A STUDY ON THE CONSUMPTION OF ANTI-TUBERCULOSIS MEDICINES AT KATUTURA INTERMIDIATE REFERRAL HOSPITAL
A RESEARCH REPORT SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE BACHELOR OF PHARMACY (HONS) DEGREE
OF
THE UNIVERSITY OF NAMIBIA
BY
THABANI MATAMBO
(201404202)
APRIL 2018
Supervisor: Mr. Bonifasius Siyuka Singu
Pharmacy Practice & Policy, School of Pharmacy University of Namibia
Abstract
Tuberculosis is amongst the world’s deadliest disease and medicine management together with utilization of anti TB medicines is important in avoiding issues such as stock outs, misuse and overstocking. The primary aim of this research is to study the consumption of anti TB medicines at Katutura intermediate referral hospital, this information will also be used to add on to the existing literature regarding anti-TB medicine use and consumption through determining the consumption rates of Anti-TB medicines. For the research Quantitative methods where used and data was collected using convenience sampling from electronic Stock cards at Katutura intermediate referral hospital pharmacy with information dating from September 2016 to August 2017. This information was then translated into statistical data for interpretation. The research concludes that anti TB medicine consumption at Katutura Intermediate referral hospital are higher than the stipulated averages documented in the national annual tuberculosis (TB) report by the Ministry of Health and Social Services as published in 2015. An ABC analysis was done for both the first and second line medicines and it was observed that RHZE and PAS both belonged to the class A in the analysis and had the most consumption and purchase cost (expenditure). It can be recommended that cheaper sources of these medicines be looked for since they cost the most. Emphasis should also be put on monitoring the shelf life, delivery schedules and stock for class A items since they occupy most of the monetary budget hence the importance of their value should be well displayed. A recommendation to MoHSS and the Hospital is to come up with more strict therapeutic approaches to avoid disease progression as the research shows how second line anti TB medicines are more expensive than first line and their value for consumption is also greater than first line despite having lesser consumption in units .
Table of Contents
Abstract i
Acknowledgements ii
Declaration iii
Abbreviations iv
CHAPTER ONE INTRODUCTION 1
1.1. Orientation of the proposed study 1
1.2. Problem statement 2
1.3. Objectives of the study 3
1.3.1. Main objective 3
1.3.2. Specific Objectives 3
1.3. Significance/ Justification of the study 4
1.5. Theoretical Framework 6
CHAPTER TWO LITERATURE REVIEW 7
CHAPTER THREE METHODOLOGY 18
3.1. Research design and setting 18
3.2. Study population 18
3.3. Sample and sampling method 18
3.4. Research Instrument 19
3.5. Data collection Procedure 19
3.6. Study variables 20
3.7. Data Analysis 20
3.8. Dissemination of Results 20
3.9. Ethical considerations 21
CHAPTER FOUR RESULTS 22
CHAPTER FIVE DISCUSSION 33
5.6 Limitations 38
CHAPTER SIX CONCLUSION 39
CHAPTER SEVEN RECOMMENDATIONS 40
CHAPTER EIGHT REFERENCES 41
CHAPTER NINE APPENDICES 43
Acknowledgements
I most humbly thank the Almighty, who has always showered his blessings unto me, every moment of my life and I seek guidance from him.
I pay a lot of thanks to my family for their support, kindness and everlasting prayers, which have always sailed me through every thick and thin moment of this journey. I would like to express my sincere gratitude to my Supervisor Mr. Bonifasius Singu for his patience, support and encouragement during my whole education at the University of Namibia’s School of Pharmacy. It would have not been possible without his much focused and highly inspired guidance.
I owe special thanks to the Hospital staff at Katutura State Hospital especially the Pharmacy staff for providing me with the best possible services regarding the information I used to come up with this research, and last but not the least, Mrs F.Amutenya from the Windhoek Health District office who sacrificed her office time in assisting me with gathering information concerning my research
Special thanks to my ever-loving friends and classmates who gave me tremendous support to complete this research.
