Knowledge, Attitude and Practice of Health Care Professionals towards Adverse Drug Reaction Reporting in Public Hospitals of Harar Town, Eastern, Ethiopia 2020

Background: Adverse drug reaction is any noxious, unintended and undesired effect of a drug which resulted from inadequate monitoring of therapy or inappropriate dosing. It may be unexpected, unknown and/or rare. Adverse drug reactions (ADRs) are an important cause of mortality and morbidity worldwide. In some case it is lifethreatening, and can be major determinants of treatment outcomes. All healthcare professionals are encouraged to report ADR But under-reporting remains a major draw-back of spontaneous reporting. Therefore this study aims to investigate the knowledge, attitudes and practices of healthcare professionals towards ADR reporting and try to fill the information gap in the study area. Objective: To assess knowledge, attitude and practice of ADR reporting among health care professionals working at Public Hospitals in Harar Town Eastern Ethiopia 2020. Methodology: Health facility based cross sectional study was conducted on 238 Health professional who are working in Public Hospitals of Harar Town Eastern Ethiopia. Sample allocates proportionately and study participant was selected by systematic random sampling method. Collected and checked data were entered in to Epi Data software version 3.1 and analysis was done by SPSS version 21. Mean value were used to classify as good or poor knowledge, altitude and practice on ADR reporting. Finding was summarized and presented in forms of tables and statement. Result: The overall prevalence of good knowledge, altitude and practice of ADR reporting was 42.9 %, 34.5 % and 39.9 % respectively. Majority 158 (66.4%) of study participant does not feel that there are adequately trained on ADR reporting. While 206 (86.6 %) and 208 (87.4%) of health professional agree that reporting drug safety is important for the public and health care system. One third of health professionals 74 (31.4%, P = 0.002) significantly reported that there had encountered ADR. Conclusion and Recommendation: On this study majority respondent had poor knowledge, altitude and ADR Reporting practices. Therefore Training provision, awareness creation, Strong and collaborative ADR reporting mechanisms, continuous monitoring and evaluation need to be established on each health institution.

Adverse drug reaction is any noxious, unintended and undesired effect of a drug that occurs at doses used for prevention, diagnosis or treatment [1]. ADRs are defined as type A type B, type C and type D. [2]. Type A reaction (predictable) is related to dosage and is an extension to the normal pharmacology of the medication. Type B reaction (unpredictable) is unrelated to normal pharmacology. Type C reactions are associated with prolonged therapy e.g. analgesic nephropathy. Type D reactions are delayed reactions e.g. carcinogenesis and teratogenesis [3]. Most ADRs resulted from inadequate monitoring of therapy or inappropriate dosing [4]. All healthcare professionals including doctors, pharmacists, nurses and other healthcare professionals are encouraged to report ADR [5]. All healthcare providers have roles to play in maintaining a balance between a medicine's benefits and risks [6] ISSN: 2690-4861 Page 2 of 6 be alarmingly very low Even though the spontaneous reporting system has been put in place as of 2002 and all health professionals are encouraged to report [12]. There for this study investigated the knowledge, attitudes and practices of healthcare professionals towards ADR reporting and try to fill the information gap Significance of the study: Assessment of knowledge, attitude and practice of health care professionals has many importances it will evaluate the factors that could possibly affect adverse drug reaction reporting by observing the present system in place so that suggestions to improve reporting among health professionals can be offered. The result of the study will help in improving ADR reporting procedure by highlighting the drawbacks in the system. It will also serve as a base line data for other researchers

Method and Materials
Study Area and Period: The study was conducted in Harar Town, which is one of the ten regional states of the Federal Democratic Republic of Ethiopia located in the Eastern part of the country at 526 km away from Addis Ababa, the capital city of Ethiopia. In the region, 3 governmental hospitals were found. Among those two, namely Jugel and Hiwot Fana specialized university hospital were selected by SRS and the study was conducted there from Feb 7 -25, 2020 G.C Study design: Quantitative Institutional based cross sectional study was utilized. After data collection each questionnaire was checked its completeness, consistency on daily bases. Epi-Data version 3.1 and SPSS version 21 were used for data entry and analysis. Data were analyzed using descriptive statistics such as proportions, percentages, ratios. Measures of central tendency and measures of dispersion were done. Mean value were used to classify as good or poor knowledge, altitude and practice on ADR reporting and respondent who score mean and above the mean value were considered as good while the rest as poor. Data Quality Assurance: To assure data quality it was be pretested on 5% the total sample in Harar Federal Police Hospital. Based on the results of pre testing necessary modification was made. Data collector and supervisor were trained for two day on objective of the study, method of data collection and discussed thoroughly on the tools and be for data collection they were allowed to fill the questionnaire and later discussion was made in all contents of the questioners and areas of difficulties were revised. The data was coded carefully in order to increase accuracy and quality of data. Ethical Considerations: Ethical clearance letter was obtained from Harar Health Science College Research Ethics Review Committee and it was submitted to the study organization and permission was secured from hospital CEO. All the participants were informed the purpose, advantages and disadvantages, there have the right to be involved or not as well as they can withdraw from the study any time they want. Informed consent was obtained. Confidentiality was maintained by avoiding names and other personal identification.

