| 1. |
- Beer, Netta, et al.
(författare)
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A qualitative study on caretakers' perceived need of bed-nets after reduced malaria transmission in Zanzibar, Tanzania
- 2012
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 12, s. 606-
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Tidskriftsartikel (refereegranskat)abstract
- Background: The elimination of malaria in Zanzibar is highly dependent on sustained effective coverage of bed-nets to avoid malaria resurgence. The Health Belief Model (HBM) framework was used to explore the perceptions of malaria and bed-net use after a noticeable reduction in malaria incidence. Methods: Nineteen in-depth interviews were conducted with female and male caretakers of children under five in North A district, Zanzibar. Deductive content analysis was used to identify meaning units that were condensed, coded and assigned to pre-determined elements of the HBM. Results: Awareness of malaria among caretakers was high but the illness was now seen as easily curable and uncommon. In addition to the perceived advantage of providing protection against malaria, bed-nets were also thought to be useful for avoiding mosquito nuisance, especially during the rainy season when the malaria and mosquito burden is high. The discomfort of sleeping under a net during the hot season was the main barrier that interrupted consistent bed-net usage. The main cue to using a bed-net was high mosquito density, and children were prioritized when it came to bed-net usage. Caretakers had high perceived self-efficacy and did not find it difficult to use bed-nets. Indoor Residual Spraying (IRS), which was recognized as an additional means of mosquito prevention, was not identified as an alternative for bed-nets. A barrier to net ownership was the increasingly high cost of bed-nets. Conclusions: Despite the reduction in malaria incidence and the resulting low malaria risk perceptions among caretakers, the benefit of bed-nets as the most proficient protection against mosquito bites upholds their use. This, in combination with the perceived high self-efficacy of caretakers, supports bed-net usage, while seasonality interrupts consistent use. High effective coverage of bed-nets could be further improved by reinforcing the benefits of bed-nets, addressing the seasonal heat barrier by using nets with larger mesh sizes and ensuring high bed-net ownership rates through sustainable and affordable delivery mechanisms.
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| 2. |
- Beer, Netta, et al.
(författare)
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High effective coverage of vector control interventions in children after achieving low malaria transmission in Zanzibar, Tanzania.
- 2013
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Ingår i: Malaria journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: Background: Formerly a high malaria transmission area, Zanzibar is now targeting malaria elimination. A major challenge is to avoid resurgence of malaria, the success of which includes maintaining high effective coverage of vector control interventions such as bed nets and indoor residual spraying (IRS). In this study, caretakers' continued use of preventive measures for their children is evaluated, following a sharp reduction in malaria transmission. Methods: A cross-sectional community-based survey was conducted in June 2009 in North A and Micheweni districts in Zanzibar. Households were randomly selected using two-stage cluster sampling. Interviews were conducted with 560 caretakers of under-five-year old children, who were asked about perceptions on the malaria situation, vector control, household assets, and intention for continued use of vector control as malaria burden further decreases. Results: Effective coverage of vector control interventions for under-five children remains high, although most caretakers (65%; 363/560) did not perceive malaria as presently being a major health issue. Seventy percent (447/643) of the under-five children slept under a long-lasting insecticidal net (LLIN) and 94% (607/643) were living in houses targeted with IRS. In total, 98% (628/643) of the children were covered by at least one of the vector control interventions. Seasonal bed-net use for children was reported by 25% (125/508) of caretakers of children who used bed nets. A high proportion of caretakers (95%; 500/524) stated that they intended to continue using preventive measures for their under-five children as malaria burden further reduces. Malaria risk perceptions and different perceptions of vector control were not found to be significantly associated with LLIN effective coverage. Conclusions: While the majority of caretakers felt that malaria had been reduced in Zanzibar, effective coverage of vector control interventions remained high. Caretakers appreciated the interventions and recognized the value of sustaining their use. Thus, sustaining high effective coverage of vector control interventions, which is crucial for reaching malaria elimination in Zanzibar, can be achieved by maintaining effective delivery of these interventions.
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| 3. |
- Beer, Netta, et al.
