Common excipients for designing self‐nanoemulsifying formulations and the list of their suppliers.
\r\n\tThis book intends to provide the reader with a comprehensive overview of the current state-of-the-art novel imaging techniques by focusing on the most important evidence-based developments in this area.
",isbn:null,printIsbn:null,pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,isNomenclature:!1,hash:"d9159ce31733bf78cc2a79b18c225994",bookSignature:"Dr. Gabriel Cismaru",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11867.jpg",keywords:"Hypertrophic Cardiomyopathy, Dilated Cardiomyopathy, Restrictive Cardiomyopathy, Transesophageal Echocardiography, Intracardiac Echocardiography, 3-Dimensional Echocardiography, Adult Congenital Heart Disease, Tetralogy of Fallot, Transposition of the Great Vessels, Coronary Artery Disease, Risk Stratification, Revascularization",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"April 21st 2022",dateEndSecondStepPublish:"May 19th 2022",dateEndThirdStepPublish:"July 18th 2022",dateEndFourthStepPublish:"October 6th 2022",dateEndFifthStepPublish:"December 5th 2022",dateConfirmationOfParticipation:null,remainingDaysToSecondStep:"3 months",secondStepPassed:!0,areRegistrationsClosed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Cismaru Gabriel is an Assistant Professor at the University of Medicine and Pharmacy Cluj-Napoca, certified in Cardiology. After completing his certification in cardiology, Dr. Cismaru began his electrophysiology fellowship at the Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu. He has authored or co-authored peer-reviewed articles and book chapters in the field of cardiac pacing, defibrillation, electrophysiological study, and catheter ablation.",coeditorOneBiosketch:"Raluca Tomoaia is an MD, Ph.D. in novel techniques in Echocardiography at the University of Medicine and Pharmacy in Cluj-Napoca, Romania., assistant professor, and a researcher in echocardiography and cardiovascular imaging.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"191888",title:"Dr.",name:"Gabriel",middleName:null,surname:"Cismaru",slug:"gabriel-cismaru",fullName:"Gabriel Cismaru",profilePictureURL:"https://mts.intechopen.com/storage/users/191888/images/system/191888.png",biography:"Dr. Cismaru Gabriel is an assistant professor at the Cluj-Napoca University of Medicine and Pharmacy, Romania, where he has been qualified in cardiology since 2011. He obtained his Ph.D. in medicine with a research thesis on electrophysiology and pro-arrhythmic drugs in 2016. Dr. Cismaru began his electrophysiology fellowship at the Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, France, after finishing his cardiology certification with stages in Clermont-Ferrand and Dinan, France. He began working at the Rehabilitation Hospital\\'s Electrophysiology Laboratory in Cluj-Napoca in 2011. He is an experienced operator who can implant pacemakers, CRTs, and ICDs, as well as perform catheter ablation of supraventricular and ventricular arrhythmias such as ventricular tachycardia and ventricular fibrillation. He has been qualified in pediatric cardiology since 2022, and he regularly performs device implantation and catheter ablation in children. Dr. Cismaru has authored or co-authored peer-reviewed publications and book chapters on cardiac pacing, defibrillation, electrophysiological studies, and catheter ablation.",institutionString:"Iuliu Hațieganu University of Medicine and Pharmacy",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"7",totalChapterViews:"0",totalEditedBooks:"2",institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}}],coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"16",title:"Medicine",slug:"medicine"}],chapters:null,productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"},personalPublishingAssistant:null},relatedBooks:[{type:"book",id:"5970",title:"Bedside Procedures",subtitle:null,isOpenForSubmission:!1,hash:"ba56d3036ac823a7155f40e4a02c030d",slug:"bedside-procedures",bookSignature:"Gabriel Cismaru",coverURL:"https://cdn.intechopen.com/books/images_new/5970.jpg",editedByType:"Edited by",editors:[{id:"191888",title:"Dr.",name:"Gabriel",surname:"Cismaru",slug:"gabriel-cismaru",fullName:"Gabriel Cismaru"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"9064",title:"Epidemiology and Treatment of Atrial Fibrillation",subtitle:null,isOpenForSubmission:!1,hash:"1cd6bf2b3181eb82446347fbe478a2bc",slug:"epidemiology-and-treatment-of-atrial-fibrillation",bookSignature:"Gabriel Cismaru and Keith Andrew Chan",coverURL:"https://cdn.intechopen.com/books/images_new/9064.jpg",editedByType:"Edited by",editors:[{id:"191888",title:"Dr.",name:"Gabriel",surname:"Cismaru",slug:"gabriel-cismaru",fullName:"Gabriel Cismaru"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"6550",title:"Cohort Studies in Health Sciences",subtitle:null,isOpenForSubmission:!1,hash:"01df5aba4fff1a84b37a2fdafa809660",slug:"cohort-studies-in-health-sciences",bookSignature:"R. 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In fact, up to 90% of today\'s drug candidates are suffering from low aqueous solubility, which is commonly associated with low bioavailability, high intra‐ and inter‐subject variability and lack of dose suitability [1, 2]. In keeping these challenges in mind, drug formulators must seek new techniques and innovative formulation approaches to overcome such hurdles and ensure effective treatments for the patients in need.
\nIt is more than a decade, when lipid‐based formulations have been considered as a well‐established strategy for improving oral bioavailability and minimizing variable food effect of poorly soluble compounds. Lipids have been used as carriers in various delivery systems for drug administration, including solutions, suspensions, emulsions, and more attractively self‐emulsifying/microemulsifying/nanoemulsifying drug delivery systems (SEDDS/SMEDDS/SNEDDS) that are designed to increase solubility and bioavailability of drugs belonging to the BCS Class II–IV [3]. Among several approaches, which are currently available to incorporate active pharmaceutical drugs into lipid vehicles in a variety of dosage forms, SEDDS, SMEDDS and or SNEDDS have proved to be the most successful approaches in improving the bioavailability [4]. The initial key achievement of these formulation systems (SEDDS/SMEDDS/SNEDDS) is to increase the solubilization of the poorly water soluble drugs (PWSDs) by the formation of emulsions and or micellar systems (colloidal solutions).
\nThese systems advantageously present the drug in solubilized form, and their relatively smaller droplet sizes provide a large interfacial area enhancing the activity of pancreatic lipase to hydrolyze triglycerides and thereby promoting faster drug release containing mixed micelles of bile salts. The development of Neoral® (cyclosporin A) as a commercial product exhibits an excellent example of the utilization of these systems [5].
\nNanotechnology has become a buzzword for scientific experts, and efforts are ongoing to extend its applications in various medical and pharmaceutical aspects. The nanoscale technologies can be generally categorized into: lipid‐based nanocarriers, polymeric nanocarriers, inorganic nanocarriers, and drug nanoparticles or nanosuspensions [6]. Within the lipid‐based nanocarriers category, there has been a resurgence of interest in nanoemulsions since low energy emulsification methods, such as spontaneous or self‐nanoemulsification, have been developed. SNEDDS are anhydrous homogenous liquid mixtures, composing oil, surfactant, drug and/or cosolvents, which spontaneously form transparent nanoemulsion (20–250 nm droplet size) upon aqueous dilution with mild agitation [6, 7].
\nBeing nanosized, SNEDDS offer a strong alternative to the more conventional oral formulations of lipophilic compounds. SNEDDS introduce the drug in solution within nanosized oil droplets. These fine droplets are emptied rapidly from the stomach resulting in faster drug release all over the gastrointestinal (GI) tract. An additional advantage of SNEDDS over simple oily solutions is granting much larger interfacial area for partitioning of the drug between oil and water leading to ease of dispersibility [8]. In contrast to oily solutions, SNEDDS does not depend on the action of bile salts, enzymes and/or other effects related to the (fed/fasted) state of the stomach [9]. Thus, SNEDDS can reduce the variability in rate and extent of absorption and grant more reproducible plasma concentration levels [10].
\nCompared with conventional nanoemulsions, SNEDDS can offer the advantages of improved physical and/or chemical stability of the formulation and ability to fill them into unit dosage forms, such as soft/hard capsules, which improve their commercial viability, patient compliance/tolerability and reduce palatability‐related concerns [6]. A key feature of a successful SNEDDS formulation is its capability to hold the drug in solution, throughout the GIT, for sufficient time to allow for absorption [11]. Many PWSDs have high solubility in SNEDDS formulations but could make a risk of precipitation after aqueous dispersion of the formulation or during its digestion in the intestine [12].
\nThe current chapter will provide all the information to probe factors which influence the selection of successful lipid nanoformulations and affect the fate of the PWSDs after oral administration. The investigational research presented in this chapter will also provide additional information regarding current practice of lipid formulations with a particular emphasis on self‐nanoemulsifying drug delivery systems (SNEDDS), the trends and perspectives and the fate of PWSDs formulated in SNEDDS.
\nLipid excipients are comprised of a large group of physically and chemically diverse glycerides, which may be used in simple (single oil solutions of the drug substance) or in more complex nanocarriers (SMEDDS/SNEDDS, drug dissolved in the mixture of glyceride, surfactant and or cosolvent), with considerable flexibility in formulation design [12].
\nSimple oil formulations are generally composed of mono‐, di‐, or triglycerides or their derivatives and differ on the content of medium‐ (C6‐C10 in chain length) or long‐chain (C12‐C24 in chain length) fatty acids. Glyceride esters are water immiscible, and their solvent capacities for drug substances vary according to the fatty acid chain length. Many lipid excipients (oils, surfactants), which are regarded as acceptable food grade materials, expected to be well tolerated by the body [13], even as parenteral emulsion dosage form [14]. These excipients have a history of use in a wide variety of pharmaceuticals.
\nIn simple terms, lipid nanoformulations can be distinguished according to their dispersion and digestion in the aqueous content of the gut [15, 16]. Emulsion droplet size has been considered to be an important part in the performance of self‐nanoemulsifying systems since particle size can determine the rate and extent of drug release
Excipients play a key role in designing successful nanoformulations with a sound control strategy and influence business‐critical and clinically significant drug product performance outcomes such as stability, bioavailability and manufacturability. The design of lipid‐based nanoformulations, particularly SNEDDS, is comparatively simple as the drug need to be incorporated into a suitable oil‐surfactant mixture, which could be filled in a soft or hard gelatin capsules. Various choices of lipid excipients are available in the market. Numerous lipids are amphiphilic in nature, which contain both hydrophilic and lipophilic portions (fatty acid) [18]. The morphology of the lipids should be assessed as melting point increases when the length of fatty acid chain increases, but it decreases when unsaturation of the fatty acid increases [19]. Choice of excipients for successfully designed lipid‐based nanocarriers is determined based on factors, such as miscibility; solvent capacity; self‐dispersibility; digestibility; irritancy; toxicity; purity; chemical stability; compatibility with capsule; melting point; and cost. Since these excipients can affect the drugs bioavailability, it is necessary to identify the characteristics of these excipients. Details of the lipids (oils, nonionic surfactants, cosolvents), their compositions and list of suppliers are given in Table 1.
