Major depressive disorder (MDD) is a prevalent and debilitating mental health condition. This study aimed to compare the clinical efficacy, safety, and cost-effectiveness of vortioxetine and escitalopram in the treatment of MDD among outpatients at NRI General Hospital, Guntur, Andhra Pradesh. A non-randomised interventional trial was conducted over eight months involving 180 patients diagnosed with MDD based on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Participants were equally divided into two groups, one receiving vortioxetine and the other escitalopram monotherapy. Clinical outcomes were assessed using the Hamilton Depression Rating Scale (HAM-D), and safety was evaluated using the World Health Organization (WHO) causality assessment scale. A pharmacoeconomic analysis was conducted using the incremental cost-effectiveness ratio (ICER). Both groups showed significant improvement in HAM-D scores (p < 0.0001), with no statistically significant difference in efficacy between the two treatments, although escitalopram demonstrated slightly greater symptom reduction (mean score reduction: 14.37 vs. 12.7). Vortioxetine, however, was associated with fewer and less severe adverse drug reactions. Cost-effectiveness analysis revealed escitalopram to be more economical than vortioxetine (average cost of Indian Rupee2129.44 vs. Indian Rupee3448.20 per patient), with a negative ICER indicating it as the more cost-effective option. These findings suggest that escitalopram is the more cost-effective antidepressant for MDD treatment in this study setting, while vortioxetine's favourable safety profile may offer advantages for patients prioritising tolerability, highlighting the importance of individualised treatment selection based on both clinical and economic considerations.
Background: Adverse Drug Reactions (ADRs) are a significant concern in health care, affecting patient safety and healthcare costs. Active surveillance through spontaneous reporting (SR) by healthcare professionals (HCPs) is essential for identifying and managing ADRs.This study aimed to assess the knowledge, attitudes, and perceptions of HCPs at a government hospital in Botswana regarding ADR reporting. Method: A cross-sectional study was conducted using stratified random sampling. Knowledge was operationalised as prior use of an ADR reporting form, chosen as a practical indicator of familiarity with reporting procedures. Attitudes and perceptions were measured using Likert-scale items, with internal consistency assessed using Cronbach's alpha. Data analysis included descriptive statistics and Pearson Chi-square test. Results: Of the 260 distributed questionnaires, 133 were completed (51% response rate). Response rates varied across strata, with pharmacy staff accounting for a smaller proportion of respondents. While 26.3% of participants reported prior training, 39.8% had used an ADR reporting form. A significant association was observed between encountering an ADR and reporting it (chi 2 = 42.62, df = 1, p < 0.0001). ADR reporting was rated as highly important (M = 4.67, SD = 0.63), and perceptions reflected moderate agreement with positive views of reporting (M = 3.07, SD = 1.17). Workload (21.8%) and poor communication (5.3%) were cited as barriers, and 22.8% supported regular workshops to improve reporting. Conclusion: The study revealed a lack of knowledge on ADR reporting among HCPs, leading to underreporting. Despite positive attitudes, factors like workload and communication challenges hinder reporting. Continuous training and workshops are recommended to improve HCPs' reporting skills and promote pharmacovigilance. Integrating digital tools could simplify ADR reporting, reduce barriers, and improve communication among HCPs and regulators.
The critical antivenom shortage in South Africa is a consequence of fragmented regulations, constrained manufacturing capacity and weak stakeholder coordination. The snakebite envenoming (SBE) burden is preventable if access and equity are prioritised. Priority barriers were identified using the nominal group technique (NGT) through two expert consultations with members of the South African National Snakebite Advisory Group (NSAG). Experts emphasised urgent reforms to regulation, improved surveillance, supply chain governance and clinical guidance. Recommended actions include listing SBE as a notifiable medical condition, streamlining Section 21 import authorisation processes, strengthening national stockholding strategies, and restructuring South African Vaccine Producers (SAVP) through a public-private partnership. Through strong stakeholder engagement and leveraging technical expertise, the chronic antivenom shortage could be reversible. Without immediate regulatory and strategic reform, preventable deaths and disability from snakebite will continue.
Background: Proton pump inhibitors (PPIs) are approved for shorth-term (<= 12 weeks) use in children older than one month. Long-term PPI therapy has been associated with increased risk of gastrointestinal and respiratory infections, fractures and micronutrient deficiencies. This study will be the first to describe paediatric PPI use in hospitalised paediatric patients in South Africa in relation to Hospital Level Paediatric Standard Treatment Guidelines (STG)-recommendations of PPI therapy. Methods: A retrospective cross-sectional study was conducted across two tertiary public hospitals in South Africa (01 February 2023-31 January 2024). Data from medical records of paediatric hospitalised patients (< 18 years) who received a PPI prescription within the study period were evaluated. Data analysed included demographic data, in-hospital and discharge PPI prescription particulars. Descriptive statistics were used to present the analysed data. Results: Among 400 patients, only 28% of prescriptions aligned with STG-recommended indications, while 48% of prescriptions were prescribed for non-recommended indications. The median duration of PPI therapy was 31 days and only 7% of prescriptions complied with STG-recommended durations. Long-term use (> 12 weeks) occurred in 17.5% of patients. Deprescribing strategies of PPI prescriptions was employed in 23.8% of cases, predominantly intravenous (IV)-to-oral de-escalation. Conclusion: The findings highlight STG prescribing deviations and infrequent attempts of PPI deprescribing. Structured PPI prescription review processes, clear STG recommendations and proactive deprescribing strategies are required to promote rational PPI use.