(författare)
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Magistral Compounding with 3D Printing : A Promising Way to Achieve Personalized Medicine
- 2023
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Ingår i: Therapeutic Innovation and Regulatory Science. - : Springer Nature. - 2168-4790 .- 2168-4804. ; 57:1, s. 26-36
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Tidskriftsartikel (refereegranskat)abstract
- Background Magistral compounding has always been an integral part of pharmacy practice. The increasing demand worldwide for personalized drug treatments might be accommodated by an increase in magistral compounding. The new, flexible technology of 3D medicine printing could advance this process even further. However, the issue of how 3D medicine printing can be implemented within the existing magistral compounding infrastructure has not been explored. Aims To investigate how 3D printing can be integrated into the existing compounding system by taking regulatory, economic, and profession-oriented aspects into account. Methods Semi-structured interviews were conducted with relevant Dutch stakeholders representing various health institutions, such as health ministries and boards, professional bodies, and different types of pharmacies. Participants were identified through purposeful sampling. Content analysis was applied to identify the main themes. Results A total of 15 Dutch stakeholders were interviewed. It was found that the prevalence of compounding in community pharmacies in the Netherlands has decreased as a result of the practice shifting to specialized compounding pharmacies due to higher costs, lack of space, and the need to fulfill quality requirements. All interviewees considered 3D printing to be a promising compounding technique for community pharmacies, as it offers an automated approach with high digital flexibility and enables adapted formulations, including 'polypills.' Regulatory and quality assurance challenges were considered comparable to those of normal magistral products; however, there remain pending regulatory issues regarding quality control, particularly for Active Pharmaceutical Ingredients containing intermediate feedstock materials (e.g., prefilled cartridges) in 3D printing. 3D printing was believed to become cost effective over time. Conclusion In the Netherlands, specialized compounding pharmacies have largely taken over compounding activities. 3D printing could be introduced within this system; however, challenges regarding how to regulate prefilled cartridges have yet to be addressed. Compounding using 3D printing in regular community pharmacies could enhance patients' individualized treatment; however, this activity would require incentives to stimulate the return of compounding to normal pharmacy practice.
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| 4. |
- Beer, Netta, et al.
(författare)
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Scenarios for 3D printing of personalized medicines : A case study
- 2021
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Ingår i: Exploratory Research in Clinical and Social Pharmacy. - : Elsevier. - 2667-2766. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background3D printing is a promising new technology for medicines' production. It employs additive manufacturing techniques, and is ideal for producing personalized medicines (e.g., patient-tailored dose, dosage form, drug release kinetics).ObjectiveTo investigate how 3D printing technologies can be implemented in a European pharmaceutical system, by suggesting different scenarios and assessing aspects that could affect its implementation.MethodQualitative, semi-structured interviews were conducted with key stakeholders (e.g., from ministry, authorities, research organizations, pharmacies) in the Netherlands to elicit perspectives on 3D printing of personalized medicines. The Netherlands were chosen since it has a strong tradition in compounding. Five general scenarios were investigated: placing the 3D printers in industry, community pharmacies, hospital pharmacies, compounding facilities, and in patients' homes. Content analysis was used, building on verbatim transcripts.ResultsFifteen stakeholders were interviewed. Regulatory, economic, ethical and organizational challenges were identified to varying degrees in the different scenarios. The industry and home scenarios were associated with the most challenges, hospital pharmacies and compounding facilities with the least. Other important aspects identified were the role of community pharmacies, and who should design the tablets to be printed.ConclusionAll potential scenarios for 3D printing of personalized medicines include challenges. These should be taken into account when pursuing the use of 3D printing of medicine.