\nFunction | \nComposition and description | \nCommercial name | \nSupplier | \n
---|---|---|---|
Oil | \nMiglyol 812, 810, Capmul MCM, Captex 355, etc. | \nGattefosse corporation, France; Abitec Corp., Janesville, USA; Sasol GmbH, Witten, Germany; Nikko Chemicals Co., Tokyo, Japan; Hamburg, Germany; Germany | \n|
Vegetable oils are glyceride esters of mixed unsaturated long‐chain fatty acids, commonly known as long‐chain triglycerides | \nSoybean oil, sesame oil, corn oil, olive oil, peanut oil, cottonseed oil, rapeseed oil, etc. | \n||
Novel semisynthetic medium‐ and long‐chain derivatives. Esters of propylene glycol and mixture of mono‐ and diglycerides of caprylic/capric acid | \nImwitor 988, Imwitor 308, Maisene 35‐1, etc. | \n||
traditionally thought of as hydrophobic surfactants, such as sorbitan fatty acid esters | \nSpan 80, 85, etc. | \n||
Nonionic surfactant | \nindustries | \nPolysorbate 85 (Tween 85), TO‐106 V, Tagat TO, etc. | \n|
derivatives with saturated alkyl chains resulting from hydrogenation of materials derived from a vegetable oil. Other derivatives include polysorbate 80 which are predominantly ether ethoxylates and phospholipids | \nCremophor RH40, Cremophor EL, HCO30, Tween 20, 80, poloxamer 407, various Labrasols, Labrafac Labrafils, Gelucires, Soy phosphatidylcholine, etc. | \n||
Cosolvent | \nThe most popular water soluble cosolvents are propylene glycol, polyethylene glycol, ethanol and glycerol. Others are diethylene glycol monoethyl ether, propylene carbonate, tetrahydrofurfuryl alcohol, polyethylene glycol ether | \nPG, PEG 300, PEG 400, 600, transcutol, glycofurol, etc. | \n|
Other excipient | \nMany oil‐soluble antioxidants | \nα‐Tocopherol, β‐carotene, butylated hydroxytoluene (BHT), butylated hydroxyanisole (BHA), propyl gallate, ascorbyl palmitate, etc. | \n
Common excipients for designing self‐nanoemulsifying formulations and the list of their suppliers.
Lipid‐based nanoformulations as drug delivery vehicles signify a promising strategy that incorporates or encapsulates the drug molecules and are biodegradable or biocompatible. They are containing nanosized droplets typically ranging from 0 to 250 nm [20]. The entrapped drug molecules can be taken intact and protected against degradation by gastrointestinal (GI) fluids, while drug absorption through the GI epithelium or lymphatic transport can be enhanced. Possible mechanisms of transport of these nanocarriers across GI mucosa are introduced later in the chapter. These focus on effects of size and surface properties of the nanocarriers on the nonspecific or targeted uptake by enterocytes and/or M cells. Applications of various oral nanocarrier formulations, such as lipid nanoparticles and SMEDDS/SNEDDS, are reviewed in several recent publications [4, 21, 22]. Figure 1 shows an encapsulated SNEDDS designed for oral administration, which are the most efficient formulations for improving the apparent aqueous solubility of PWSDs.
\nThe encapsulated SNEDDS designed for oral administration of PWSDs. *Adapted with permission from Ref. [
Within the scope of the current chapter, the most advanced SNEDDS and/or SMEDDS systems have been explored as potential nanocarriers, which are much more stable kinetically and thermodynamically and showed great potential for improving the bioavailability of orally administered drugs. In a pure drug nanoparticle formulation, submicron size particles of drugs are stabilized in aqueous medium with generally regarded as safe (GRAS) listed excipients blend. Such formulation can be used for drugs with poor solubility in water and oil, high melting point, high log
When saquinavir (HIV protease inhibitor) in 1995 was marketed for the first time as mesylate salt formulation in a hard gelatin capsule (Invirase®), its bioavailability was only 4% and highly variable [23]. Later on, after 2 years, a self‐nanoemulsifying formulation of saquinavir (Fortovase®) containing medium‐chain mono‐ and diglycerides, povidone and α‐tocopherol was able to increase bioavailability threefold higher than Invirase® in humans [23, 24]. Several other published [10, 25, 26] and unpublished case studies are also available that established the significance of rational approach in designing SMEDDS/SNEDDS which can improve the
The potentiality of nanoemulsions within lipid‐based drug delivery systems was explored almost four decades ago. In simple term, nanoemulsions are the emulsions comprising nanosized droplets and they are well dispersed, transparent and kinetically stable for several months. Their physical stability can be improved by careful selection of surfactants and the ratio of oil/water/surfactant and also the efficiency of equipment used to reduce droplet sizes. Not only for oral delivery, nanoemulsions are used as greater transmucosal and transdermal drug delivery vehicles due to their remarkable wetting, spreading and penetration abilities.
\nSMEDDS and SNEDDS are almost similar lipid dosage form which can be prepared from same materials comprising a simple mixture of oils, surfactants and possibly cosolvents. SMEDDS have the ability to form fine oil in water (O/W) microemulsion, and SNEDDS produce nanoemulsion upon mild agitation in the presence of an aqueous (preferably intestinal) media [28]. The structure provides both SMEDDS and SNEDDS as good candidates for oral delivery of PWSDs with adequate solubility in oil only or oil/surfactant blends and establishes the desired reproducible pharmacokinetic profile. Upon dilution, SMEDDS form transparent microemulsions, with a droplet size of <50 nm [11], while SNEDDS produce transparent dispersions of oil and water stabilized by surfactants, with droplet sizes between 20 and 250 nm and kinetically but not thermodynamically stable systems [29]. These two systems are the most famous colloidal dispersions within lipid‐based systems but physicochemically different. Structures and properties of nanoemulsion can be changed on long‐term storage but not for microemulsions at same temperature, pressure and composition. The formation of SMEDDS is spontaneous, and SNEDDS need high‐energy methods for their fabrication, but both systems need some external energy to overcome kinetic energy barriers and support mass transport. In comparison, SNEDDS need lesser surfactant‐to‐oil ratio than SMEDDS. The preparation of SNEDDS involve specific mixing order in which surfactant must be mixed first with oil phase, whereas SMEDDS do not need any specific mixing order for their preparation. Ternary phase diagrams are required to have a suitable selection of both systems which should be coherent with different phases involved in preparation.
\nAn important best‐known example is Sandimmune Neoral® which was introduced in 1994 became the turning point for development of SMEDDS in oral lipid‐based formulations of PWSD [30]. This formulation contains Cremophor RH40 (polyoxyl hydrogenated castor oil), corn oil glycerides, propylene glycol and ethanol, which emulsifies spontaneously into a microemulsion with a particle size smaller than 100 nm. This new formulation (Sandimmune Neoral®) resulted in a twofold increase in the bioavailability compared to the earlier product Sandimmune® [31]. Recent years, SMEDDS and SNEDDS have gained lots of interest as potential drug delivery vehicles largely due to their clarity, simplicity of preparation, thermodynamic stability and their abilities to be filtered and to incorporate a wide range of drugs of varying lipophilicity.
\nBy considering several factors in mind, Pouton [20, 32] introduced a lipid formulation classification system (LFCS) into four Types (I–IV) which differentiate lipid‐based formulations from one to another that is being used as a framework to categorize nanoformulations. These four Types of formulations were classified on the basis of formulation compositions, their aqueous dispersibility and the potential effects of lipid digestion and possible drug precipitation from lipids. Among the LFCS, Type III systems are the most attractive formulations as they produce microemulsions/nanoemulsions (SMEDDS and SNEDDS) of lipid‐surfactant mixtures with particle sizes in the range of 0–250 nm upon dispersion. The microemulsions can be used for many other drug delivery/application systems, such as topical, intra venous, trans‐dermal, etc. There are several marketed products available which were developed as Type III formulations since the drugs may be absorbed from the microemulsions and or nanoemulsions without the digestion of lipids and/or surfactants present. Type III systems further divided into subtype IIIA and IIIB according to the hydrophilic content of the SMEDDS and SNEDDS. Type IV systems are efficient formulations as they also produce SMEDDS and/or SNEDDS and have high drug loading ability but may loss solvent capacity upon dilution with aqueous media.
\nThe excipients commonly used in designing SNEDDS are liquid at room temperature, and their compatibility with semi‐solid and solid dosage forms allows encapsulating into soft/hard gelatin capsules for oral delivery. This could be a great challenge as the interaction between liquid formulation and capsule shell may result in either brittleness or softness of the shell [33]. In addition, the stability of liquid formulations could be another major issue (e.g., leaching and rancidity) since some drugs might suffer significant chemical instability in both aqueous and oily formulations. Apart from that, manufacturing liquid‐filled soft gelatin capsules is a slow process and requires specialized equipment, having risk of formulation components migrating into capsule shell [23].
\nTherefore, to address this limitation, incorporation of liquid lipid formulations into a solid dosage form is convincing and desirable. Liquid lipid formulations could be transformed into acceptable free flowing fine powder by loading the formulation on a suitable solid carrier as solid SNEDDS [34, 35]. Only few studies have attempted to investigate the conversion of such formulations into free flowing powders by adsorption using various inorganic high surface area materials (i.e., neusilin, syloid, aeroperal and aerosol) that are amenable to encapsulation or tableting [36, 37]. On the other hand, the final powder preparation should have acceptable flow properties to achieve the best content uniformity and weight variation. The current interest in solidification technique by both the industry and academia is raised enormously due to the attractive properties including independence of gastric transit, flexibility in dose dividing, decrease in intra‐ and inter‐subject variability, highest safety profile and physical/chemical stability improvement.
\nFor lipid nanoformulations, drug solubility determines the maximum drug loading capacity (single unit dose) and is increased when the drug is highly lipid soluble or when the formulation contains high proportions of surfactant or cosolvent. The solubilization capacity of the nanoformulations (SNEDDS) is likely to decrease when excipients are dispersed and digested in the GI tract. As a result, the drug concentrations in the GI fluids are elevated from the equilibrium solubility and could cause extreme precipitation.
\nTo predict the likely fate of the drug on dispersion effectively, one should investigate its solubility in the formulations during aqueous dilution. The solubility of PWSDs within the diluted nanoformulations can be determined using a shake‐flask method to observe how the drug solubility is changed as water is incorporated into the system. The samples are prepared by adding an excess amount of drug to the formulation, which is then shaken and thoroughly mixed with a vortex mixer. The samples are incubated in a dry heat incubator at 37°C for 7 days and centrifuged to separate excess solid drug from the dissolved drug. An aliquot of the supernatant is weighed and diluted in an appropriate solvent. The dissolved drug concentration can be analyzed by UV‐vis spectrophotometer.
\nFigure 2 shows the fenofibrate solubility in nanoformulations (SMEDDS/SNEDDS) of LFCS Type IIIB and IV systems which was studied over 10–100 dilution with water. The results suggest how fenofibrate solubility decreased markedly, with several Type IIIB and IV nanoformulations, as the formulation was diluted with water [12]. After adding only 10% w/w water to the anhydrous formulation (drug dissolved at 80% of its equilibrium solubility), the one‐third drug solubility had dropped down from the initial solubility of the formulation. The data predict that if fenofibrate was dissolved at its equilibrium solubility in the anhydrous formulations, its solubility would be exceeded in all cases when the formulation is diluted 1 in 10 or 1 in 100.
