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BackgroundThe World Health Organization (WHO) has warned that substandard and falsified medicines threaten health, especially in low- and middle-income countries (LMIC). However, the magnitude of that threat for many medicines in different regions is not well described, and high-quality studies remain rare. Recent reviews of studies of cardiovascular and diabetes medicine quality recorded that 15.4 % of cardiovascular and 6.8% of diabetes samples failed at least one quality test. Review authors warn that study quality was mixed. Because they did not record medicine volume, no study reflected the risk posed to patients.Methods and FindingsWe investigated the quality of five medicines for cardiovascular disease and diabetes in Malang district, East Java, Indonesia. Our sample frame, based on dispensing volumes by outlet and price category, included sampling from public and private providers and pharmacies, and reflected the potential risk posed to patients. The content of active ingredient was determined by High Performance Liquid Chromatography, and compared with the labelled content. Dissolution testing was also performed.We collected a total of 204 samples: amlodipine (88); captopril (22); furosemide (21); glibenclamide (21); and simvastatin (52), comprising 83 different brands/products. All were manufactured in Indonesia, and all samples met specifications for both assay and dissolution. None was suspected of being falsified.ConclusionsWhile we cannot conclude that the prevalence of poor-quality medicines in Malang district is zero, our sampling method, which reflects likely exposure to specific brands and outlets, suggests that the risk to patients is very low; certainly nothing like the rates found in recent reviews of surveys in LMICs. Our study demonstrates the feasibility of sampling medicines based on likely exposure to specific products, and underlines the dangers of extrapolating results across countries.What is already known on this topicThe World Health Organisation suggests that as many as one in 10 medicines in low- and middle-income countries are of poor quality, but studies of the prevalence of substandard and falsified rarely take into account patient exposure.Medicines for non-communicable diseases and studies from large middle-income countries are under-represented in existing studies.What this study addsWe showed that it is feasible to sample medicines based on patient exposure. Our exposure-based study of cardiovascular and diabetes medicines in Indonesia, a lower-middle income country that is the world’s fourth most populous, found that all met quality standards.How this study might affect research, practice or policyAdopting exposure-based methods for sampling and/or calculating the prevalence of substandard and falsified medicines would improve our understanding of the potential public health impact of poor-quality products globally.

Background: Drug management is one of the primary health centre management activities that aims to ensure the continuity and affordability of pharmaceutical preparations. Aim: This study aims to determine the relationship between the level of knowledge of drug managers and drug management in several primary health centres of Malang regency. Method: The study was observational analytic using questionnaire instruments to analyse the level of knowledge of drug managers and three checklists to analyse drug management through three indicators of drug management: (1) conformity of stock to the national formulary, (2) conformity of stock to the disease patterns, and (3) the percentage of expired drugs. Result: There was no significant relationship between the level of knowledge and the first (p = 0.842), second (p = 0.236), and the third indicator (p = 0.361). Conclusion: Not all drug lists in the national formulary are required by each primary health centre. The inventory is adjusted to the consumption and epidemiology.

Simvastatin adalah obat yang harus diperoleh dengan resep dokter. Ketidaktepatan penggunaannya dapat berdampak kesalahan dalam pengobatan dan berisiko menimbulkan reaksi obat yang tidak dikehendaki (ROTD). Penggunaan obat yang tidak tepat salah satunya disebabkan oleh informasi yang tidak lengkap atau tidak benar yang didapatkan pasien dimana akan berpengaruh pada tingkat pengetahuan pasien. Tujuan penelitian ini adalah untuk mengetahui hubungan antara tingkat pengetahuan dan ketepatan penggunaan obat simvastatin pada pasien hiperkolesterolemia di Apotek Kota Malang. Penelitian ini menggunakan metode penelitian observasional analitik dengan rancangan penelitian cross sectional , pemilihan sampel apotek dilakukan dengan teknik random sampling secara cluster sampling . Untuk pemilihan sampel responden digunakan teknik purposive sampling yaitu dipilih berdasarkan kriteria inklusi dan eksklusi. Pada penelitian ini subyek penelitian berjumlah 100 responden, analisis yang digunakan untuk mengetahui hubungan antara tingkat pengetahuan dan ketepatan penggunaan obat simvastatin adalah analisis korelasi somers’d . Didapatkan hasil penelitian responden yang memiliki tingkat pengetahuan baik cenderung lebih tepat dalam penggunaan simvastatin (tepat = 51,8%, tidak tepat= 48,2%) dibandingkan dengan responden yang memiliki pengetahuan yang cukup (tepat= 27,3%, tidak tepat= 72,7%) dan kurang(tepat= 16,7%, tidak tepat= 83,3%). Hasil analisis uji somers’d menunjukkan p=0.000 (p