Thabani Matambo
B.Pharm 4:201404202
University of Namibia School of Pharmacy
Declaration
I hereby declare that the research submitted by me titled “A STUDY ON THE CONSUMPTION OF ANTI-TUBERCULOSIS MEDICINES AT KATUTURA INTERMIDIATE REFERRAL HOSPITAL” is based on my own research work and has not been submitted to any other institution for any other degree or used for other purposes outside my research field.
Date:_________ Signature: _____________________
Thabani Matambo B.Pharm 4 ,University of Namibia School of Pharmacy
Abbreviations
TB- Tuberculosis
KIRH Katutura Intermediate and Referral Hospital
DRTB Drug Resistant Tuberculosis
MDRTB Multi Drug Resistant
MoHSS Ministry of Health and Social Services
UNAM University of Namibia
IUATLD International union against Tuberculosis and Lung disease
WHO World Health Organization
NTLP National Tuberculosis and leprosy Programme
R Rifampicin
H Isoniazid
Z Pyrazinamide
E Ethambutol
S Streptomycin
Cyc Cyloserine
Lev Levofloxacin
Bdq Bedaquiline
Capr Capreomycin
Kan Kanamycin
PAS Para Amino Salicylic Acid
CHAPTER ONE INTRODUCTION
1.1. Orientation of the proposed study
Tuberculosis continues to pose a burden to the nation as a whole and the disease has chiefly crippled the health sector over the past years. According to the National Guidelines for the Management of Tuberculosis Namibia has one of the highest TB case notification rates worldwide (Ministry of Health and Social Services i.e. MOHSS, 2012) In Namibia TB is seen to have a high incidence in HIV positive patients as it exists as a co-infection the deadly virus. The high case load is mainly attributed to the HIV epidemic as reflected by an HIV prevalence of 18.8% among the antenatal clinic attendees and an HIV prevalence rate of 56% amongst HIV patients. In Namibia this distribution varies as with region and is most prevalent in the Kavango region. Treatment outcomes should achieve a success rate of 100% of the detected infections and these have over the years improved with the continual improvement of medicines use.
Moving on to more current data as stated by the Health Minister Dr Ben Haufiku in an article from the Namibian Newspaper (Cloette March, 2015) TB is still a major concern for the Namibian health system despite the statistical figures having shown a 7 % decline in 2014 from the 10610 diagnosed patients in 2013.However it should be noted that this does not call for complacency as TB is but a cause for concern in the infectious diseases affecting the country.
The continual rise in Drug resistant, multi drug resistant and extreme drug resistant forms of TB continue to be a threat in monitoring the disease as they have had a large impact on medicine use, hence demanding more capital and a more hands on approach by health care workers. We consequently have to continually worry and account for the statistics regarding medicine use because, medicines save lives and improve health, they are costly, medicines promote trust and participation, medicines are different from other consumer products thus substantive improvements in the supply and use of medicines is possible (Managing Distribution Volume 3, 2013).
As of date no valid research article has been published on the consumption of anti-TB medicines hence there are no set points as to compare whether there is a direct relationship between TB medicine consumption and the disease burden so as to see if resources are adequately being used as well as to fill in the existing gaps in literature concerning such information. Thus the research is of great importance so as to come up with set standards which will help assess anti-TB medicine use.
1.2. Problem statement
Rational use of medicines requires that "patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community. It should be noted that irrational use has detrimental effects on patient’s health and the budget of the ministry of health and social services. Unregulated consumption of tuberculosis medication may lead to their shortages as well as a financial strain owing to the costliness of these medicines. With Namibia undergoing such an economic crisis it is thus important to have strict monetary control when it comes to purchase and consumption of medical supplies and medications. Tuberculosis is an endemic of which data as of 2012 reports an annual case notification rate of 529 with 206 new smear positive cases being conveyed as per 100000 people (MoHSS, 2014).