\nEffect of aqueous dilution on solubility of fenofibrate in nanoformulations representing LFCS Types IIIB and IV systems. Data are presented as mean ± SD (n = 3).
Technically, it is difficult to characterize drug release from emulsions
In SGF, all the SNEDDS showed superior dissolution profiles with respect to Stugeron® tablet (Figure 3). At 15 min, Stugeron® tablet managed to release only 66.5% drug in solution where the optimal formulations were able to release 84–95% drug in solution. This indicates the ability of these formulations to provide more efficient and rapid release of CN with respect to the marketed tablet. Upon shifting from SGF to SIF, Stugeron® showed significant precipitation (87–92% precipitated), while the SNEDDS were able to hold high amount of CN (78–93%) in solution (Figure 3). This finding suggests the immense need for developing a SNEDDS that could enhance the drug dissolution profile and resist the sharp pH‐dependent changes particularly for week bases.
\nDissolution profiles of cinnarizine SNEDDS 1 [MCT/MCDM/T85 (25/25/50)], SNEDDS 2 [MCT/MCM/T85 (25/25/50)] and Stugeron® tablets. Data are expressed as mean ± S.E, n = 3. **Abbreviations: MCT—medium‐chain triglycerides (M810); MCDM—mixture of medium‐chain di‐ and monoglycerides (I988); MCM—medium‐chain monoglycerides (I308); T85—Tween 85.
A standard USP dissolution apparatus is suitable for the establishment of a dispersion test, but emphasis should be on precipitation rather than dissolution [4]. This is why, dynamic dispersion test is highly considered for the prediction of whether precipitation is likely to occur prior to digestion. In the dispersion study, samples are removed from the dispersion vessel at various intervals for at least 24 h and analyzed to determine the likelihood of precipitation during GI transit. Dispersion testing is vital for LFCS Types III and IV formulations (produce SNEDDS), which may loss solvent capacity on dispersion due to migration of water soluble components into the bulk aqueous phase. Care is needed in the design of lipid‐based nanoformulations to ensure that the precipitation of the drug is minimized.
\nWhen the lipid nanoformulations approach to the high volume of gastric fluid, it is dispersed rapidly and reduces solubilization capacity of the drug due to the high content of surfactant/water soluble cosolvent, thus potentially generates supersaturation. Even though supersaturation in the stomach is not desirable as most of the drugs are absorbed in the small intestine, it poses threat for drug precipitation before the drug enters to small intestine. Therefore, SMEDDS/SNEDDS should be designed to minimize supersaturation in the stomach or at least to maintain a period sufficient to allow gastric emptying prior to drug precipitation.
\nCorrelations between the investigations of the equilibrium solubility of the drug in the aqueous diluted formulation (10–99% diluted) and corresponding dynamic dispersion tests could help to predict whether precipitation is likely to take place, and whether it would affect bioavailability [12]. The imbalance between high initial solubilized drug concentrations and lower equilibrium drug solubilities during lipid dispersion and digestion
This is why, SNEDDS must contain drugs less than equilibrium solubility (approximately 50–90% of the equilibrium solubility) to avoid any precipitation. In recent studies, precipitation inhibitors have been introduced in supersaturated SNEDDS to overcome the risk of precipitations [40]. Supersaturated SNEDDS inhibit and minimize the nucleation process and subsequent drug precipitation in GIT by achieving and then sustaining the metastable supersaturated state. The commonly used water soluble precipitation inhibitors are PVP, HPMC, NaCMC and MC polymers [41].
\nTriglycerides alone (LFCS Type I) are poor solvents for most of the hydrophobic drugs but suitable for highly lipophilic compounds. If lipid‐based formulations contain mixed glycerides, polar oils, surfactants and/or cosolvents (LFCS Type II and III), it is likely to improve the solvent capacity of the formulation. Therefore, formulators are always preferred to add water soluble surfactants and cosolvents against pure oils, ultimately sometimes resulting in the complete exclusion of oily excipients to produce oil‐free formulations (LFCS Type IV). However, the formulator must keep well balance between oils and surfactants/cosolvents in the formulation to avoid risk of drug precipitation on aqueous dispersion. Several studies showed that small changes in formulation compositions are not expected to cause large changes in drug solubility, but there could be a dramatic drop in solvent capacity upon aqueous dilution [4, 12, 42]. Dilution of a cosolvent implies a substantial loss of solvent capacity, while the loss of solvent capacity may not be suffered with the use of surfactant. This could be possible due to the linearity between solubilized drug to the number of micelles present and therefore to the surfactant concentration. Drugs which are more soluble in surfactant or cosolvent than pure oil are at high precipitation risk because solvent capacity of surfactant and cosolvent decreases upon dilution but not pure oil. Hence, increasing the solubility of a drug by including a cosolvent is generally a poor strategy than using a nonionic surfactant [11, 43]. Figure 4 shows the extreme precipitation of an anticancer drug, paclitaxel using LFCS Types III and IV formulations.
\nPercentage of the original dose of paclitaxel remaining in solution after 1:100 dilutions in the dispersion medium (paclitaxel was originally dissolved at 80% of the equilibrium solubility in the anhydrous mixture). One gram formulation was dispersed in 100 ml water, and then, the samples were withdrawn periodically over 24 h to examine the drug precipitations. Data are presented as mean ± SD (n = 3).
It is quite difficult to predict the fate of the PWSDs on dispersion of a typical LFCS Type IIIA lipid formulation. The hydrophilic surfactant used in Type IIIA systems is substantially separated from the oily components, forming a micellar solution in the continuous phase. Hence, one might question: does this system lower the overall solvent capacity for the drug or not? However, this may depend on the log
Following ingestion of a lipid‐based dosage form (capsule/tablet), the formulation is initially dispersed in the stomach where the digestion of exogenous dietary lipid is started by the action of gastric lipase on the lipid‐water interface. Gastric lipase releases about 15% of free fatty acids from lipids [45]. Within the small intestine, pancreatic lipase together with its co‐lipase completes the breakdown of dietary glycerides to diglyceride, monoglyceride and fatty acid. The presence of exogenous lipids in the small intestine also stimulates secretion of endogenous biliary lipids including bile salt, phospholipid and cholesterol from the gallbladder [45]. In the presence of elevated bile salts concentrations, lipid digestion products are subsequently incorporated into a series of colloidal structures including multilamellar/unilamellar vesicles, bile salt phospholipid mixed micelles and micelles [46]. Together these species significantly expand the solubilization capacity of the small intestine for both lipid digestion products and drugs, and this can be studied relatively easily as a preformulation exercise.
\nSufficient aqueous solubility along with good intestinal permeability is crucial for adequate drug absorption, ultimately leading to sufficient bioavailability. On the other hand, PWSDs are associated with poor and variable absorption and often affected by the various food intakes. Several studies have already documented lipid‐based nanoformulations, particularly SNEDDS, as an absorption enhancer for PWSDs when administered orally [4, 47]. Possible mechanisms for improving drug absorption include: (i) an increase in the membrane fluidity facilitating transcellular absorption, (ii) larger surface area provided by the fine emulsion droplets, hydrolysis and formation of mixed micelles, (iii) paracellular transport by opening tight junction mainly for ionized drugs or hydrophilic macromolecules, (iv) inhibition of P‐gp and/or CYP450 to increase intracellular concentration and residence time, and (v) stimulation of lipoprotein/chylomicron production. The natural process of digestion offers the possibility that very lipophilic drugs could be taken up into the lymphatic system by partitioning into chylomicrons in the mesentery. This is expected to be a mechanism of absorption for drugs with log
The mixed micelles substantially transport digestion products across the unstirred water layer and reach the vicinity of the aqueous‐microvillus interface to allow for lipid absorption through the mucosal cells. However, it is possible that digestion of a lipid formulation could reduce the solubility of the drug in the gut lumen, which would result in the precipitation of the drug and a decrease in the absorption rate. Therefore, more investigation on
The fate of the lipid carrier in the GI tract is essentially important for the absorption of the incorporated drug and therefore has to be closely analyzed. It is evident that the solvent capacity of the formulation can be lost on digestion, leading to drug precipitation [26, 50]. However, the investigation of the lipolysis by
Lipolysis can be carried out as an
Substance of the mixture for 10 ml aqueous media | \n||
---|---|---|
Lipid 250 mg Pancreatic lipase 1 ml (800 TBU/ml) Lipolysis buffer 9 ml | \n||
Composition of the lipolysis buffer | \nConcentration (fed state) | \nConcentration (fasted state) | \n
Bile salt (BS, mM) | \n20 | \n5 | \n
Phospholipid (PL, mM) | \n5 | \n1.25 | \n
Trizma maleate (mM) | \n0.5 | \n0.5 | \n
Ca+ (mM) | \n0.05 | \n0.05 | \n
Na+ (mM) | \n1.5 | \n1.5 | \n
Composition of mixture for
Lipolysis is allowed to proceed for a fixed time (30–60 min), the reaction is then subjected to high‐speed ultracentrifugation, and further drug analysis in the various phases allows predicting whether the drug will remain solubilized in the intestinal lumen after digestion of the formulation. However, if the drug is partially precipitated, then drug will be found in the pellet, which may be still in solution. The rate and extent of lipolysis can be quantified by the data generated from the pH‐stat. This technique was recently applied in LFCS Types I–IV formulations to predict the effect of formulation on the fate of a number of drug compounds and assumed that surfactants are subjected to digestion, probably for SMEDDS and SNEDDS, where water soluble surfactants are used predominantly. Lipolysis experiments may play a vital role in the near future for establishing strong methods for
The
To overcome these issues, it is necessary to develop
In the beginning of 1980s, the
There are several tools which can be used to establish
For many drugs with poor aqueous solubility, the technique of developing SMEDDS/SNEDDS provides a powerful and effective solution to improve their solubility in the aqueous contents of the GI tract that is the main obstacle for such drugs. The most critical step in designing the nanoformulations of lipid‐based systems for PWSDs is the selection of the most suitable oil, surfactant and/or cosolvent for a particular drug with certain physicochemical properties. So, the formulators must keep a balance and make compatibility between the factors of different formulations such as self‐emulsification efficiency, drug loading capacity, droplet size distribution,
Population growth becomes an urgent global concern with an expected half of the world’s population growth will be concentrated in just nine countries [1]. With the highest rate of population growth, Africa is expected to account for more than half of the world population growth between 2015 and 2050 [2]. Ethiopia is among countries with higher fertility rates in the world and high populous nations in Africa [3]. Fertility rates are determinant actors of the human development index (HDI) affecting life expectancy, education, per capita income, and other indicators [4]. The role of family planning (FP) in decreasing fertility rate which could reduce maternal and child mortality, and other health costs thereby improving maternal and child health is widely advocated [5, 6].
Implants such as Implanon, Sino implant, and Jadelle are among the modern contraceptive methods that are long-acting, reversible, and hormonal contraceptives [7, 8]. Contraceptive implants are one of the most effective family planning methods which widely available and have increased global acceptance [9, 10]. Implants are better options of contraception than other long-term family planning methods as they easily insert and remove and have fewer side effects [10].