Student mental health has become an urgent concern in South Africa, particularly within higher education settings, where academic pressure, social stresses, and structural inequalities intersect. Pharmacy students face a distinct set of challenges related to the intensity of their programmes and the expectations associated with professional competence. This qualitative study explored the lived experiences of pharmacy students regarding mental health support structures at Rhodes University. Using a phenomenological approach, data were collected through document analysis of nine institutional texts and semi-structured interviews with twenty undergraduate and postgraduate students. Thematic analysis demonstrated the absence of a formal mental health policy, limited visibility and accessibility of services, and the persistence of cultural and gendered stigma. Peer networks emerged as crucial sources of informal support and resilience. The findings highlight the need for a comprehensive, culturally responsive mental health strategy that integrates student well-being into academic and institutional practices.
Background: An essential component of the pharmacist internship is to establish whether the intern is competent to practise independently. In South Africa, this decision is based on multiple assessments: examination, portfolio of evidence, and progress reports. Globally, there has been development and adoption of Entrustable Professional Activities (EPAs) to assess both pharmacy students and interns in the workplace. This letter reviews assessments for pharmacy interns in South Africa, discusses the use of EPAs in pharmacy education, and argues for their integration as a means to enhance the structure, consistency, and future-readiness of the existing framework. Methods: This letter does not employ a specific methodological approach. It reviewed the current assessment framework used by the South African Pharmacy Council to evaluate pharmacist interns and compared these to EPAs used in pharmacy education. Findings: The current assessment framework, based on competency principles, lacks a structured and prospective mechanism to determine the interns' readiness for independent practice. Literature has shown that EPAs have been used successfully internationally to longitudinally evaluate the competency of pharmacy students and interns to complete profession-based activities in the workplace. EPAs have demonstrated applicability in evaluating clinical reasoning and decision-making through the assigning of a level of entrustment for specific clinical tasks. Conclusion: The structured pharmacy internship model in South Africa provides a strong foundation for piloting EPAs. Given the dearth of local information, this letter calls for the development and piloting of EPAs to assess pharmacy workplace competencies.
Long waiting times remain a persistent challenge in South African public sector pharmacies, undermining patient satisfaction and efficiency. At Kalafong Tertiary Hospital, a high-volume facility serving approximately 1000 patients daily, average waiting times reached 120 minutes, double the provincial benchmark of 60 minutes. Contributing factors included limited human resources, reliance on manual dispensing systems, and patients being ineligible for alternative distribution models, such as the Centralised Chronic Medicines Dispensing and Distribution system (CCMDD) or DAPLAPMEDS. In March 2024, the hospital pharmacy department introduced SkipTheQ, a digital booking system accessible via a mobile app, web platform and WhatsApp. The platform allows patients to schedule collection slots, enabling pharmacy staff to pre-pack prescriptions in advance. Since implementation, waiting times have dropped to 50.5 minutes, with over 6500 patients registered and more than 15 250 appointments served. Patient feedback has been overwhelmingly positive, and staff report improved workload distribution. This experience demonstrates that low-cost, digital innovation can strengthen operational efficiency, improve patient experience, and align pharmacy services with broader health system goals.
Background: Probiotics are live microorganisms that confer health benefits by positively influencing gut microbiota and overall gastrointestinal health. Pharmacists, as key healthcare professionals, are well-positioned to educate both patients and other practitioners on the appropriate use of probiotics. However, in South Africa, there is limited research on pharmacists' knowledge, attitudes, and perceptions regarding probiotic supplements. This study aimed to assess the knowledge, attitudes, and perceptions of community pharmacists in South Africa toward the use of probiotics through a structured survey. Methods: A cross-sectional, descriptive survey was conducted among community pharmacists across South Africa. Results: Of the respondents, 18.5% demonstrated a high level of knowledge about probiotics, while 11.3% showed poor knowledge (Mean +/- SD = 13.81 +/- 2.8). Positive attitudes were observed in 51.3% of participants, whereas 47.6% exhibited positive perceptions. Statistically significant but weak correlations were found between knowledge and attitudes (r = 0.1537, p = 0.0179), and between attitudes and perceptions (r = 0.3214, p < 0.0001). Conclusion: The findings reveal that while pharmacists generally hold positive attitudes and perceptions toward probiotics, their knowledge remains limited. This study highlights a critical gap and underscores the need for targeted educational initiatives to enhance pharmacists' understanding and effective communication regarding probiotic use in clinical practice.
Obesity is a chronic metabolic disorder that has reached epidemic proportions globally and in South Africa, contributing to the increasing burden of cardiometabolic diseases. Although lifestyle modifications remain a fundamental approach, long-term weight loss is often limited, necessitating the use of pharmacotherapy. Historically, centrally acting sympathomimetics, such as phentermine, have been predominant in South African treatments, albeit with restrictions concerning their safety and duration. This review examines the evolution of obesity pharmacotherapy from traditional agents, including phentermine and orlistat, to contemporary incretin-based therapies. Particular emphasis is placed on glucagon-like peptide-1 receptor agonists and dual incretin agonists, such as semaglutide and tirzepatide, which have demonstrated unprecedented efficacy in clinical trials involving patients with obesity. Emerging multi-hormonal and non-injectable agents are also discussed. This article underscores the transition from short-term appetite suppression to sustained pharmacological management of obesity and its comorbidities.