Issues of wastage especially during the dispensing and the storage process may lead to unnecessary costs which in the end may have undesirable influence on the sourcing of these medicines as the Ministry of Health works on a strict budget .Be it the case that there is a widespread outbreak it may reach a situation in which there are not enough Anti-Tb medicines and this would in turn compromise patient health. Irrational use of medicine is a problem that may lead to issues of resistance, it may also lead to the unnecessary depletion of stock as result the health setting may face medicine shortages. In addition it is unfortunate that there is little knowledge regarding the use of anti-Tuberculosis medicines in Namibia, not forgetting the scarcity in articles relating to the statistics concerned thereof.
The purpose of this research is to determine the cost of treating tuberculosis at Katutura Intermediate Referral Hospital and use it in assisting the Ministry of Health and Social Services and the hospital in forecasting as well as purchasing of anti-tuberculosis medicines.
1.3. Objectives of the study
1.3.1. Main objective
To determine the cost of treating tuberculosis at Katutura Intermediate Referral Hospital.
1.3.2. Specific Objectives
i. To determine the quantity of anti-Tuberculosis medicine used per month at Katutura Intermediate Referral in the period September 2016 to August 2017.
ii. To determine the cost of anti TB medicine use at Katutura Intermediate Referral Hospital in the period September 2016 to August 2017.
iii. To estimate the purchase cost (expenditure) on TB medicines at Katutura Intermediate and Referral Hospital in the period September 2016 to August 2017.
iv. Perform ABC classification on consumption of anti-tuberculosis drugs
1.3. Significance/ Justification of the study
The study aims to determine the monetary cost of purchase and consumption of medicines used against tuberculosis. This information could be useful to the Ministry of Health & Social services (MoHSS)in the sense that it might ration the ordering, expenditure and consumption of anti-TB medicines thereby maximizing availability of these medicines to the patient at all times making sure that issues of understocking, over stocking and wastage are reduced. This Research will not only benefit the patient alone but the whole hospital as a whole in that adequate resource and monetary allocation will be done hence henceforth many patients will be cured of the infection if they adhere as medicines will readily be available at all times. As a result treatment goals can thus be reached through these measures.
To the community this means that if there is efficient consumption of medicines more patients will be cured, provided they adhere to the treatment guidelines, thus this will have a positive social impact and remove the stigma present hence people will be more confident in reporting TB cases provided they can be cured. On a higher level the hospital, Central medical store and the ministry may use the data to have more accurate forecasts before medication procurement to ensure that expenditure on TB medicines is kept well under control such that there is effective usage of money and resources and at the same time ensuring patients do receive the treatment. The research will also help to build local capacity on the tools used to conduct pharmaceutical management assessment of anti-TB medicines.
Unfortunately there has been a gap in literature associated with the consumption of anti-tuberculosis medicines thus the research seeks on closing the gaps through providing reliable information regarding these medicine use trends by compiling the set information.
The study is henceforth justified by the fact that TB is a major killer in the country and also is a very difficult disease to control. New estimated data provided by the World health organization as of 2015 indicate a total case notification of 9944, total new and relapse of 9 614 and of these numbers 83% of the cases are known to be pulmonary tuberculosis. The disease further on cripples the health of immunocompromised people, for instance its well-known comorbidity with HIV (WHO, 2015). Within Namibia reports indicate an antenatal seroprevalence rate of 18.2% with a 47 % TB/HIV co-infection rate. Thus having known comorbidity with HIV decreases the life expectancy and standard of living of the affected patient. This being said it can therefore not be stressed enough that the disease is a cause for concern hence looking into a research like this will assist in coming up with more effective means of controlling it.