The high rate of implants utilization by couples is indicative of FP program effectiveness within a country in addition to couples’ success in spacing and limiting their births [11]. Also, implants play a crucial role in the prevention of unintended pregnancies and abortions as well as in the reduction of maternal mortality and morbidity related to complications of pregnancy and childbirth [12]. Furthermore, the use of implants is comparatively the preferred method of contraception than injectable contraceptives which should be taken every 3 months and daily pills as implants are effective from 3 to 5 years in preventing pregnancy as well as rapid return to usual fertility as soon as implants are removed [10]. However, an analysis of Demographic and Health Surveys (DHS) from four Sub- Saharan Africa (SSA) countries revealed that the proportion of women who utilized implants was much lower than short-acting methods [13].
Though implant acceptance is at an increasing rate, of reproductive-age women who used contraceptive methods, only 0.3% globally, and 7% in Africa utilized implants [9, 14]. Furthermore, in many SSA countries, less than 5% of reproductive-age women are using long-acting contraceptives [15].
In Ethiopia, the ministry of health has planned to increase contraceptive implants to 33% in the method mix in 2015 [16]. However, the Ethiopian demographic and health survey (EDHS) of 2016 showed that only 8% of women utilized implants which indicated that the plan was not achieved [3]. To increase the level of implants utilization among women in Ethiopia, different strategies have been introduced such as practicing community level implants insertion by trained health extension workers (HEWs), and provision of contraceptives implants with free cost as of other contraceptives at all levels of health care [13, 17]. Still, short-acting methods are the dominant contraceptives in the current contraceptive method mix of the country [3, 18].
Studies have been done to determine the prevalence of implant utilization and to identify factors that contribute to the low utilization of implants in Ethiopia [7, 8, 9, 15, 19]. Evidence from the abovementioned studies conducted in Ethiopia was highly varied and the results are inconsistent. More research therefore required to provide up-to-date evidence for policymakers, programmers, and other stakeholders working on FP in Ethiopia to solve problems related to implants contraceptive utilization based on evidence. Therefore, the current study aims to assess the magnitude of implant contraceptive utilization and its associated factors among reproductive-age women in Ethiopia based on all-inclusive 2016 EDHS data.
A nationwide population-based cross-sectional study was conducted using secondary data analysis from the EDHS 2016. The survey data collection was carried out from January 18, 2016, to June 27, 2016.
The data used for the current study was extracted from 2016 EDHS which was stratified into urban and rural areas. The EDHS data collection procedure followed a two-stage sampling technique to select representative respondents of independent enumeration areas in each stratum. A total of 645 clusters (202 in urban and 443 in rural) enumeration areas were selected using probability proportional allocation to the size of enumeration area in the first stage while 28 households per cluster with an equal probability systematic selection were selected from the newly formed household list in the second stage. Consecutively, a total of 18,008 households were selected for the 2016 EDHS out of which 16,650 households were identified and interviewed yielding a response rate of 92.5%. From 16,650 interviewed households, 15,683 were reproductive age women and completed the interview making a response rate of 94.2% [3]. Finally, women who were reported to be pregnant at the time of the survey were excluded, and data were weighted to adjust for non-response and differences in the probability of selection. Thus, the analysis for this study was restricted to the 14,593 (weighted) reproductive-age women who met the eligibility criteria. Women’s questionnaire which contains five different parts including the FP component was used to collect information.
After getting permission, the data was downloaded from the MEASURE DHS database: https://www.dhsprogram.com/data/dataset_admin/login_main.cfm. Statistical package for social science (SPSS) version 20 was used for statistical analysis. Descriptive analysis was used to summarize the distribution of selected background characteristics of the study participants. Frequency tables and graphs were used to summarize and present findings. The data were weighted to adjust for non-response and account for the disproportionate sampling. Bivariate logistic regression analysis was used to select variables fitted for multivariable logistic regression. Variables with a p-value of less than 0.2 in the bivariate logistic regression were included in the multivariable logistic regression. Before running the final model, multicollinearity between candidate variables was checked using variance inflation factor (VIF). Multivariable logistic regression analysis was performed to identify independent predictors of implant contraceptive methods utilization among reproductive-age women in Ethiopia. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were respectively calculated to measure the association between predictor variables and implant contraceptive utilization. Results were considered statistically significant for p-values <0.05. finally, model fitness was checked using Hosmer and Lemeshow’s test.
The study result was analyzed based on 14,593 reproductive age women in the 2016 EDHS dataset. The mean age of women was 27.1 (± 8.11) years with the majority (24.8%) of women were aged 15–19 years. The majority, 11,468 (78.6%) of women were married, and 9707 (66.5%) were Orthodox religious followers. Out of reproductive age women interviewed, 1760 (12.1%) were from the Oromia region. Concerning the residence of participants, 10,613 (72.7%) were rural residents. About, 9559 (65.5%) of women were not working at the time of the survey. Regarding educational status, 6880 (47.1%) were not educated and 4662 (31.9%) women had completed primary education. About, 4713 (32.3%) of the women were from the poorest family (Table 1).
Variables | Frequency | Percent |
---|---|---|
Age 15–19 20–24 25–29 30–34 35–39 40–44 45–49 | 3612 2277 2885 2626 1997 833 363 | 24.8 15.6 19.8 18.0 13.7 5.7 2.5 |
Marital status Married Never married/divorced/widowed/separated | 11,468 3125 | 78.6 21.4 |
Religion Orthodox Muslim Protestant Catholic | 9707 4194 504 188 | 66.5 28.7 3.5 1.3 |
Place of residence Urban Rural | 3980 10,613 | 27.3 72.7 |
Educational level No formal education Primary school Secondary school Higher education | 6880 4662 1965 1086 | 47.1 31.9 13.5 7.5 |
Respondents’ current working status Yes No | 5034 9559 | 34.5 65.5 |
Monthly income Poorest Poorer Middle Richer Richest | 4713 2611 2594 2389 2286 | 32.3 17.9 17.8 16.4 15.6 |
Region Tigray Afar Amhara Oromia Somalia Benishangul SNNPR Gambela Harari Dire Dawa Addis Ababa | 1297 1365 1309 1760 1592 1027 1659 1017 895 1089 1583 | 8.9 9.4 9.0 12.1 10.9 7.0 11.4 7.0 6.1 7.4 10.8 |
Socio-demographic and socio-economic characteristics of reproductive age women in Ethiopia, 2016.
More than three out of five (61.8%) reproductive-age women have started their first sex before the age of 18 years with the mean age of 17.1 (SD ± 5.58) years. The mean age of first childbirth for those who gave birth was 24.88 (SD ± 4.64) years with about half (50.1%) of women giving birth in their age of 18–24 years. The mean number of living children was 2.0 (SD ± 1.8) with more than two-fifths (42.6%) of women having 1–2 living children. Only, 1107 (7.6%) of women had a history of terminated pregnancy. Around, 4961 (34%) of the women want to have children after 2 years. Concerning partners’ desire to have children, 9494 (65.1%) reported that their husbands need to have more children. Regarding decision-making on contraceptive use, 3079 (21.1%) reproductive age women made the decision jointly with their husbands (Table 2).
Variables | Frequency | Percent |
---|---|---|
Age at first sex Less than 18 years 18–24 years 25 and above years | 9024 5143 426 | 61.8 35.1 2.9 |
Age at first childbirth Not had childbirth Less than 18 years 18–24 years 25 and above years | 318 5737 7319 1219 | 2.2 39.3 50.1 8.4 |
Number of living children (parity) None 1 to 2 3 to 4 5 and more | 4440 6216 3133 804 | 30.4 42.6 21.5 5.5 |
Does husband want to have an additional child? Yes No | 9494 5099 | 65.1 34.9 |
History of a terminated pregnancy Yes No | 1107 13,486 | 7.6 92.4 |
Fertility preference Wants within 2 years Wants after 2 years Wants no more children Undecided | 3714 4961 2785 3133 | 25.5 34.0 19.1 21.4 |
Decision maker for using contraception Mainly respondent Mainly husband/partner Jointly Others | 2247 8355 3079 912 | 15.4 57.3 21.1 6.2 |
Reproductive and obstetric characteristics of reproductive age women in Ethiopia, 2016.
About three-fourths, 10,978 (75.2%) of women did not hear family planning messages on the radio for the last few months. The majority, 13,666 (93.6%) of women did not hear family planning messages in newspaper/magazines last few months, and almost three-fourths, 10,929 (74.9%) of women did not hear family planning messages on television last few months. Only, 5636 (38.6%) of women reported that they were visited a health facility in the last 12 months. Out of reproductive-age women who have visited a health facility in the last 12 months, 1935 (34.3%) had a discussion about FP with the healthcare worker and 1606 (28.5%) were counseled by healthcare workers regarding the side effects of contraceptives. Out of women counseled regarding the side effects of contraceptives, 754 (46.9%) of women were told how to deal with side effects. The survey indicated that the majority (93.8%) of women had good knowledge about any contraceptive methods (Table 3).
Variables | Frequency | Percent |
---|---|---|
Heard family planning on the radio last few months Yes No | 3615 10,978 | 24.8 75.2 |
Heard family planning on television last few months Yes No | 3664 10,929 | 25.1 74.9 |
Heard family planning in the newspaper/magazine last few months Yes No | 927 13,666 | 6.4 93.6 |
The visited health facility in the last 12 months Yes No | 5636 8957 | 38.6 61.4 |
Discussed FP with healthcare worker (n = 5636) Yes No | 1935 3701 | 34.3 65.7 |
Counseled by healthcare worker regarding the side effects (n = 5636) Yes No | 1606 4030 | 28.5 71.5 |
Counseled by healthcare worker how to deal with side effects (n = 1606) Yes No | 754 852 | 46.9 53.1 |
Knowledge of any contraceptives Good Poor | 13,686 907 | 93.8 6.2 |
Exposure to mass media and family planning messages among reproductive age women in Ethiopia, 2016.
The magnitude of implant contraceptive methods utilization among reproductive-age women in Ethiopia was 9.4% (95% CI: 8.8, 10.0). There was a disparity of implant contraceptive utilization based on regions of Ethiopia; 212 (1.5%) reproductive age women utilized implant contraceptives from the Amhara region, and 186 (1.3%%) women utilized implants contraceptive from Addis Ababa city administration (Figure 1).
Utilization of implant contraceptive methods among reproductive age women by region of Ethiopia, 2016.
The overall prevalence of current contraceptive utilization among reproductive-age women in Ethiopia was 26.9%. The most preferred contraceptive method for reproductive-age women was injectable 1824 (12.5%) whereas emergency contraception 8 (0.1%)was the least preferred contraceptive method (Figure 2).
Utilization of currently contraceptive methods by method type among reproductive age women in Ethiopia, 2016.
In bivariate logistic regressions analysis; marital status, place of residence, educational status of women, current working status, number of living children, age at first childbirth, abortion history, fertility preference, husband desire for more children, decision making on contraceptive use, discussed FP with a healthcare worker, counseling about contraceptive side effects, knowledge on contraceptives, heard family planning message on radio, heard family planning message in newspaper and heard family planning message on television were identified candidate variables for multivariable logistic regression at p-value less than 0.2. Accordingly, the result of multivariate logistic regression analysis revealed that marital status, place of residence, number of living children, history of a terminated pregnancy, husband desire for more children, decision making on contraceptive use, knowledge on contraceptives, discussed FP with the healthcare worker and heard family planning message on television were significantly associated with utilization of implant contraceptives.
