ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS HALAL
PHARMACEUTICALS IN TUANKU MIZAN ARMED FORCES HOSPITAL
Lt Nurhazirah Bt Zulkefli
Pharmacist, Ministry of Defence
HALAL PHARMACEUTICAL FORUM, PULLMAN BANGSAR HOTEL, 29 Sept 2018
Knowledge, Attitude, and Practice Studies Related to Halal Pharmaceuticals
No. Study Title Bibliography PopulationEnrolment
PeriodNo. of
Respondent
1KAP Regarding Halal Pharmaceuticals among General Publics in Malaysia
Saleeha S. et alGeneral Public of Penang State
Sept – Oct 2012
458
2Assessment of KAP among hospital pharmacists regarding Halal Pharmaceuticals
Saleeha S. and Azmi S.
Hospital Pharmacists, Government Setting
Jan - Mar 2013
135
3KAP among doctors working in hospitals, regarding halal pharmaceuticals; A cross sectional Assessment
Saleeha S. et alHospital Doctors, Government Setting
Jan – Feb2013
243
4KAP regarding Halal Pharmaceuticals, among academicians in various universities of Malaysia
Saleeha S. et al
Academicians, Pharmacy, Medical, Dental Schools, Private and Public Universities
Nov - Dec 2012
170
5Knowledge, Attitude and Practice towards Halal Vaccine products among public in Klang district
Umi SafinazMahmud
Public in Klang District
Oct - Nov 2015
389
6Knowledge, Attitude and Practice towards Halal Pharmaceuticals among patients in HATTM
Nur Hidayah AbdRahim
Patients in HATTMApr - May
2016390
What is Knowledge, Attitude & Practice (KAP) study
▪ Knowledge means patients awareness and understanding about what halal and haram
medicine is.
▪ Attitude can be defined as patients perspectives and opinions on Halal medicine
▪ Practice refers to the ways in which they demonstrate their knowledge and attitude
Public,
Penang
Public, Klang Patients
HATTM
Hospital
Pharmacists
Hospital
Doctors
Academicians
5.5
25.2
14.44.5 6
0.6
94.5
74.8
85.695.5 94
99.4
Percentage of Knowledge towards
Halal Pharmaceuticals
Poor Good
Public,
Penang
Public, Klang Patients
HATTM
Hospital
Pharmacists
Hospital
Doctors
Academicians
1
38.6
0.5 4 2
12
99
61.4
99.5 96 98
88
Percentage of Attitudes towards
Halal PharmaceuticalsNegative Positive
Public,
Penang
Public, Klang Patients
HATTM
Hospital
Pharmacists
Hospital
Doctors
Academicians
5
47.3
67.7
1 1 0
95
52.7
32.3
99 99 100
Percentage of Perception/Practice
towards Halal Pharmaceuticals
Poor Good
Practice
on HP
IDENTIFYING HALAL AND NON-HALAL MEDICATIONS
1. Halalkah Ubat Anda, Abd Rahman ▪ Published by Crescent News, 2012
▪ Author: Abd Rahman Baco, B. Pharm (IIUM)
▪ 14 chapters explaining the contents of the suspected drug; gelatin, alcohol, pig enzymes.
▪ Included the list of medicines banned by the National Fatwa Council and the Indonesian Ulama Council.
▪ Explains the opinions of the latest scholars and fatwa issued by local religious figures
References - Books
References - Books2. Halal Index: Pig Based Pharmaceuticals. Volume 1 (2011)• Author: Prof. Dr. Zhari Ismail, Professor in Pharmaceutical Chemistry,
USM. Chairman for drafting the MS2424 (Malaysian Standards for Halal Pharmaceutical Guidelines
• Main information derived from the Halal Pharmacopeiea Project which involves analyzing and classifying pharmaceuticals into halal categories from current pharmacopeias (BP, USP, EP, ChP, and JP) to establish a comprehensive halal pharmaceutical database.
• Identified 52 porcine based ingredients with their specific anatomy.
3. Ubat Daripada Sumber Babi dan PilihanAlternatif (2010)▪ Published by Halal Science Solution, 2010
▪ Author: Abd Rahman Baco, B. Pharm (IIUM)
▪ Information derived from authors experiences, newspapers, websites
▪ Identified 92 porcine based ingredients.