1.5. Theoretical Framework
CHAPTER TWO LITERATURE REVIEW
Tuberculosis Overview
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis remains amongst one of the deadliest communicable disease on the planet (WHO, 2014). Due to the continual rise in the different strains of TB i.e. Drug resistant TB, Multi Drug Resistant TB and Extensively Drug resistant TB (CDC, 2016). These thus call upon different treatment methods which should thus consist of different medication whose rational use and management is of great importance in achieving maximum therapeutic efficacy. According to the 2014 Global Tuberculosis Report an estimated 9.0million developed Tuberculosis and 1.5million died, with an estimated amount of 3600,000 of whom where HIV positive. However as it stands Tuberculosis associated deaths and complications are decreasing and an estimated number of 37 million lives were saved between 2000 and 2013. However given the number of deaths that occur due to preventable causes it can be said that effort still needs to be put so as to meet the Millennium Development Goals. When looking at the 2015 Global targets two out of six regions have achieved all three 2015 targets for reductions in TB disease burden (incidence, prevalence, mortality): the Region of the Americas and the Western Pacific Region. The South-East Asia Region appears on track to meet all three targets. Incidence, prevalence and mortality rates are all falling in the African, Eastern Mediterranean and European Regions but not fast enough to meet targets. This thus raises a concern as to where the problem is originating from hence measures should be undertook so as to meet the required targets.
The disease burden of TB not only poses a threat to the Health of populations but the cost of Anti Tuberculosis medicines is quite strenuous on the health budget given that it is a disease that can be prevented. The disease becomes more costly to treat when it develops to drug resistant Tuberculosis and this can be seen form the relative price of the Anti-TB medicines as according t line and the duration of treatment as well as the hospital costs hence measure should be undertook to see that the disease does not progress into resistant forms as these become more costly to manage.
Financing of Anti Tuberculosis Medication
Within each country there are measures that exist and aspects of management, which include how medicines are controlled and ordered. The process of drug management includes selection, procurement, distribution, rational use, and financing as well as quality assurance. In 1994 an article published by Weil described the difficulties in forecasting requirements, dramatic differences in prices on a country to country basis as well as the problems that are involved in the processes of quality assurance and distribution. Furthermore this paper provides an outlines of information on the differences in prices between countries, including vital data on the continued increase in TB drug prices in US as compared with stable or declining costs internationally. He also pointed out some of the major differences in prices existed between non-profit suppliers.
Most of these drugs were provided in FDC products of which these came to be because of a major initiative by the WHO and the International union against Tuberculosis and Lung disease (IUATLD) in 1998 and 1999 aimed at promoting the use of FDC tablets for the first-line treatment of TB in all TB programs, including both DOT and standard programs. The promotion of FDCs proved to be a major boost in combating Tuberculosis because it helped increase adherence and compliance. Furthermore when looking at the prices of drugs it has been noticed that they have generally increased over time. First-line drugs (that include isoniazid, rifampicin, pyrazinamide and ethambutol) have generally increased in price over the past 20 years in the developed world particularly the USA, while the international prices have remained stable or possibly decreased slightly. For the second-line drugs the situation is more complex. Suppliers are now limited, large-scale tenders are not announced accurately and the true international price is not very clear. As at now the ‘free market’ is not yet functioning efficiently. However, as the demand increases and as more DOTS-Plus programs are established, it is more likely that the prices of these drugs will decrease and stabilize at lower levels. Further research is needed to identify the reasons for the considerable price variations that exist between countries and between the public and private sectors within the same countries. tuberculosis is a disease of such public health significance hence it may be reasonable, in countries where the private sector provides a substantial portion of the TB care, to allow the private sector to purchase FDC drugs at reasonable national tender prices. This act would substantially reduce the price to patients and would likely boost the use of FDC preparations.
Expenditure in Tuberculosis
Primarily the key priorities for donors include strong investment cases and improving value-for-money in public health programs. These donors are the backbone for assistance in coming up with mechanisms and programs aimed at financially aiding the combating diseases in High burden diseased countries (HBCs). An example of such a mechanism is the Global Fund program whose main aim or purpose is assisting in the fight against AIDS, TB and Malaria and is the world's largest health financing mechanism for the three diseases. Aidspan has conducted a simple analysis of expenditure by national tuberculosis programs as reported by governments, excluding contributions by the US government relative to the burden of disease. (Mwangi,2014) The analysis aims at assessing the proportional contribution by the Global Fund to other sources of funding in 22 countries that are classified as high-burden. Their classification as high-burden countries (HBC) is given because when they are combined together they constitute about 80% of the total burden of disease, and a recording of over 1 million of the deaths reported annually from TB.