Married reproductive-age women were 1.94 times (AOR = 1.94, 95%CI: 1.42, 2.65) more likely to use implants as compared to those women who are never married, divorced, and widowed. Urban women were 1.66 times (AOR = 1.66, 95%CI: 1.32, 2.10) more likely to use implants as compared to their rural counterparts. Women having 1–2 living children was 39% times (AOR = 0.61, 95%CI: 0.42, 0.88) less likely to use implants as compared to women having five and more children. Likewise, women having 3–4 living children was 42% times (AOR = 0.58, 95%CI: 38, 0.90) less likely to use implants as compared to women with five and more children. Besides, those women who reported their husband’s desire for more children were 36% times (AOR = 0.64, 95% C.I: 0.48, 0.84) less likely to use implants than those who reported that their husband would not want more children. Women who had a history of terminated pregnancy were 1.48 times (AOR = 1.48, 95% C.I: 1.11, 1.98) more likely to use implants as compared to those women who had no history of terminated pregnancy. Women who had a joint decision on contraception were having 2.09 times (AOR = 2.09, 95% C.I: 1.27, 4.11) higher odds of using implants than those who decided with the help of other persons. Women who had good knowledge of contraceptives were 9 times (AOR = 9.01, 95% C.I: 4.59, 18.90) more likely to use implants as compared with those who had poor knowledge. Women who discussed FP with healthcare workers were 1.59 times (AOR = 1.59, 95% C.I: 1.22, 2.06) more likely to use implants as compared to those women who did not discuss FP with a healthcare worker. Women who heard family planning messages on television were 1.60 times (AOR = 1.60, 95% C.I: 1.45, 2.81) more likely to use implants than those women who did not hear family planning messages on television (Table 4).
Variables | Utilization of implants | COR (95% CI) | AOR (95% CI) | |
---|---|---|---|---|
Yes | No | |||
Marital status Married Never married/divorced/widowed | 1217 161 | 10,251 2964 | 2.19 (1.85, 2.59) 1 | 1.94 (1.42, 2.65)* 1 |
Residence Urban Rural | 456 922 | 3524 9691 | 1.36 (1.21, 1.53) 1 | 1.66 (1.32, 2.10)* 1 |
Educational status No formal education Primary school Secondary school College/University | 826 311 140 101 | 6054 4351 1825 985 | 1.33 (1.07, 1.65) 0.70 (0.55, 0.88) 0.75 (0.57, 0.97) 1 | 0.74 (0.52, 1.06) 0.77 (0.55, 1.07) 0.88 (0.61, 1.28) 1 |
Respondents’ current working status Yes No | 595 783 | 4439 8776 | 1.50 (1.34, 1.68) 1 | 1.08 (0.93, 1.69) 1 |
Number of living children (parity) None 1 to 2 3 to 4 5 and more | 538 573 170 97 | 3902 5643 2963 707 | 1.01 (0.80, 1.27) 0.74 (0.59, 0.93) 0.42 (0.32, 0.54) 1 | 0.83 (0.56, 1.22) 0.61 (0.42, 0.88)* 0.58 (0.38, 0.90)* 1 |
History of a terminated pregnancy Yes No | 151 1227 | 956 12,259 | 1.58 (1.32, 1.89) 1 | 1.48 (1.11, 1.98)* 1 |
Age at first childbirth Not had childbirth Less than 18 years 18–24 years 25 and above years | 50 693 492 143 | 268 5044 6827 1076 | 1.40 (0.99, 1.99) 1.03 (0.85, 1.25) 0.54 (0.45, 0.66) 1 | 1.33 (0.79, 2.26) 1.07 (0.84, 1.64) 0.34 (0.24, 1.06) 1 |
Fertility preference Wants within 2 years Wants after 2 years Wants no more children Undecided | 297 273 121 687 | 3417 4688 2664 2446 | 0.31 (0.27, 0.36) 0.21 (0.18, 0.24) 0.16 (0.13, 0.20) 1 | 0.35 (0.27, 1.46) 0.35 (0.72, 1.12) 0.75 (0.49, 1.50) 1 |
Does husband want to have more children? Yes No | 986 392 | 8508 4707 | 1.39 (1.23, 1.57) 1 | 0.64 (0.48, 0.84)* 1 |
Decision maker for using contraception Mainly respondent Mainly husband/partner Jointly Others | 163 742 190 283 | 2084 7613 2889 629 | 0.17 (0.14, 0.22) 0.22 (0.19, 0.25) 0.15 (0.12, 0.18) 1 | 0.41 (0.59, 1.09) 0.82 (0.39, 1.16) 2.09 (1.27, 4.11)* 1 |
Knowledge on contraceptives Good Poor | 1336 42 | 12,350 865 | 2.23 (1.63, 3.05) 1 | 9.01 (4.59, 18.90)* 1 |
Discussed FP with the healthcare workers Yes No | 204 388 | 1731 3313 | 1.01 (0.84, 1.20) 1 | 1.59 (1.22, 2.06)* 1 |
Counseled by healthcare worker about side effects Yes No | 168 424 | 1438 3606 | 0.99 (0.82, 1.20) 1 | 1.29 (0.98, 1.68) 1 |
Heard FP’s message on the radio Yes No | 255 1123 | 3360 9855 | 0.67 (0.58, 0.77) 1 | 0.91 (0.68, 1.20) 1 |
Heard FP’s message on television Yes No | 198 1180 | 3466 9749 | 0.47 (0.40, 0.55) 1 | 1.60 (1.45, 2.81)* 1 |
Heard FP message in newspapers Yes No | 63 1315 | 864 12,351 | 0.69 (0.53, 0.89) 1 | 0.92 (0.58, 1.48) 1 |
Bivariable and multivariable analysis for implant contraceptive utilization among reproductive age women in Ethiopia, 2016.
∗Statistically significant (
This all-inclusive study provides vibrant evidence on the utilization of implant family planning services and associated factors among reproductive-age women in Ethiopia. Besides, the finding of this study revealed that the current utilization of implants was very low as compared to the national family planning coasted implementation targets which planned to increase contraceptive prevalence rate to 55% at the end of 2020 by increasing the share of the implant to 33% in the method mix [18]. This may imply the need to evaluate and strengthen the designed interventions like community health education and behavioral change communication (BCC) to avert attitudinal and informational barriers and misconceptions towards implants family planning methods. Moreover, the finding may also infer the poor quality of family planning counseling, especially on the prevailing myths and misconceptions of implant contraceptive methods by health care professionals. This study also indicated that the proportion of women using implant contraceptive methods was much lower than the level of use at the global level [20].
The overall prevalence of implant contraceptive utilization among reproductive-age women in Ethiopia was 9.4% (95% CI: 8.8, 10.0). The finding is almost consistent with the result of other previous studies [21, 22, 23]. However, the current prevalence is lower than the findings of other studies [24, 25, 26]. The reason for these discrepancies could be due to differences in the provision of reproductive health services, availability, and accessibility of long-acting family planning methods in safe and convenient services for all women. The variation might also be due to socio-demographic, religious belief, norm, and other cultural differences which could have a paramount effect on implant contraceptive utilization.
The current prevalence is also lower than the results of other studies done in different parts of the country [10, 27, 28]. The discrepancy might have occurred due to a difference in the study population. This study was conducted among reproductive-age women residing in both urban and rural areas, whereas those studies were conducted based on urban settings which increase the proportion of women using implant contraceptive methods.
In the current study, marital status was an independent predictor of implant contraceptive method utilization among reproductive-age women in Ethiopia. Married reproductive-age women were 1.94 times more likely to use implants contraceptives as compared to those women who are never married, divorced, and widowed. The finding is consistent with a study conducted in Nigeria [24]. This is because married reproductive age women have a higher probability of practicing regular sexual intercourse than those women who are never married, divorced, and widowed [29, 30]. Furthermore, most married reproductive age women might have the desired number of children which might have a paramount effect on implant contraceptive utilization.
The residence was also independently associated with implant contraceptive utilization. Urban women were 1.66 times more likely to use implants as compared to their rural counterparts. The finding is supported by a systematic review and meta-analysis conducted on factors associated with long-acting family planning service utilization in Ethiopia [31]. This could be because urban women are more likely to be better educated, have better access to the health care service, and better access to family planning messages through mass media than rural women which have a vital impact on implants contraceptive utilization [32]. Conversely, rural women may need more children to get help for their fieldwork which has a negative effect on their implant’s contraceptive utilization [33, 34, 35, 36]. This may imply the need to strengthen the community-based implant family planning service provision through the effort of health extension workers which could have a contribution to the increasing use of contraceptive implants by rural women.
Women having 1–2 living children were 39% times less likely to use implants as compared to women with five and more children. Likewise, women having 3–4 living children were 42% times less likely to use implants as compared to women with five and more children. The finding is supported by a systematic review and meta-analysis done in Ethiopia [31], and other previous studies [27, 37, 38]. The reason could be women with five and more children may think that the number of children that they already have could be enough for them. This may also be due to the reason that reproductive-age women having a fewer number of children may need to bear more children to attain the desired family size [39]. Additionally, women with more births would be more likely to be older and they could likely prefer a longer period of spacing pregnancies than younger women [40]. Different literature reported that utilization of modern contraceptives including implants could increase as the number of living children increases [10, 41, 42].
Furthermore, women who reported their husband’s desire for more children were 36% times less likely to use implants than those who reported that their husband would not want more children. The finding is supported by a systematic review and meta-analysis done in Ethiopia [31], and other similar studies [24, 27, 37, 38]. This is attributable to gender expectations which can limit women’s autonomy and the benefits that women can gain when they do a decision to contraceptive use. In most parts of the Ethiopian community, husbands’ opposition could delay the decision to use contraceptives. Thus, this entails enhanced efforts in the empowerment of women as part of family planning programs [43].
Women who had a history of terminated pregnancy were 1.48 times more likely to use implants as compared to those women who had no history of terminated pregnancy. This finding is consistent with a study in Luanda, Angola, which indicated that a history of abortion was associated with implant contraceptive use [44]. The reason could be explained by those women with a history of terminated pregnancy might be had an unintended pregnancy, but they may not desire to have children currently or within a few years. Thus, to achieve their wish women may use implant contraceptives or will use long-acting methods.
Women who had a joint decision on contraception were having 2.09 times higher odds of using implants than those who decided with the help of other persons. The finding is consistent with other studies [24, 27, 37]. This indicated that the involvement of women regarding fertility and choice of contraception decision had an increased possibility of modern contraceptive use including long-term methods [45]. This strengthens evidence reported on the importance of male involvement in joint couple’s decisions on family planning method choice, and contraceptive utilization [7].
Women who had good knowledge of contraceptives were nine times more likely to use implants as compared with those who had poor knowledge. The finding is supported by other studies conducted in different settings [24, 26, 27, 37]. This might be due to the fact that having a better understanding and knowledge of contraceptive methods could help women to know more about the duration of protection, advantage, safety, and side effect of each contraceptive as well as where to get the methods.
