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Faculty of Applied Sciences

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Author: search.filters.author.Adam, JamilaHas files: Yes

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    Antibodies to erythropoietin are associated with erythropoietin resistance in hemodialysis patients in KwaZulu-Natal (South Africa)
    (Medknow, 2020) Benjamin, Sherilene; Adam, Jamila; Krishna, Suresh Babu Naidu; Assounga, Alain G.
    Recombinant human erythropoietin (rHuEPO) is a glycoprotein and biological equivalent to the endogenous compound administered to treat anemia of end-stage renal disease patients. Resistance to rHuEPO has been reported, whereby patients require higher and higher doses of rHuEPO to maintain an adequate hemoglobin level. In this study, assessment of native and administered erythropoietin (EPO), antibody and hemoglobin levels was carried out on a sample of patients with renal failure on hemodialysis (HD). This is a randomized controlled trial where consecutive subjects attending HD units at Addington Hospital and King Edward Hospital, Durban (South Africa) were included until the target number was reached. Forty patients with renal failure on HD and receiving recombinant EPO Beta (Recormon) for treatment of anemia via the subcutaneous route in weekly doses of 2000 IU, 4000 IU, 6000 IU, 8000 IU, 12,000 IU, or 18,000 IU according to the severity of the anemia were included after obtaining informed consent. Also included in the study were 10 HD patients not on rHuEPO therapy and 10 healthy individuals from the Durban University of Technology, recruited as described above to form the control group. ELISA was used to measure serum levels of EPO as well as antibodies to EPO. Results were analyzed by descriptive, inferential methods and by logistic regression analysis using IBM SPSS Statistics for Windows version 22.0. Antibodies to EPO were found in almost all patients who were receiving EPO. The highest levels of antibody to EPO were found to be associated with patients receiving the highest weekly dose of EPO (18,000 IU). Logistic regression analysis also revealed that serum levels of EPO, gender or age were not associated with any significant variation of serum antibody level. High levels of serum antibodies to EPO are a risk factor for EPO resistance.
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    Pharmaceutical care integration in rural public health districts
    (2022-10-30) Pillay, Naleeni; Adam, Jamila; Krishna, Suresh Babu Naidu
    Background: South Africa’s healthcare system is in transition, which presents an opportunity for public sector pharmaceutical service development. Focus on primary healthcare (PHC) re-engineering and the National Health Insurance (NHI) mandate reinforce the importance of many healthcare professionals and processes, thus highlighting the need to explore the pivotal role pharmacists can play in a collaborative approach to primary healthcare. Setting: This study was conducted in uMzinyathi and Ugu, two rural districts in KwaZulu-Natal, South Africa. Methods: A mixed method research methodology was adopted in four phases. Key informants as well as PHC authorised prescribers, visiting doctors and pharmacists who support the “ideal” clinics participated in the study. Data were collected through specifically designed questionnaires and focus group interviews. The PHC facilities were also inspected for legal compliance using the South African Pharmacy Council’s primary health care clinics inspection questionnaire. Data were interpreted thematically and using factor analysis. Results: This study found that pharmacists can improve primary care at public clinics. Public health, primary care and clinical patient outcomes were also highlighted. Continuing nursing and pharmacy education, patient safety and quality of care were also significant collaborative intervention criteria. This study demonstrated statistically significant differences between doctors and authorised nurse prescribers in four medication processes: diagnosis and prescribing; administration and documentation; education and training; and medication review. Pharmacists focussed more on pharmaceutical care – monitoring patient compliance, educating patients about chronic medication, providing drug information to prescribers, and identifying prescribing errors rather than prescribing rights. Conclusion: The role of pharmacists in rural public healthcare was unexploited. Therefore, to ensure optimal patient outcomes and safety, pharmacist advocacy in these underserved rural communities could drive pharmacovigilance through adverse drug reporting, antibiotic stewardship, medicine supply management, clinical governance with ongoing prescription audits, structured training for PHC authorised nurse prescribers, patient engagement, and interaction. This study identifies barriers such as unclear roles, lack of transportation for outreach services, language difficulties, a lack of resources and devices, and a lack of doctors as well as authorised nurse prescribers. As the NHI is expanded, the pharmacist’s role and collaboration with doctors and authorised nurse prescribers could improve patient health outcomes and rural public healthcare delivery