The total expenditure by TB programs globally has been documented for the period 2002 to 2011 by Floyd and colleagues (Floyd, 2013). The total reported as spent by NTPs grew from $1.7 billion in 2002 to $4.4 billion in 2011. By 2013, this had grown to over $6 billion (Global TB Report 2013), contributed in the form of national budget allocations, foreign loans to governments, grants from donors ,either agencies or in bilateral contributions from governments and grants through the Global Fund. Again, by 2013, the Global Fund was the largest external investor in TB case management, responsible for about 80% of the total international spending on TB, with over $700 million in disbursements were sent to countries that year.
In the first paper of its kind, Floyd (2013) looked at the trends in funding and spending around TB between 2002 and 2011 across 104 countries including all HBC. They also examined the cost per patient successfully treated, measuring the value for money in each of the programs. This money mostly paid for diagnosis and treatment for drug susceptible TB. Between 2002 and 2012, more than 43 million cases had been successfully treated. Cost for treatment in low- and lower middle-income countries ranged between $100 and $500 per patient. As TB is a notifiable disease, there is now a substantial body of data available on rates of disease, treatment completion and the demography of those affected. Most of this data is considered as open-source. Data regarding finance is also increasingly available although it remains harder to interpret it often due to the variability in what is reported and when.
There are a number of current approaches to estimating the total costs of the TB burden. Generally, analysts usually separate the direct and indirect costs. The Direct costs are identified as the program costs, which include human and lab-based or medical resources, administration, supervision, and lab or associated costs with running the programs, and also the patient costs which include access to healthcare and maintaining their treatment for as long as deemed necessary.
On the other hand the indirect costs to patients include lost productivity costs due to the disease and lost opportunity to families who have to spend scarce resources caring for the patient instead of spending on other essential needs. Methods currently in use by most NTPs do not usually report the cost of treatment during outpatient visits or in-patient costs (i.e. the cost of staying in hospital or treatment facilities once diagnosed).
Tuberculosis in Namibia
According to the MoHSS report 2014-2014 Namibia remains among the top 5 countries with the highest TB burden .The number of tuberculosis cases that have been diagnosed and treated in Namibia has maintained a downward trend from 16,156 cases in 2004 to 9,882 cases in 2014, representing a 39% decline during this period. The following table shows the case notification of TB in the country in the year 2014.
Table 1-TB Case notifications 2014(from National Tuberculosis and Leprosy Programme, Summary Report 2014-15)
From table 1 it can be seen that relapses where encountered which is a cause for concern as some of the cases may thus become Drug Resistant TB which is more deadly as well as more costly to treat. A total of 137 cases of multi drug resistance tuberculosis (MDR_TB) were reported in 2014, of which 6 were extensively drug resistance tuberculosis (XDR-TB). This signified a slight decline in reported MDR-TB cases from 174 reported the previous year. The number of reported cases of rifampicin resistant tuberculosis diagnosed using the Xpert MTB/Rif test increased from 89 cases in 2013 to 199 cases in 2014(MoHSS, 2016)
The distribution of TB cases in the country is not uniform, with the majority of the cases being reported in Khomas, Ohangwena, Erongo and Kavango regions (see figure 1). The per capita disease burden (number of cases per population) is however highest in Hardap, Karas and Omaheke regions(MoHSS,2016)
Figure 1- The burden of tuberculosis in the different regions of Namibia (from National Tuberculosis and Leprosy Programme, Summary Report 2014-15)
Anti-TB Medicine Consumption and management in Namibia
Reports of Tuberculosis by MoHSS indicate that Namibia continued to struggle with the issue of drug resistant TB in 2014. Patients with drug resistant (DR) TB were reported in all regions in 2014. While the estimated cost of treating one patient with TB (usual form) is less than N$1000, it is estimated that the cost of treating one patient with DRTB averages more than N$51,000. From the 2012 treatment cohort 68% of MDR-TB cases were successfully treated. However there has been a general increase in the number of Drug resistant TB in Namibia. In the year 2014 a total of 363 cases of Drug Resistant TB where reported as opposed to 302 reported cases in 2013 and 252 in 2012. This is a cause for concern as we know DRTB costs more than the usual form of TB in terms of the money spent during treatment. Henceforth measures put need to be more strict and patients should at least adhere to first line treatment and avoid defaulting to avoid the costliness nature of having to treat DRTB. (MoHSS, 2015)
As stated in the 3rd edition of the National Guidelines for the Management of Tuberculosis (2011) management of medicines is an essential part of any health care system but plays an even more critical role in TB because TB is a difficult disease to cure requiring drugs of a multi-drug regimen and making sure that these medications are adhered to. One sub strategy of the STOP TB campaign is to ensure an effective medicines supply and management system. This thus brings us to our research topic of keeping track of the statistical figures involved in the process. We seek to harness information regarding to the use of medicines in the TB ward at Katutura state hospital.