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| 5. |
- Beer, Netta
(författare)
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Targeting malaria elimination : an assessment of malaria control interventions for children in Zanzibar
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: After decades of neglect, a renewed global focus on malaria was initiated in the 90s, followed by global financial support in the early 2000s. Zanzibar has been in the forefront of these renewed efforts: Case management and vector-control interventions have been implemented and scaled-up rapidly, resulting in markedly reduced malaria transmission and the targeting of malaria elimination. Aim: The overall aim of this thesis was to assess caretakers' uptake of malaria control interventions for under-five children in Zanzibar, an area where malaria transmission has rapidly decreased. Methods: In Study I, a follow-up survey of 210 caretakers was performed to assess caretaker adherence to Artemisinin-based Combination Therapies (ACTs), where caretakers were interviewed in their homes four days after receiving the three-day treatment for their children. In Studies II & III, an assessment of the effective coverage of vector control interventions was carried out in two community-based surveys in 2006 and 2009, with 509 and 560 caretakers, respectively. Both surveys were done in North A and Micheweni districts. In the 2006 survey, the system effectiveness of a targeted free mass distribution of long-lasting insecticidal nets (LLINs) was also assessed, and in the 2009 survey, caretaker perceptions of the malaria situation in Zanzibar and of vector control interventions, were evaluated. Perceptions of malaria and vector control interventions were further explored by conducting in-depth interviews with 19 caretakers (Study IV). Results: Moderate adherence of 77% to Artesunate-Amodiaquine (AsAq) was documented, and was mostly due to misunderstanding or forgetting the correct dose regimen. Factors associated with adherence were caretaker's education exceeding 7 years and receiving the exact number of pills to complete the treatment regimen, while administering the first dose at the health facility resulted in complete adherence (I). System effectiveness of the targeted mass distribution had increased in the distribution scale-up in North A district as compared to the pilot distribution in Micheweni. This resulted in high (87%) and equitable effective coverage of LLINs in under-five children in the North A district. Effective coverage was associated with receiving an LLIN and thinking that LLINs were better than conventional nets (II). Effective coverage of LLINs in under-fives in the 2009 survey was also equitable and relatively high (70%) following an un-targeted mass distribution, while effective coverage of IRS was as high as 95%, resulting in almost perfect effective coverage (98%) of at least one vector control intervention (III). Seasonality was found to interrupt continuous adherence to bed-nets (III & IV). Low risk perceptions of malaria (III & IV) were not significantly associated with effective coverage (III), although the higher perceived risk for children is in line with the finding that children were prioritized for use of bed-nets (III & IV). Vector control interventions were generally well accepted (II-IV), and caretakers appreciated the importance of their continued use as malaria further declines (III). Conclusions: Findings of this thesis indicate that caretaker uptake of malaria control interventions for children remains high in Zanzibar in the face of declining malaria burden. ACTs, freely provided at public health facilities, were relatively well adhered to, and the high effective coverage of IRS, together with satisfactory effective coverage of LLINs, provided an almost perfect effective coverage of vector control interventions. This high effective coverage elevates the prospects of achieving malaria elimination in Zanzibar.
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| 6. |
- Chao, Meie, et al.
(författare)
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Data-enriched edible pharmaceuticals (DEEPs) : Patients' preferences, perceptions, and acceptability of new dosage forms and their digital aspects – An interview study
- 2022
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Ingår i: Exploratory Research in Clinical and Social Pharmacy. - : Elsevier. - 2667-2766. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn the field of pharmaceuticals, there is a shift away from the traditional “one-size-fits-all” concept to a more patient-centered one. A potential approach to obtain personalized medicine is with printed Data-Enriched Edible Pharmaceuticals (DEEPs). DEEPs that are printed in the pattern of QR codes contain both the patient-tailored dose and data that can be used to give patients personalized drug information and combat counterfeit medicines.ObjectivesThe study aims to explore patients' preferences, perceptions, and acceptability of DEEPs, and the digital aspects of them.MethodsThirteen participants, living in Denmark, were interviewed twice using a semi-structured approach. Interviews were conducted face-to-face or via video calls. The interviews were transcribed, translated, and analyzed using thematic coding analysis.ResultsThe participants found it useful to participate in the design of their own medicine. The orodispersible nature of DEEPs and the possibility to select color, embedded images, flavors, and physical dimensions of DEEPs were considered beneficial for patients' adherence. Patients' personal preferences, convenience, and aesthetics were the main drivers for their favored design of DEEPs. The acceptability of digital healthcare in connection to DEEPs was found to be related to the participants' level of digital literacy.ConclusionsThe participants generally had a positive attitude towards DEEPs and the digital aspects of them. However, to accept digital healthcare in connection to DEEPs, it should be adaptable and easy to use for everyone. The combination of digital healthcare and on-demand fabricated DEEPs could potentially contribute to higher patient adherence and safety in the future.
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