Pil Oral Kombinasi adalah suatu cara kontrasepsi untuk wanita yang berisi gabungan hormon estrogen dan progesteron yang bekerja dengan cara menekan ovulasi. Efek samping merupakan alasan utama untuk penghentian penggunan pil kontrasepsi. Tujuan dari penelitian ini yaitu untuk mengetahui karakteristik efek samping yang dialami oleh akseptor terkait penggunaan kontrasepsi oral serta angka kunjungan ulang kepada tenaga kesehatan. Penelitian ini menggunakan teknik purposive sampling untuk menentukan sampel akseptor dan teknik stratified random sampling untuk menentukan apotek yang digunakan sebagai tempat penelitian. Metode pengumpulan data yang digunakan adalah kuesioner. Apotek yang sesuai kriteria penelitian dan dijadikan tempat pengambilan data sebanyak 18 apotek dengan jumlah sampel pada penelitian ini sebanyak 106 akseptor. Berdasarkan hasil penelitian ini, dari total 106 akseptor menunjukkan efek samping tidak haid sama sekali sebanyak 14 akseptor, bercak saat menstruasi sebanyak 19 akseptor, pusing/sakit kepala sebanyak 49 akseptor, peningkatan berat badan sebanyak 54 akseptor, perubahan suasana hati sebanyak 11 akseptor, mual/muntah sebanyak 28 akseptor, timbul jerawat sebanyak 23 akseptor, dan efek pembesaran/ketat payudara sebanyak 9 akseptor. Angka kunjungan ulang kepada tenaga kesehatan dari 106 akseptor kontrasepsi oral kombinasi sebanyak 66,04% tidak pernah pergi ke tenaga kesehatan jika mengalami efek samping. Kesimpulan yang diperoleh yaitu efek samping yang paling banyak dialami oleh akseptor adalah peningkatan berat badan, diikuti oleh pusing/sakit kepala, mual/muntah, timbul jerawat, bercak saat menstruasi, amenore, perubahan suasana hati, dan efek samping yang paling sedikit terjadi adalah pembesaran/ketat payudara serta angka kunjungan ulang kepada tenaga kesehatan masih kurang. Kata kunci: efek samping, kontrasepsi oral, kontrasepsi oral kombinasi, kunjungan ulang kepada tenaga kesehatan kesehatan.

Objective: The use of oral contraceptive requires specific instructions. Pharmacist, as a part of healthcare provision, is able to counsel their clients about the proper use of oral contraceptive to be successful in family planning program. Pharmacist must be able to explain what acceptors should do if she misses pills and possible side effects because side effects are the most common reasons for women discontinuing combined oral contraceptive (COC). Therefore, counseling is an important part of family planning service. To provide more effective counseling, this study used “Sukses Ber-KB” computer application as a counseling tool. We aimed to determine the effect of this tool on improving the knowledge of oral contraceptive acceptors interviewed at pharmacies in Malang.Methods: Pharmacy selection was done by cluster random sampling based on the five districts of Malang, while acceptors were selected using a purposive sampling method, resulting in 106 COC acceptors. This study comprises pre-experimental research (one group pretest-posttest) with a cross-sectional study design, the analysis using Wilcoxon test.Results: The analysis of the results using a Wilcoxon test showed a significance value of 0 (p