It should then be noted that the use of TB medicine involves the management of these very same medicines of which the main concern here are matters including Stock Control which basically revolve under two principles that are to ensure that the correct items are available in the right quantities, right amounts at the time when they are needed and it also improves accountability. (MoHSS, 2012)
Assessing anti-TB medicines use is thus an important player in management of TB medicines. The 3rd edition of the National Guidelines for the Management of Tuberculosis (MoHSS, 2012) state that it is important to have statistical data as it:
• Assists the District TB/Leprosy control officer (DTLC) in forecasting needs.
• Helps in Ordering medicines from the relevant distribution channels
• Prevents stock outs.
ABC classification
In Supply Chain Management it is a well-known fact that a relatively small number of items account for most of the value of annual consumption. Analysis of this phenomenon is known as Pareto analysis or ABC analysis. Within a supply system, analysing consumption patterns and the value of total consumption for all the items is very useful, the inventory items can be classified into three categories A, B and C and this is based on the value of their annual usage. Other tools such the therapeutic category analysis and price comparison analysis build on the ABC analysis. ABC Is a powerful tool, with uses in procurement, selection, management of distribution and promotion of rational medicine use.
I. Selection
Reviewing of class A medicines helps in uncovering high-use items for which low-cost alternatives are readily available in the market place. ABC analysis also helps managers in identifying purchases that are made for items that are not on formulary or those items that are not approved for use in the supply system.
II. Procurement
ABC analysis helps in facilitating procurement related activities, such as determining sources for lower-priced products, assuring procurement should be a priority, and assessing how order frequency affects overall supply.
III. Determining order frequency
Ordering class A items more often and in smaller quantities should lead to a reduction in inventory-holding costs. Frequency and quantity influence supply activities in at least six ways: 1) they determine average inventory levels. higher order quantity means higher inventory levels.2) they determine procurement workload ,higher order quantity means a lower number of orders and lower order quantity indicates a higher number of orders. 3)they determine safety stock, more frequent ordering means less inventory and less safety stock.4) they influence bulk prices, larger orders mean more special bulk rates.5) they determine storage space requirements for medicines.6) and they influence the likelihood of losses to expiry, less frequent bulk purchasing may lead to more expired medicines.
IV. Seeking lower-cost sources for class A Items
The procurement office is required to concentrate on getting lower prices for class A items by searching for cheaper dosage forms or cheaper suppliers. Price reduction for items classified as A products in the analysis can lead to massive savings
V. Monitoring order status and Monitoring procurement priorities
There must be emphasis on monitoring the order status of class A items, because an unexpected shortage may lead to expensive emergency purchase. ABC analysis can help monitor procurement patterns in comparison with the priorities of the health system.
VI. Comparing actual and planned purchases and Distribution and inventory management
ABC analysis can be used be used to compare actual and planned purchases in a public-sector supply system. In addition to selection and procurement, ABC analysis can also help with distribution and inventory management activities such as;
VII. Monitoring shelf life and Delivery schedule
There should be emphasis given to class A items to minimize waste caused by medicines exceeding their shelf lives. Divided deliveries of class A items can lead to prolonged shelf lives even when medicines are ordered only once a year.
