IV

IV. DISCUSSION
This is the first study in Egypt that evaluated the KAP of healthcare professionals regarding ADRs and pharmacovigilance. Overall, the ADR reporting knowledge of the physicians was low. Under-reporting of ADRs is a worldwide phenomenon and this has been established from previous studies 14,15. It is a known fact that information regarding ADRs changes on a daily basis and hence the need for constant updating of the knowledge of health care professionals in this area. Most respondents in this study obtained their information on ADRs from patients, drug information sheets and texts on drugs. Lack of, or inadequate, access to the internet can be a major limiting factor (where internet facilities are poor) for obtaining current reports on ADRs as most information from drug inserts and textbooks on drugs may be outdated and may not reflect the current state of information on ADRs. In order to address some of the determinants of under- reporting found in this study, ADR reporting guidelines should be made available in the form of booklets and posters at conspicuous locations in health care facilities to serve as a constant reminder. This should be in addition to regular sensitization of all health care workers on the importance of pharmacovigilance in order to decrease morbidity and mortality among the population. Improving ADR reporting, apart from reducing the incidence of adverse drug reactions in clinical practice, will also lead to a reduction in health care costs. Efforts should also be made to make the reporting process by patients simple and straightforward. The lack of awareness of the availability of pharmacovigilance committee by more than half of the respondents indicates the need to extend the level of sensitization for health care workers to improve their ADR reporting.
This study has shown inadequate knowledge of doctors about ADRs and reporting similar to the previous reports among physicians in many countries across Europe 16-18, America 19, 20 and Asia 21,22. Perhaps, the undergraduate training in pharmacovigilance and medicine risk perceptions may be either insufficient or improperly delivered to prepare the doctors for the task of ADR monitoring and reporting in their future career. A significant number of the respondents were not aware of the existence of a national pharmacovigilance centre in Egypt. Most of the respondents were willing to report reactions to newly marketed drugs and serious reactions to established products because they perceived post-marketing surveillance as an important part of pharmacovigilance.
The main limitation of this study was the relatively small number of respondents. In addition, some other factors that are associated with self-reporting studies such as accuracy of recall, personal bias could also have affected, in some ways, the results of this study. It can be assumed that under-reporting of ADRs in Minia , Egypt is due in part to negative attitude of physicians themselves as the findings of the study have found a relatively negative attitude towards ADRs reporting.