Result:
A total of 238 Health professional were included on the study which makes the response rate 100 %.

Altitude of respondents on ADR reporting
The overall prevalence of good altitude was 82 (34.5%) and majority 156 (65.5%) had poor altitude towards ARD Reporting. More than half 171 (71.8%) of respondents agree that ADR should be reported spontaneously at regular base. While 206 (86.6 %) and 208 (87.4%) of health professional agree that reporting drug safety is important for the public and health care system. Among study participants 190 (79.8%) and 105 (44.1%) of respondent agree and disagreed that there is a need to be sure that ADR is related to drug before reporting and also only ADR that cause persistent disability should be reported (

Practice of the respondents on ADR reporting
The overall prevalence of good ADR reporting practice was 95 (39.9%) while majority 143(60.1%) had poor ARD Reporting practice. One third 174 (73.1%) and 173 (72.7%) of health professional reported that they does not have encountered ADR and also do not noted the ADR their encounter. One third of health professionals 74 (31.4%, P = 0.002) significantly reported that ADR their encountered. And 102 (42.9) of health professional reported that they give advice sometimes on possible adverse effects of drugs they prescribed. Majority 196 (71.0%) and 164 (68.9%) of respondent reported that their don't know the presence of ADR reporting system in their work place and also their institution (Work place) does not provide information regarding ADR reporting (

Discussion
The overall prevalence of good Knowledge, Altitude and practice on this study was low which was (42.9%), (34.5%) and (39.9%) respectively. The study was conducted in Harar town and 238 health professional were participated and majority were 186 (78.2%) Nurse followed by Pharmacist 23 (9.7%), health officer 15 (6.3%) and physicians 14 (5.9 %) . In this study majority (58.4 %) of respondents replied that ADR is not the same with side effect which is lower than (76.9%) study conducted in Adam [13] this discrepancy might be due to difference in study area. In this study 80 (33.6 %) respondents felt that they are adequately trained in ADR reporting which was higher than study conducted in Adama (16.9%) [13]. In this study (69.7 %) of respondent do know the presence of national ADR of reporting system and (62.2%) also do not know the availability of ADR reporting form which was higher than study conducted in Adam (41.5 %) and (52.3%) respectively this difference showed that ADR reporting was not given emphasis and it doesn't consider as a professional duties [13]. In this study (71.8%) of respondent agree that ADR should be reported spontaneously at regular base this finding in line (70.6 %) with study conducted in Pakistan [14]. Regarding the presence of ADR reporting system in our study (71%) of respondent did not know presence of ADR reporting system which was higher than study conducted in Pakistan (53.4 %) [14].This difference might be due to study setting variation. Regarding ADR training in this study (66.4%) feel that there are not adequately trained in ADR reporting which was lower than study conducted in (86.9%) Pakistan [13] and (83.1%) Adama [14] this difference might be due to variation in sample size and study population.

Conclusion and recommendation Recommendations
On this study majority respondent had poor knowledge, Altitude and ADR Reporting Practices this may showed that ADR reporting would not give emphasis as a duty of health professionals and it was neglected. Even if ADR encounter during their practice on daily based, majority of professional does not know the presence of national ADR reporting system and the availability of ADR reporting form. Therefore in order to improve ADR reporting Knowledge Altitudes and practice of health Professionals Training provision, awareness creation, Strong and collaborative ADR reporting mechanisms, continuous monitoring and evaluation need to be established on each health institution. Finally health care tires needs to give emphasis and established functional structure that strongly maintains ADR reporting activities.