One of the aims included in the United Nations Millennium Development Goals is to decrease the number of the world’s population without access to sanitation and water that is safe, by half by the year 2015. The use of water that is not safe for consumption leads to water–related diseases. For the purpose of this study gastro–intestinal disease was redefined as diseases of the gastro–intestinal tract caused by pathogens that spread via contaminated drinking water, poor sanitation and inadequate hygiene. Information obtained regarding the use of gastro–intestinal disease medication, may provide information about the prevalence of gastro–intestinal disease in South Africa. The general objective of this study was to determine the prescribing patterns of gastro–intestinal medication in different geographical areas in the private health care sector of South Africa. A retrospective drug utilisation review was conducted on data obtained from a medicine claims database of a pharmacy benefit management company for 2007 and 2008. A pharmacoepidemiological approach was followed in order to determine the prevalence of gastro–intestinal disease as well as the use of gastro–intestinal medication in South Africa as well as the different provinces of South Africa. The impact of water quality and sanitation on the prevalence of gastro–intestinal disease was also investigated. Gastro–intestinal medication (used in the treatment of gastro–intestinal disease) included the following pharmacological groups according to the MIMS®–classification: antivertigo and anti–emetic agents (group 1.8), antispasmodics (group 12.3), antidiarrhoeals (group 12.7), minerals and electrolytes (group 20.4, selected according to specified NAPPI–codes) and antimicrobials (group 18). Antimicrobials had to be prescribed in combination with one of the specified gastro–intestinal medication groups in order to be classified as a gastro–intestinal medication. In 2007 and 2008 respectively, 428864 and 340921 gastro–intestinal medication items were prescribed. The most frequently prescribed gastro–intestinal medication pharmacological groups in 2007 and 2008 were beta–lactam antimicrobials (with proportion percentages of 22.77% and 20.85% in 2007 and 2008 respectively), antivertigo and anti–emetic agents, antispasmodics, antidiarrhoeals and quinolone antimicrobials. Minerals and electrolytes represented only a small proportion (2.99% and 2.56% in 2007 and 2008 respectively) of the prescribed gastro–intestinal medication in South Africa. In the Free State and Western Cape antivertigo and anti–emetic agents were the most frequently prescribed gastro–intestinal medication items, while in other provinces beta–lactam antimicrobials ranked the highest. In all provinces except the Western Cape and the Northern Cape, amoxicillin/clavulanic acid was the most frequently prescribed gastro–intestinal medication active ingredient. In the Western Cape loperamide was the most frequently prescribed active ingredient, while ciprofloxacin ranked highest as active ingredient in the Northern Cape in 2008. Based on the prescribing patterns of gastro–intestinal disease medications the treatment of gastro–intestinal disease in this section of the private health care sector of South Africa, does not fully comply with the Standard Treatment Guidelines with regard to the use of antimicrobials and electrolyte replacement therapy. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.

The prevalence of epilepsy in society is general knowledge; however the impact on social activity as well as other daily factors are not always fully recognised. Epilepsy frequently poses a problem with regard to work–related activities (Heaney, 1999:44). Moran et al. (2004:425) indicated that the major impacts of epilepsy on life were work and school difficulties, driving prohibition, psychological and social life of which restriction of work or schooling has the greatest impact on epileptic’s life. In all cases the type, severity, and frequency of the seizures as well as the age would be relevant. Davis et al. (2008:451) established that 39% of all epileptics were not adherent to their therapy and in patients over 65 this was even higher at 43 %. Non–adherence with antiepileptic medicine appears to be related to increased health care utilisation and costs and may also lead to an increased probable accidents or injuries The general objective was to investigate anti–epileptic medicine prescribing patterns and treatment cost in a section of the private health care sector by using a medicine claims database. A retrospective drug utilisation study was done on the data claims from a pharmacy benefit management company for the study period 1 January 2005 to 31 December 2008. Firstly epilepsy was investigated in order to understand the disease and to determine the prevalence and treatment thereof. It was found that epilepsy is still one of the most common neurological conditions and according to the findings, 2 out of every hundred patients were using anti–epileptic medicine in this section of the private health care sector. To make this condition socially more acceptable and understandable, public education for special target groups concerning the disorder must be conducted as well as employment training programmes for people with epilepsy themselves. The utilisation patterns of anti–epileptic drugs were reviewed, analysed and interpreted. It was determined that anti–epileptic medicine items are relatively expensive with regards to other medicine items on the total database. With regard to gender, more females are using anti–epileptic medicine than males on the database. The largest age group of patients using anti–epileptic medicine, is between > 40 years and <= 64 years of age. It was also clear that prevalence increase as age increase. With regard to the different prescribers, the number of items prescribed by a general practitioner was almost double that of the other prescribers. It was further established that newer anti–epileptic medicines are more expensive than older anti–epileptic medicine according to the cost per tablet in this section of the private health care sector. Carbamazepine and valproate were the two active ingredients that were most frequently prescribed as a single item on a prescription. After a cost–minimisation analysis was done, R134 685.66 could have been saved when generic substitution was implemented. The refill–adherence rate decreased as age increased. Only 30.46% of the trade names was refilled according to acceptable refill–adherence rates. The refill–adherence rate according to active ingredient showed that medicine items containing, phenobarbitone/vit B or gabapentin had the lowest unacceptable refill–adherence rate. The limitations for this study was stipulated and recommendations for further research regarding anti–epileptic medicine were also made. / Thesis (M.Pharm (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2011.