Women who discussed FP with healthcare workers were 1.59 times more likely to use implants as compared to those women who did not discuss FP with a healthcare worker. The finding is consistent with a study conducted in Nigeria [24]. This implies that counseling and informed choice are important principles in the provision of family planning services that could help women to use contraceptive methods they preferred. Furthermore, women may understand the benefit of implants over short-acting methods in its longer protection of pregnancy and convenience to use while discussing with a healthcare worker.
Women who heard family planning messages on television were 1.60 times more likely to use implants than those women who did not hear family planning messages on television. The finding is supported by a systematic review and meta-analysis done in Ethiopia [31], and other previous studies [24, 27, 37, 38]. This could be explained by the fact that women who heard family planning messages on mass media may have a better understanding and a good insight on implant contraceptives, and can compromise unreasonable misconceptions and other barriers which preclude family planning service utilization.
The study used nationally representative data with a large sample size which better reflects the proportion of reproductive-age women using implant contraceptive method and its associated factors at the national level. The temporal relationship between implants contraceptive use and the determinant variables cannot be assured since the study used data from a single time survey, and the evidence should be utilized with caution. The analysis did not incorporate some important factors like distance to a health facility, quality of family planning services, peer-related factors that could influence reproductive-age women’s implant contraceptive behavior as this is not collected in the EDHS data. Besides, the association of qualitative variables like sociocultural factors to implants contraceptive utilization was not addressed as qualitative information was not fully available in the EDHS dataset.
The study showed that the magnitude of implant contraceptive utilization among reproductive-age women in Ethiopia is very low. The finding of this study also showed that marital status, place of residence, number of living children, a history of a terminated pregnancy, husband desire for more children, decision making on contraceptive use, knowledge on contraceptives, discussed FP with the healthcare worker and heard family planning message on television were independent predictors of implants contraceptive use among reproductive-age women in Ethiopia. The finding of this study suggests any intervention strategy which is designed and being implemented to promote implants contraceptive method utilization should consider the aforementioned factors for its better success. In addition, the provision of quality counseling and information on FP, and women empowerment should be promoted so that women can freely decide on the type of contraceptive they would like to use. Moreover, emphasis should be given to rural women to implants contraceptive method use.
We thank the Demographic Health Survey Program (http://www.dhsprogram.com) for the data.
BDM wrote the proposal, analysis, report writing, and drafted the manuscript. CAW made revisions to the proposal, participated in data analysis, and drafted the manuscript. All authors reviewed, revised, and approved the manuscript for publication.
No funding has been obtained from any source to carry out this study.
The authors declare that they have no competing interests.
Ethics approval and consent to participate
After developing a protocol, permission to access the 2016 EDHS data was obtained from the MEASURE DHS website at: www.dhsprogram.com by agreeing with the conditions of DHS data use stated on the DHS consent letter to the author. Ethical clearance to conduct the survey was approved by the Ethical Review Board of Ethiopia Central Statistical Agency (CSA) and the Ethiopian Health and Nutrition Research Institute (EHNRI) Review Board, the National Research Ethics Review Committee (NRERC) at the Federal Democratic Republic of Ethiopia. As indicated in the EDHS 2016 publications, written informed consent for participation was taken from study participants and written informed consent for participation was also obtained from their parent or guardian for those children (under 16 years old).
The dataset of the EDHS is not available as a public domain survey dataset but can be accessed with the request by registration on the MEASURE DHS website at: www.dhsprogram.com
AOR | adjusted hazard ratio |
CI | confidence interval |
EDHS | Ethiopian Demographic and Health Survey |
FP | Family planning |
MEASURE DHS | monitoring and evaluation to assess and use results demographic and health surveys |
SNNPR | Southern Nations, Nationalities, and Peoples’ Region. |
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This research has received competitive public grants from the European Commission, the Spanish Ministry of Economy and Competitiveness, the Valencia Region Government, and the University of Alicante.",institutionString:"University of Alicante",institution:{name:"University of Alicante",institutionURL:null,country:{name:"Spain"}}},editorTwo:null,editorThree:null},{id:"15",title:"Chemical Biology",coverUrl:"https://cdn.intechopen.com/series_topics/covers/15.jpg",isOpenForSubmission:!0,editor:{id:"441442",title:"Dr.",name:"Şükrü",middleName:null,surname:"Beydemir",slug:"sukru-beydemir",fullName:"Şükrü Beydemir",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003GsUoIQAV/Profile_Picture_1634557147521",biography:"Dr. Şükrü Beydemir obtained a BSc in Chemistry in 1995 from Yüzüncü Yıl University, MSc in Biochemistry in 1998, and PhD in Biochemistry in 2002 from Atatürk University, Turkey. He performed post-doctoral studies at Max-Planck Institute, Germany, and University of Florence, Italy in addition to making several scientific visits abroad. He currently works as a Full Professor of Biochemistry in the Faculty of Pharmacy, Anadolu University, Turkey. Dr. Beydemir has published over a hundred scientific papers spanning protein biochemistry, enzymology and medicinal chemistry, reviews, book chapters and presented several conferences to scientists worldwide. He has received numerous publication awards from various international scientific councils. He serves in the Editorial Board of several international journals. 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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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He worked on the structure-function relationships of glycoconjugates and his main project was the investigations on the biological roles of the de-N-glycosylation enzymes (Endo-N-acetyl-β-D-glucosaminidase and peptide-N4-(N-acetyl-β-glucosaminyl) asparagine amidase). From 2002 he contributes to the understanding of the Blood-brain barrier functioning using proteomics approaches. He has published more than 70 papers. 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Since then, he has been working as an Adjunct Professor in the same Department at the University of Pavia. His research activity during the first years was primarily focused on the purification and structural characterization of enzymes from animal and plant sources. During this period, Prof. Iadarola familiarized himself with the conventional techniques used in column chromatography, spectrophotometry, manual Edman degradation, and electrophoresis). Since 1995, he has been working on: i) the determination in biological fluids (serum, urine, bronchoalveolar lavage, sputum) of proteolytic activities involved in the degradation processes of connective tissue matrix, and ii) on the identification of biological markers of lung diseases. 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He previously worked as a post-doctoral fellow at the Ben-Gurion University of Negev, Israel; University of the Free State, South Africa; and Central University of Technology Bloemfontein, South Africa. He obtained his Ph.D. in Organic Chemistry from Nagaoka University of Technology, Japan. He has published more than seventy-four journal articles and attended several national and international conferences as speaker and chair. Dr. Kendrekar has received many international awards. He has several funded projects, namely, anti-malaria drug development, MRSA, and SARS-CoV-2 activity of curcumin and its formulations. He has filed four patents in collaboration with the University of Central Lancashire and Mayo Clinic Infectious Diseases. His present research includes organic synthesis, drug discovery and development, biochemistry, nanoscience, and nanotechnology.",institutionString:"Visiting Scientist at Lipid Nanostructures Laboratory, Centre for Smart Materials, School of Natural Sciences, University of Central Lancashire",institution:null},{id:"428125",title:"Dr.",name:"Vinayak",middleName:null,surname:"Adimule",slug:"vinayak-adimule",fullName:"Vinayak Adimule",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/428125/images/system/428125.jpg",biography:"Dr. Vinayak Adimule, MSc, Ph.D., is a professor and dean of R&D, Angadi Institute of Technology and Management, India. He has 15 years of research experience as a senior research scientist and associate research scientist in R&D organizations. He has published more than fifty research articles as well as several book chapters. He has two Indian patents and two international patents to his credit. Dr. Adimule has attended, chaired, and presented papers at national and international conferences. He is a guest editor for Topics in Catalysis and other journals. He is also an editorial board member, life member, and associate member for many international societies and research institutions. His research interests include nanoelectronics, material chemistry, artificial intelligence, sensors and actuators, bio-nanomaterials, and medicinal chemistry.",institutionString:"Angadi Institute of Technology and Management",institution:null},{id:"284317",title:"Prof.",name:"Kantharaju",middleName:null,surname:"Kamanna",slug:"kantharaju-kamanna",fullName:"Kantharaju Kamanna",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/284317/images/21050_n.jpg",biography:"Prof. K. Kantharaju has received Bachelor of science (PCM), master of science (Organic Chemistry) and Doctor of Philosophy in Chemistry from Bangalore University. He worked as a Executive Research & Development @ Cadila Pharmaceuticals Ltd, Ahmedabad. He received DBT-postdoc fellow @ Molecular Biophysics Unit, Indian Institute of Science, Bangalore under the supervision of Prof. P. Balaram, later he moved to NIH-postdoc researcher at Drexel University College of Medicine, Philadelphia, USA, after his return from postdoc joined NITK-Surthakal as a Adhoc faculty at department of chemistry. Since from August 2013 working as a Associate Professor, and in 2016 promoted to Profeesor in the School of Basic Sciences: Department of Chemistry and having 20 years of teaching and research experiences.",institutionString:null,institution:{name:"Rani Channamma University, Belagavi",country:{name:"India"}}},{id:"158492",title:"Prof.",name:"Yusuf",middleName:null,surname:"Tutar",slug:"yusuf-tutar",fullName:"Yusuf Tutar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/158492/images/system/158492.jpeg",biography:"Prof. Dr. Yusuf Tutar conducts his research at the Hamidiye Faculty of Pharmacy, Department of Basic Pharmaceutical Sciences, Division of Biochemistry, University of Health Sciences, Turkey. He is also a faculty member in the Molecular Oncology Program. He obtained his MSc and Ph.D. at Oregon State University and Texas Tech University, respectively. He pursued his postdoctoral studies at Rutgers University Medical School and the National Institutes of Health (NIH/NIDDK), USA. His research focuses on biochemistry, biophysics, genetics, molecular biology, and molecular medicine with specialization in the fields of drug design, protein structure-function, protein folding, prions, microRNA, pseudogenes, molecular cancer, epigenetics, metabolites, proteomics, genomics, protein expression, and characterization by spectroscopic and calorimetric methods.",institutionString:"University of Health Sciences",institution:null},{id:"180528",title:"Dr.",name:"Hiroyuki",middleName:null,surname:"Kagechika",slug:"hiroyuki-kagechika",fullName:"Hiroyuki Kagechika",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/180528/images/system/180528.jpg",biography:"Hiroyuki Kagechika received his bachelor’s degree and Ph.D. in Pharmaceutical Sciences from the University of Tokyo, Japan, where