1.                   Introduction

 Adverse Drug Reaction (ADR) remains one of major causes of morbidity and mortality [1]. Proper monitoring of adverse reaction is necessary. İt is important for healthcare professionals to know where and how to report an ADR. It is important to improve the Knowledge, Attitude and Practices (KAP) of the healthcare professionals regards to the ADR reporting and the Pharmacovigilance In order to enhance the reporting rate. Physicians, pharmacist and nurses have responsibility in reporting Adverse Drug Reaction (ADR). ADR is underreported in developing countries. Since no study evaluated the KAP of Pharmacovigilance among healthcare professionals in Somalia we carried out a cross-sectional based study to evaluate knowledge, attitude, and practice aspects of Pharmacovigilance and ADR reporting among healthcare professionals in the Somalia-Turkey training and research hospital the largest hospital in Somalia. A total of 100 questionnaires about KAP toward Pharmacovigilance and ADRs were developed and distributed. WHO defines adverse drug reaction as an: “Any response to a drug which is noxious and unintended, and which occurs at doses normally used in man for prophylaxis, diagnosis, or therapy of disease, or for the modification of physiological function” [2].

 The first WHO Collaborating Centre to be established for Pharmacovigilance was the Uppsala Monitoring Centre (UMC). The principal function of the Uppsala Monitoring Centre is to manage the international database of ADR reports received from National Centres [3] of Pharmacovigilance importance include 1) Drug monitoring 2) Pharmaceutical preparations - adverse effects 3) Adverse drug reaction reporting 4) Product surveillance, Post marketing 5) Legislation, Drug I. Series (6) The aims of this study was to evaluate knowledge, attitude, and practice aspects of adverse drug reaction reporting and Pharmacovigilance among healthcare professionals in the Somalia-Turkey training and research hospital.

 2.       Materials and Methods

 The study was carried out at Somalia-Turkey training and research hospital which is the largest hospital in capital of Somalia Mogadishu. The study design cross-sectional using questionnaire and the study included all health care professionals (Physicians, nurses, and pharmacists) in the hospital who gave their consent. The questionnaire consisted of questions on socio-demographic characteristics of the participants (Table 1) in the first section and 11 multiple-choice questions to assess knowledge of healthcare professionals towards Pharmacovigilance in second section (Table 2).

One point was given for each correct answer and zero points for each incorrect answer. The third section assessed the attitudes and practices of healthcare professionals towards Pharmacovigilance. (Table 3,4). The independent variables included in the data analysis were age, sex, marital status, and Professional status. There were three main outcome variables, namely, knowledge of healthcare workers towards Pharmacovigilance, attitude of the healthcare workers towards Pharmacovigilance, and practice of the healthcare workers towards Pharmacovigilance

81 out 100 distributed questionnaires were completed with a response  rate of (81%). 18 out of 81 (22%)  did not know about the term pharmacovigilance, only 54% correctly defined pharmacovigilance and only 46% correctly defined adverse drug reaction,only 8.1% were aware about the  the location of international center for adverse drug reaction monitoring, (57.6%) agreed that there is no center for adverse drug reaction monitoring in somalia, the knowledge level about pharmacovigilance considered to be poor in this study Attitude: 82.9% were agreed that pharmacovigilance should be taught in detail to health care practitioners, only 27 % were willing to report adverse drug reaction voluntarily, Most of subjects (79.6%) agreed with establishment of pharmacovigilance monitoring centre in their working institutions, The majority of them  (41.6%) believe that Managing patient is more important , 65.7% ever reported an adverse drug reaction, (70.2%) experienced an adverse drug reaction during  their clinical practices.

3.                   Results

 There was a poor knowledge of Pharmacovigilance among healthcare professionals, only 54% defined Pharmacovigilance correctly and only 8.1% knew about the correct international center of Pharmacovigilance, 57.6 % said there is a center of Pharmacovigilance in Somalia, attitude of healthcare professionals was moderate , only 27% correctly responded about that Pharmacovigilance reporting is voluntary,79.6% agreed with establishing Pharmacovigilance monitoring center in their institution, and 82.9% agreed with teaching Pharmacovigilance in detail to health care practitioners, the practice of healthcare practitioners towards Pharmacovigilance was moderate, 65.7% ever reported an adverse drug reaction, and 70.2% experienced an adverse drug reaction during clinical practices,41.6 % agreed that managing patient is more important than reporting and adverse drug reaction while 25% did not know where and how to report an adverse drug reaction.

 4.                   Discussion

 This is the first study in Somalia that evaluated knowledge of healthcare professionals towards Pharmacovigilance. A study conducted in a teaching hospital in south India showed that knowledge score was higher than this study [4]. Another study conducted in a tertiary care hospital in Gujarat showed that KAP of postgraduate students towards Pharmacovigilance was poor [5]. Another study in Kuwait showed that KAP of pharmacists working in secondary and tertiary hospitals towards Pharmacovigilance was good [6].

 Strengths and limitations of the study

 To our knowledge there is no study in Somalia that assessed the KAP of Pharmacovigilance among healthcare professionals. And our study included in addition doctors, pharmacists and nurses because among healthcare providers, nurses and pharmacist are in a unique position to report and monitor adverse drug reactions. The limitation of this study was the small number of participants.

 Ethical approval: The study protocol was approved by the institutional review board of our institution.

 5.                   Conclusion

 This study showed that knowledge of healthcare professionals towards Pharmacovigilance was poor. Majority of respondents agreed that reporting of adverse drug reaction is necessary, there is no gap between adverse drug reaction reported (65.7) and experienced (70.2) in this study.

Table 1: Demographic Characteristics of respondents.

Table 2: Knowledge of healthcare professionals.

Table 3: Attitude of healthcare practitionaries towards pharmacovigilance.

Table 4: Practice of healthcare practionaries towards pharmacovigilance.

1.       Shepherd G, Mohorn P, Yacoub K, May DW (2017) Adverse drug reaction deaths reported in United States vital statistics, 1999-2006. Ann Pharmacother 46: 169-175.

2.       ASHP Guidelines on Adverse Drug Reaction Monitoring and Reporting (2017) Medication Misadventures-Guidelines.

3.       World Health Organization (2017) Pharmacovigilance.

4.       Anon (2017) The Importance of Pharmacovigilance.

5.       The Importance of Pharmacovigilance - Safety Monitoring of Medicinal Products: Chapter 2 - A Short History of Involvement in Drug Safety Monitoring by WHO (2017).

World Health Organization (2017) Adverse Drug Reactions Monitoring.