VIII. Stock counts and Storage
Cyclic stock counts should be guided by ABC analysis, with more frequent counts for class A items. Proper storage and improving control for issuance and storage of class A medicines at user points such as hospitals and health centre facilities can help reduce waste and organized theft of various medicines (Embrey, 2013)
In general ABC in classifies medicines the following boundaries i.e.
• Class A (highest annual usage)-with 10 to 20% of the items accounting for 75-80 % of the funds spent
• Class B – represent another 10 to 20% of the items and 15-20% of the funds
• Class C- Account for 60 to 90% of the items but only 5-10% of the funds
CHAPTER THREE METHODOLOGY
3.1. Research design and setting
The study followed a retrospective, quantitative and comparative design in nature. Data was compiled from electronic stock cards from the Katutura Intermediate Referral Hospital (KIRH) pharmacy for the time period of September 2016 until August 2017.
3.2. Study population
The study population used where all first and second line anti TB medicines at Katutura Intermediate Referral Hospital whose data was obtained from electronic stock cards, order books and PMIS reports from the pharmacy.
3.3. Sample and sampling method
Data was collected using convenience sampling from electronic Stock cards at Katutura intermediate referral hospital pharmacy with information dating from September 2016 to August 2017.This information comprised of first and second-line anti-TB medicines with data including their monthly consumption, expenditure by the hospital and stock on hand. Convenience sampling was used for selecting the sample so as to obtain only the set of Anti-TB medicines that are conventional treatment and leave out the ones used to treat opportunistic infections. The research involved non probability methods since we had a certainty of our information and samples where based on subjective data that was coming from the electronic stock cards. In essence the Research is Quantitative.
3.4. Research Instrument
Data was collected from electronic stock cards and issue books from Katutura Intermediate Referral Hospital Pharmacy, as well as from the Khomas District office of Health .A research tool which is well elaborated in the annexures was used which was able to capture information on the consumption and expenditure of Anti-Tuberculosis medicines including the amounts used as per month for the period stipulated.
3.5. Data collection Procedure
For the data collection procedure information was obtained by systemically going through every electronic stock card and order books in Katutura Intermediate Referral Hospital pharmacy and thus recording information regarding use of anti-Tuberculosis medicine. The information collected dated from the 1st of September 2016 to the 31st of August 2017. This data was then be inputted into the data tool which thus helped analyze the results. The tool was thus able to capture information on first and second line Anti-TB drugs such as the quantity of medicines ordered, quantity of Medicines Received, Expenditure, stock ,consumption per month, cost of consumption, package size, units present as per medicine and average unit price of the medicine. This information was thus used to come up with the consumption rates of anti TB medicine use at Katutura state Hospital for the stipulated period of one year.
This information was used in conjunction with the number of patients initiated on either first or second line treatment per month. This information was gathered from the Health District office TB department in which monthly reports where able to capture the number of patients initiated on treatment at Katutura State Hospital. This information was then used in the result analysis so as to determine the relationship between the number of patients and the consumption cost.
3.6. Study variables
Independent: disease profile
Dependent: electronic stock cards and order books and quantity of medicines consumed and purchase cost
3.7. Data Analysis
For the data analysis information from the data collection tool which included quantity of medicines ordered, quantity of Medicines received, expenditure, stock, consumption per month, cost of consumption, package size, units present as per medicine and average unit price of the medicine was exported to Microsoft word. After this the data was then computed into graphical values and charts so as to observe medicine use trends. Lastly from the averages and totals of the medicine consumption information of anti TB medicines from September 2016 to August 2017 information concerning the consumption rates was able to be compiled, analyzed and is ready for presentation upon request.
3.8. Dissemination of Results
This research shall be presented to an academic panel from the University of Namibia and the results obtained will fully be interpreted and presented to this panel. Upon correction of the research by the panel research will be edited on missing areas and published in a peer reviewed journal. External stake holders will be provided with this data only under legal grounds and when every required channel has been considered as this is vital information.