he served as an associate professor until 2004. He is currently a professor at the Institute of Biomaterials and Bioengineering (IBB), Tokyo Medical and Dental University (TMDU). From 2010 to 2012, he was the dean of the Graduate School of Biomedical Science. Since 2012, he has served as the vice dean of the Graduate School of Medical and Dental Sciences. He has been the director of the IBB since 2020. Dr. Kagechika’s major research interests are the medicinal chemistry of retinoids, vitamins D/K, and nuclear receptors. He has developed various compounds including a drug for acute promyelocytic leukemia.",institutionString:"Tokyo Medical and Dental University",institution:{name:"Tokyo Medical and Dental University",country:{name:"Japan"}}},{id:"94311",title:"Prof.",name:"Martins",middleName:"Ochubiojo",surname:"Ochubiojo Emeje",slug:"martins-ochubiojo-emeje",fullName:"Martins Ochubiojo Emeje",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94311/images/system/94311.jpeg",biography:"Martins Emeje obtained a BPharm with distinction from Ahmadu Bello University, Nigeria, and an MPharm and Ph.D. from the University of Nigeria (UNN), where he received the best Ph.D. award and was enlisted as UNN’s “Face of Research.” He established the first nanomedicine center in Nigeria and was the pioneer head of the intellectual property and technology transfer as well as the technology innovation and support center. Prof. Emeje’s several international fellowships include the prestigious Raman fellowship. He has published more than 150 articles and patents. He is also the head of R&D at NIPRD and holds a visiting professor position at Nnamdi Azikiwe University, Nigeria. He has a postgraduate certificate in Project Management from Walden University, Minnesota, as well as a professional teaching certificate and a World Bank certification in Public Procurement. Prof. Emeje was a national chairman of academic pharmacists in Nigeria and the 2021 winner of the May & Baker Nigeria Plc–sponsored prize for professional service in research and innovation.",institutionString:"National Institute for Pharmaceutical Research and Development",institution:{name:"National Institute for Pharmaceutical Research and Development",country:{name:"Nigeria"}}},{id:"436430",title:"Associate Prof.",name:"Mesut",middleName:null,surname:"Işık",slug:"mesut-isik",fullName:"Mesut Işık",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/436430/images/19686_n.jpg",biography:null,institutionString:null,institution:{name:"Bilecik University",country:{name:"Turkey"}}},{id:"268659",title:"Ms.",name:"Xianquan",middleName:null,surname:"Zhan",slug:"xianquan-zhan",fullName:"Xianquan Zhan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/268659/images/8143_n.jpg",biography:"Dr. Zhan received his undergraduate and graduate training in the fields of preventive medicine and epidemiology and statistics at the West China University of Medical Sciences in China during 1989 to 1999. He received his post-doctoral training in oncology and cancer proteomics for two years at the Cancer Research Institute of Human Medical University in China. In 2001, he went to the University of Tennessee Health Science Center (UTHSC) in USA, where he was a post-doctoral researcher and focused on mass spectrometry and cancer proteomics. Then, he was appointed as an Assistant Professor of Neurology, UTHSC in 2005. He moved to the Cleveland Clinic in USA as a Project Scientist/Staff in 2006 where he focused on the studies of eye disease proteomics and biomarkers. He returned to UTHSC as an Assistant Professor of Neurology in the end of 2007, engaging in proteomics and biomarker studies of lung diseases and brain tumors, and initiating the studies of predictive, preventive, and personalized medicine (PPPM) in cancer. In 2010, he was promoted to Associate Professor of Neurology, UTHSC. Currently, he is a Professor at Xiangya Hospital of Central South University in China, Fellow of Royal Society of Medicine (FRSM), the European EPMA National Representative in China, Regular Member of American Association for the Advancement of Science (AAAS), European Cooperation of Science and Technology (e-COST) grant evaluator, Associate Editors of BMC Genomics, BMC Medical Genomics, EPMA Journal, and Frontiers in Endocrinology, Executive Editor-in-Chief of Med One. He has\npublished 116 peer-reviewed research articles, 16 book chapters, 2 books, and 2 US patents. His current main research interest focuses on the studies of cancer proteomics and biomarkers, and the use of modern omics techniques and systems biology for PPPM in cancer, and on the development and use of 2DE-LC/MS for the large-scale study of human proteoforms.",institutionString:null,institution:{name:"Xiangya Hospital Central South University",country:{name:"China"}}},{id:"40482",title:null,name:"Rizwan",middleName:null,surname:"Ahmad",slug:"rizwan-ahmad",fullName:"Rizwan Ahmad",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/40482/images/system/40482.jpeg",biography:"Dr. Rizwan Ahmad is a University Professor and Coordinator, Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Saudi Arabia. Previously, he was Associate Professor of Human Function, Oman Medical College, Oman, and SBS University, Dehradun. Dr. Ahmad completed his education at Aligarh Muslim University, Aligarh. He has published several articles in peer-reviewed journals, chapters, and edited books. His area of specialization is free radical biochemistry and autoimmune diseases.",institutionString:"Imam Abdulrahman Bin Faisal University",institution:{name:"Imam Abdulrahman Bin Faisal University",country:{name:"Saudi Arabia"}}},{id:"41865",title:"Prof.",name:"Farid A.",middleName:null,surname:"Badria",slug:"farid-a.-badria",fullName:"Farid A. Badria",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/41865/images/system/41865.jpg",biography:"Farid A. Badria, Ph.D., is the recipient of several awards, including The World Academy of Sciences (TWAS) Prize for Public Understanding of Science; the World Intellectual Property Organization (WIPO) Gold Medal for best invention; Outstanding Arab Scholar, Kuwait; and the Khwarizmi International Award, Iran. He has 250 publications, 12 books, 20 patents, and several marketed pharmaceutical products to his credit. He continues to lead research projects on developing new therapies for liver, skin disorders, and cancer. Dr. Badria was listed among the world’s top 2% of scientists in medicinal and biomolecular chemistry in 2019 and 2020. He is a member of the Arab Development Fund, Kuwait; International Cell Research Organization–United Nations Educational, Scientific and Cultural Organization (ICRO–UNESCO), Chile; and UNESCO Biotechnology France",institutionString:"Mansoura University",institution:{name:"Mansoura University",country:{name:"Egypt"}}},{id:"329385",title:"Dr.",name:"Rajesh K.",middleName:"Kumar",surname:"Singh",slug:"rajesh-k.-singh",fullName:"Rajesh K. Singh",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/329385/images/system/329385.png",biography:"Dr. Singh received a BPharm (2003) and MPharm (2005) from Panjab University, Chandigarh, India, and a Ph.D. (2013) from Punjab Technical University (PTU), Jalandhar, India. He has more than sixteen years of teaching experience and has supervised numerous postgraduate and Ph.D. students. He has to his credit more than seventy papers in SCI- and SCOPUS-indexed journals, fifty-five conference proceedings, four books, six Best Paper Awards, and five projects from different government agencies. He is currently an editorial board member of eight international journals and a reviewer for more than fifty scientific journals. He received Top Reviewer and Excellent Peer Reviewer Awards from Publons in 2016 and 2017, respectively. He is also on the panel of The International Reviewer for reviewing research proposals for grants from the Royal Society. He also serves as a Publons Academy mentor and Bentham brand ambassador.",institutionString:"Punjab Technical University",institution:{name:"Punjab Technical University",country:{name:"India"}}},{id:"142388",title:"Dr.",name:"Thiago",middleName:"Gomes",surname:"Gomes Heck",slug:"thiago-gomes-heck",fullName:"Thiago Gomes Heck",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/142388/images/7259_n.jpg",biography:null,institutionString:null,institution:{name:"Universidade Regional do Noroeste do Estado do Rio Grande do Sul",country:{name:"Brazil"}}},{id:"336273",title:"Assistant Prof.",name:"Janja",middleName:null,surname:"Zupan",slug:"janja-zupan",fullName:"Janja Zupan",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/336273/images/14853_n.jpeg",biography:"Janja Zupan graduated in 2005 at the Department of Clinical Biochemistry (superviser prof. dr. Janja Marc) in the field of genetics of osteoporosis. Since November 2009 she is working as a Teaching Assistant at the Faculty of Pharmacy, Department of Clinical Biochemistry. In 2011 she completed part of her research and PhD work at Institute of Genetics and Molecular Medicine, University of Edinburgh. She finished her PhD entitled The influence of the proinflammatory cytokines on the RANK/RANKL/OPG in bone tissue of osteoporotic and osteoarthritic patients in 2012. From 2014-2016 she worked at the Institute of Biomedical Sciences, University of Aberdeen as a postdoctoral research fellow on UK Arthritis research project where she gained knowledge in mesenchymal stem cells and regenerative medicine. She returned back to University of Ljubljana, Faculty of Pharmacy in 2016. She is currently leading project entitled Mesenchymal stem cells-the keepers of tissue endogenous regenerative capacity facing up to aging of the musculoskeletal system funded by Slovenian Research Agency.",institutionString:null,institution:{name:"University of Ljubljana",country:{name:"Slovenia"}}},{id:"357453",title:"Dr.",name:"Radheshyam",middleName:null,surname:"Maurya",slug:"radheshyam-maurya",fullName:"Radheshyam Maurya",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/357453/images/16535_n.jpg",biography:null,institutionString:null,institution:{name:"University of Hyderabad",country:{name:"India"}}},{id:"418340",title:"Dr.",name:"Jyotirmoi",middleName:null,surname:"Aich",slug:"jyotirmoi-aich",fullName:"Jyotirmoi Aich",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000038Ugi5QAC/Profile_Picture_2022-04-15T07:48:28.png",biography:"Biotechnologist with 15 years of research including 6 years of teaching experience. Demonstrated record of scientific achievements through consistent publication record (H index = 13, with 874 citations) in high impact journals such as Nature Communications, Oncotarget, Annals of Oncology, PNAS, and AJRCCM, etc. Strong research professional with a post-doctorate from ACTREC where I gained experimental oncology experience in clinical settings and a doctorate from IGIB where I gained expertise in asthma pathophysiology. A well-trained biotechnologist with diverse experience on the bench across different research themes ranging from asthma to cancer and other infectious diseases. An individual with a strong commitment and innovative mindset. Have the ability to work on diverse projects such as regenerative and molecular medicine with an overall mindset of improving healthcare.",institutionString:"DY Patil Deemed to Be University",institution:null},{id:"349288",title:"Prof.",name:"Soumya",middleName:null,surname:"Basu",slug:"soumya-basu",fullName:"Soumya Basu",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035QxIDQA0/Profile_Picture_2022-04-15T07:47:01.jpg",biography:"Soumya Basu, Ph.D., is currently working as an Associate Professor at Dr. D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India. With 16+ years of trans-disciplinary research experience in Drug Design, development, and pre-clinical validation; 20+ research article publications in journals of repute, 9+ years of teaching experience, trained with cross-disciplinary education, Dr. Basu is a life-long learner and always thrives for new challenges.