Halal Pharmaceutics and Development of Halal FORSIHAT
▪ Background: Concerning the issues of halal/haram/syubhah that might belisted in the “Formulari Ubat – Ubatan Perkhidmatan Kesihatan AngkatanTentera Malaysia (FORSIHAT)”.
▪ Purpose: To determine pig derived pharmaceutical compounds available inFORSIHAT.
▪ Methods: The API listed in the formulary were cross referenced with fivesources of halal/haram databases:
▪ Halal Index
▪ Ubat Daripada Sumber Babi dan Pilihan Alternatif
▪ University Malaya Medical Centre (UMMC) Formulary
▪ Halal/Haram Book (in progress by Prof Noorizan A. Aziz, UITM)
▪ Assessment of Halal Medicines in HAT Tuanku Mizan from CUCMS studies.
▪ The analysis then categorized into RED, GREY, GREEN lists
1. Halal FORSIHAT Apps• 7 items are red list• 75 Items are grey list
References - Apps
Bil Generic name Brand name Source
1. GASTROINTESTINAL & HEPATOBILIARY SYSTEM
1 Loperamide Imodium Gelatine (bone, connective tissue, organs)
2Pancreatic Enzymes & Vitamins
Enzyplex Pancrease of the hog, ox
3 Pancreatin Creon 10,000 Pancrease of the hog, ox
2. CARDIOVASCULAR & HEMATOPOITIC SYSTEM
4 Enoxaparin Sodium Clexane Porcine (intestinal mucosa)
5 Nadroparin Calcium Fraxiparine Porcine (intestinal mucosa)
6 Tinzaparin Innohep 10,000 iu Enzyme from porcine mucosal heparin
3. HORMONES
7Recombinant Human Somatropin
Genotropin Porcine (anterior pituitary gland)
RED LIST
Purchased 2016:64 bot of 100’s (RM10,752.00)
Purchased 2016:40mg/0.4ml – 292 box of 2’s (RM11,586.56)60mg/0.6ml – 305 box (RM14,823.00)
GREY LIST
19
15
12
9
53 3 2 2 1 1 1 1 1
Grey List by Pharmacological Group
bilangan item (n = 75)
GREY LISTPharmacology Source of Ingredient
Allergy & Immune System – Antivenoms Animal non-porcine
Cardiovascular - Recombinant
Coagulation Factor VIIA (Novoseven)Human venous plasma
Endocrine & Metabolic System –
ThyroxineSynthetic, Animal non-porcine
Oncology – Bevacizumab Chinese hamster ovary
Contraceptive Agents -
Levonorgesterel/Ethinylestradiol (Loette)Synthetic, Animal non-porcine
Genitourinary System - Chorionic
Gonadotrophin Human
Human gonadotropins, Chinese
hamster ovary
Antiinfectives - Peginterferon Alpha 2-ArDNA technology of cloned human
leucocyte
Respiratory – Beractant Bovine
Eye - Ranibizumab (Lucentis) Animal non-porcine
IV & Other Sterile Solution -
Human Albumin
Fraction of human blood/plasma
serum/placenta
References - Apps2. UMMC On-line Formulary
• 119 items are of animal origins
• Only 6 are porcine based
References - Apps
3. MyJAKIM apps• Useful info for the public to ascertain
halal status• Just type brand name• ie. Uphamol (acetominophen
/paracetamol) by CCM
References - Apps
e-Fatwa
www.e-fatwa.gov.my/admin/
The Use of Ethanol and Issues
▪ Highly advisable to follow the limit of 0.5% alcohol based on similarity of functionin both food and pharmaceuticals.
▪ The use of ethanol in pharmaceutical syrup and suspension dosage form shouldnot be allowed due to two ethical issues:
▪ Syrup or suspension dosage form is usually formulated for infants/children.Hence, the percentage allowed should be minimal.
▪ It is for consumption and can be misused regardless of its ability to intoxicateor not
Muzakarah Khas
JK Fatwa Majlis
Kebangsaan Bagi
Hal Ehwal Ugama
Islam pada:
14 – 16 Julai 2011
Source: Kausar Ahmad, Manufacturing of Halal Pharmaceuticals, 2015
Take Home Message
▪ We need more R&D in Halal Pharmaceutical
▪ Good knowledge and attitude will lead to patients having good
practice in finding halal alternatives.
▪ Educate, educate, educate patients that they have an
informed right to have halal alternatives medicine