract of the plant species on animal model involving male and female Albino rats; to investigate the antinociceptive activity of the plant species on mice; to determine the safety profile of the plant by investigating the acute toxicity and to carry out HPLC study in order to characterize the plant species. Animals were divided into groups of six each and fasted overnight prior to the induction of diabetes in rats using Streptozocin (STZ). The plasma glucose was measured at intervals of 30 min for 4 hours by means of a glucometer. Cnicus benedictus (100 – 400 mg/kg, i.p.) significantly reduced the blood glucose concentrations of fasted normal rats with percentage maximum reduction ranging from 46 to 79% and chlorpropramide (250 mg/kg, i.p.) significantly reduced the blood glucose concentrations of fasted normal rats by 84%. Cnicus benedictus (100 – 400 mg/kg, i.p.) significantly reduced the blood glucose concentrations of STZinduced diabetic rats with percentage maximum reduction ranging from 44.82 to 66.04% and chlorpropramide (250 mg/kg, i.p.) significantly reduced the blood glucose concentration of STZ-induced diabetic rats by 71.71%. In the oral glucose tolerance test, administration of leaf methanol extract of Cnicus benedictus (100 – 400 mg/kg, i.p.) following oral glucose load on fasted normoglycaemic rats significantly reduced the increased blood glucose concentrations with percentage maximum reduction ranging from 42.45 to 70.75%. Chlorpropramide (250 mg/kg, i.p.) following oral glucose load on fasted normoglycaemic rats significantly reduce the increased blood glucose concentration with a percentage maximum reduction of 79.04%. In acetic acid writhing test, animals were divided into groups of eight per dose. Cnicus benedictus (25-400 mg/kg, i.p.) significantly reduced the number of writhes in mice with percentage inhibition of the writhes ranging from 67.95 to 73.71%. Indomethacin (20 mg/kg, i.p.) and paracetamol (500 mg/kg, i.p.) significantly reduced the number of writhes in mice with percentage inhibition of 75.44 and 69.18% respectively. Combined treatment of lowest and sub-effective doses of C.benedictus (12.5 mg/kg, i.p.) and indomethacin (10 mg/kg, i.p.) significantly reduced the writhes with a percentage inhibition of 58.32%. In hot plat test, animals were divided into groups of eight per dose. Cnicus benedictus (25-400 mg/kg, i.p.) significantly delayed the reaction times of the mice to hot-plate thermal stimulation. Morphine (10 mg/kg, i.p.) significantly delayed the reaction time of the mice to the hot-plate stimulation. The no-adverse-effect-level (NOAEL) of leaf methanol extract of Cnicus benedictus was obtained at 3200 mg/kg (p.o.) and the LD50 value of the plant species was found to be 4000 mg/kg (p.o.). The HPLC fingerprint of the leaf methanol extract of Cnicusbenedictus showed distinct peaks at the following retention times of 6.387, 14.628, 18.431, 23.228 and 29.829 min. In conclusion, the data obtained showed that leaf methanol extract of Cnicus benedictus possesses both antidiabetic and antinocipetive activities. / National Research Foundation (NRF)