\r\nHer research area is the design and synthesis of small molecule partial agonists of PPAR-γ in lung cancer. She is also using artificial intelligence and deep learning methods to understand the exosomal miRNA’s role in cancer metastasis. Dr. Basu is the recipient of many awards including the Early Career Research Award from the Department of Science and Technology, Govt. of India. She is a reviewer of many journals like Molecular Biology Reports, Frontiers in Oncology, RSC Advances, PLOS ONE, Journal of Biomolecular Structure & Dynamics, Journal of Molecular Graphics and Modelling, etc. She has edited and authored/co-authored 21 journal papers, 3 book chapters, and 15 abstracts. She is a Board of Studies member at her university. She is a life member of 'The Cytometry Society”-in India and 'All India Cell Biology Society”- in India.",institutionString:"Dr. D.Y. Patil Vidyapeeth, Pune",institution:{name:"Dr. D.Y. Patil Vidyapeeth, Pune",country:{name:"India"}}},{id:"354817",title:"Dr.",name:"Anubhab",middleName:null,surname:"Mukherjee",slug:"anubhab-mukherjee",fullName:"Anubhab Mukherjee",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/0033Y0000365PbRQAU/ProfilePicture%202022-04-15%2005%3A11%3A18.480",biography:"A former member of Laboratory of Nanomedicine, Brigham and Women’s Hospital, Harvard University, Boston, USA, Dr. Anubhab Mukherjee is an ardent votary of science who strives to make an impact in the lives of those afflicted with cancer and other chronic/acute ailments. He completed his Ph.D. from CSIR-Indian Institute of Chemical Technology, Hyderabad, India, having been skilled with RNAi, liposomal drug delivery, preclinical cell and animal studies. He pursued post-doctoral research at College of Pharmacy, Health Science Center, Texas A & M University and was involved in another postdoctoral research at Department of Translational Neurosciences and Neurotherapeutics, John Wayne Cancer Institute, Santa Monica, California. In 2015, he worked in Harvard-MIT Health Sciences & Technology as a visiting scientist. He has substantial experience in nanotechnology-based formulation development and successfully served various Indian organizations to develop pharmaceuticals and nutraceutical products. He is an inventor in many US patents and an author in many peer-reviewed articles, book chapters and books published in various media of international repute. Dr. Mukherjee is currently serving as Principal Scientist, R&D at Esperer Onco Nutrition (EON) Pvt. Ltd. and heads the Hyderabad R&D center of the organization.",institutionString:"Esperer Onco Nutrition Pvt Ltd.",institution:null},{id:"319365",title:"Assistant Prof.",name:"Manash K.",middleName:null,surname:"Paul",slug:"manash-k.-paul",fullName:"Manash K. Paul",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/319365/images/system/319365.png",biography:"Manash K. Paul is a scientist and Principal Investigator at the University of California Los Angeles. He has contributed significantly to the fields of stem cell biology, regenerative medicine, and lung cancer. His research focuses on various signaling processes involved in maintaining stem cell homeostasis during the injury-repair process, deciphering the lung stem cell niche, pulmonary disease modeling, immuno-oncology, and drug discovery. He is currently investigating the role of extracellular vesicles in premalignant lung cell migration and detecting the metastatic phenotype of lung cancer via artificial intelligence-based analyses of exosomal Raman signatures. Dr. Paul also works on spatial multiplex immunofluorescence-based tissue mapping to understand the immune repertoire in lung cancer. Dr. Paul has published in more than sixty-five peer-reviewed international journals and is highly cited. He is the recipient of many awards, including the UCLA Vice Chancellor’s award and the 2022 AAISCR-R Vijayalaxmi Award for Innovative Cancer Research. He is a senior member of the Institute of Electrical and Electronics Engineers (IEEE) and an editorial board member for several international journals.",institutionString:"University of California Los Angeles",institution:{name:"University of California Los Angeles",country:{name:"United States of America"}}},{id:"311457",title:"Dr.",name:"Júlia",middleName:null,surname:"Scherer Santos",slug:"julia-scherer-santos",fullName:"Júlia Scherer Santos",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/311457/images/system/311457.jpg",biography:"Dr. Júlia Scherer Santos works in the areas of cosmetology, nanotechnology, pharmaceutical technology, beauty, and aesthetics. Dr. Santos also has experience as a professor of graduate courses. Graduated in Pharmacy, specialization in Cosmetology and Cosmeceuticals applied to aesthetics, specialization in Aesthetic and Cosmetic Health, and a doctorate in Pharmaceutical Nanotechnology. Teaching experience in Pharmacy and Aesthetics and Cosmetics courses. She works mainly on the following subjects: nanotechnology, cosmetology, pharmaceutical technology, aesthetics.",institutionString:"Universidade Federal de Juiz de Fora",institution:{name:"Universidade Federal de Juiz de Fora",country:{name:"Brazil"}}},{id:"219081",title:"Dr.",name:"Abdulsamed",middleName:null,surname:"Kükürt",slug:"abdulsamed-kukurt",fullName:"Abdulsamed Kükürt",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/219081/images/system/219081.png",biography:"Dr. Kükürt graduated from Uludağ University in Turkey. He started his academic career as a Research Assistant in the Department of Biochemistry at Kafkas University. In 2019, he completed his Ph.D. program in the Department of Biochemistry at the Institute of Health Sciences. He is currently working at the Department of Biochemistry, Kafkas University. He has 27 published research articles in academic journals, 11 book chapters, and 37 papers. He took part in 10 academic projects. He served as a reviewer for many articles. He still serves as a member of the review board in many academic journals. He is currently working on the protective activity of phenolic compounds in disorders associated with oxidative stress and inflammation.",institutionString:null,institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"178366",title:"Dr.",name:"Volkan",middleName:null,surname:"Gelen",slug:"volkan-gelen",fullName:"Volkan Gelen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/178366/images/system/178366.jpg",biography:"Volkan Gelen is a Physiology specialist who received his veterinary degree from Kafkas University in 2011. Between 2011-2015, he worked as an assistant at Atatürk University, Faculty of Veterinary Medicine, Department of Physiology. In 2016, he joined Kafkas University, Faculty of Veterinary Medicine, Department of Physiology as an assistant professor. Dr. Gelen has been engaged in various academic activities at Kafkas University since 2016. There he completed 5 projects and has 3 ongoing projects. He has 60 articles published in scientific journals and 20 poster presentations in scientific congresses. His research interests include physiology, endocrine system, cancer, diabetes, cardiovascular system diseases, and isolated organ bath system studies.",institutionString:"Kafkas University",institution:{name:"Kafkas University",country:{name:"Turkey"}}},{id:"418963",title:"Dr.",name:"Augustine Ododo",middleName:"Augustine",surname:"Osagie",slug:"augustine-ododo-osagie",fullName:"Augustine Ododo Osagie",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/418963/images/16900_n.jpg",biography:"Born into the family of Osagie, a prince of the Benin Kingdom. I am currently an academic in the Department of Medical Biochemistry, University of Benin. Part of the duties are to teach undergraduate students and conduct academic research.",institutionString:null,institution:{name:"University of Benin",country:{name:"Nigeria"}}},{id:"192992",title:"Prof.",name:"Shagufta",middleName:null,surname:"Perveen",slug:"shagufta-perveen",fullName:"Shagufta Perveen",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/192992/images/system/192992.png",biography:"Prof. Shagufta Perveen is a Distinguish Professor in the Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia. Dr. Perveen has acted as the principal investigator of major research projects funded by the research unit of King Saud University. She has more than ninety original research papers in peer-reviewed journals of international repute to her credit. She is a fellow member of the Royal Society of Chemistry UK and the American Chemical Society of the United States.",institutionString:"King Saud University",institution:{name:"King Saud University",country:{name:"Saudi Arabia"}}},{id:"49848",title:"Dr.",name:"Wen-Long",middleName:null,surname:"Hu",slug:"wen-long-hu",fullName:"Wen-Long Hu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49848/images/system/49848.jpg",biography:"Wen-Long Hu is Chief of the Division of Acupuncture, Department of Chinese Medicine at Kaohsiung Chang Gung Memorial Hospital, as well as an adjunct associate professor at Fooyin University and Kaohsiung Medical University. Wen-Long is President of Taiwan Traditional Chinese Medicine Medical Association. He has 28 years of experience in clinical practice in laser acupuncture therapy and 34 years in acupuncture. He is an invited speaker for lectures and workshops in laser acupuncture at many symposiums held by medical associations. He owns the patent for herbal preparation and producing, and for the supercritical fluid-treated needle. Dr. Hu has published three books, 12 book chapters, and more than 30 papers in reputed journals, besides serving as an editorial board member of repute.",institutionString:"Kaohsiung Chang Gung Memorial Hospital",institution:{name:"Kaohsiung Chang Gung Memorial Hospital",country:{name:"Taiwan"}}},{id:"298472",title:"Prof.",name:"Andrey V.",middleName:null,surname:"Grechko",slug:"andrey-v.-grechko",fullName:"Andrey V. Grechko",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/298472/images/system/298472.png",biography:"Andrey Vyacheslavovich Grechko, Ph.D., Professor, is a Corresponding Member of the Russian Academy of Sciences. He graduated from the Semashko Moscow Medical Institute (Semashko National Research Institute of Public Health) with a degree in Medicine (1998), the Clinical Department of Dermatovenerology (2000), and received a second higher education in Psychology (2009). Professor A.V. Grechko held the position of Сhief Physician of the Central Clinical Hospital in Moscow. He worked as a professor at the faculty and was engaged in scientific research at the Medical University. Starting in 2013, he has been the initiator of the creation of the Federal Scientific and Clinical Center for Intensive Care and Rehabilitology, Moscow, Russian Federation, where he also serves as Director since 2015. He has many years of experience in research and teaching in various fields of medicine, is an author/co-author of more than 200 scientific publications, 13 patents, 15 medical books/chapters, including Chapter in Book «Metabolomics», IntechOpen, 2020 «Metabolomic Discovery of Microbiota Dysfunction as the Cause of Pathology».",institutionString:"Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology",institution:null},{id:"199461",title:"Prof.",name:"Natalia V.",middleName:null,surname:"Beloborodova",slug:"natalia-v.-beloborodova",fullName:"Natalia V. Beloborodova",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/199461/images/system/199461.jpg",biography:'Natalia Vladimirovna Beloborodova was educated at the Pirogov Russian National Research Medical University, with a degree in pediatrics in 1980, a Ph.D. in 1987, and a specialization in Clinical Microbiology from First Moscow State Medical University in 2004. She has been a Professor since 1996. Currently, she is the Head of the Laboratory of Metabolism, a division of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russian Federation. N.V. Beloborodova has many years of clinical experience in the field of intensive care and surgery. She studies infectious complications and sepsis. She initiated a series of interdisciplinary clinical and experimental studies based on the concept of integrating human metabolism and its microbiota. Her scientific achievements are widely known: she is the recipient of the Marie E. Coates Award \\"Best lecturer-scientist\\" Gustafsson Fund, Karolinska Institutes, Stockholm, Sweden, and the International Sepsis Forum Award, Pasteur Institute, Paris, France (2014), etc. Professor N.V. 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Assistant Coordinator of the Higher Course in Aesthetic and Cosmetic Technology at Universidade Paulista Campus Chácara Santo Antônio. Experience in the Pharmacy area, with emphasis on Pharmacotechnics, Pharmaceutical Technology, Research and Development of Cosmetics, acting mainly on topics such as cosmetology, antioxidant activity, aesthetics, photoprotection, cyclodextrin and thermal analysis.",institutionString:null,institution:{name:"University of Sao Paulo",country:{name:"Brazil"}}},{id:"334285",title:"Ph.D. Student",name:"Sameer",middleName:"Kumar",surname:"Jagirdar",slug:"sameer-jagirdar",fullName:"Sameer Jagirdar",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/334285/images/14691_n.jpg",biography:"I\\'m a graduate student at the center for biosystems science and engineering at the Indian Institute of Science, Bangalore, India. 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