Search results for: Gulnaz Erkomaishvili

Authors: Gulnaz Erkomaishvili, Eteri Kharaishvili, Marina Chavleishvili

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The paper discusses the economic policy of increasing national competitiveness, the tools, and means which help the country to improve its competitiveness. The sectors of the economy, in which the country can achieve a competitive advantage, are studied. It is noted that the country’s economic policy plays an important role in obtaining and maintaining a competitive advantage - authority should take measures to ensure a high level of education; scientific and research activities should be funded by the state; foreign direct investments should be attracted mainly in science-intensive industries; adaptation with the latest scientific achievements of the modern world and deepening of scientific and technical cooperation. Stable business environment and export-oriented strategy is the basis for the country’s economic growth. The studies have shown that institutional reforms in Georgia are not enough to significantly improve the country's competitiveness.

Keywords: competitiveness, economic policy, competitiveness improvement strategy, competitiveness of Georgia

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Authors: Gulnaz Erkomaishvili

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The paper discusses mineral water consumer market and development policy in Georgia, the tools and measures, which will contribute to the production of mineral waters and increase its export. The paper studies and analyses current situation in mineral water production sector as well as the factors affecting increase and reduction of its export. It’s noted that in order to gain and maintain competitive advantage, it’s necessary to provide continuous supply of high-quality goods with modern design, open new distribution channels to enter new markets, carry out broad promotional activities, organize e-commerce. Economic policy plays an important role in protecting markets from counterfeit goods. The state also plays an important role in attracting foreign direct investments. Stable business environment and export-oriented strategy is the basis for the country’s economic growth. Based on the research, the paper suggests the strategy for improving the competitiveness of Georgian mineral waters, relevant conclusions and recommendations are provided.

Keywords: mineral waters, consumer market for mineral waters, export of mineral waters, mineral water development policy in Georgia

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Authors: Gulnaz Erkomaishvili

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Introduction: There are some of the biggest technological shifts happening in the modern world. The introduction of digital technologies, information, and communication services has given rise to unprecedented global socio-political and economic changes. The role of digital technologies in increasing productivity and national competitiveness is increasing. Today, it is used in almost every area of the economy. E-commerce, organizational process in computerized management, and digital infrastructure's pace of growth is remarkably high and is a key instrument of economic development. Methodology: Different research methods are applied in the presented paper; statistical, analysis, synthesis, induction, deduction, comparison ones. Works by local and foreign scientists, Ministry of Economy and Sustainable Development, as well as various organizations' studies and reports were used as a theoretical basis for research and variety of laws, government decrees and orders, and the publications of the National Statistics Office of Georgia were used as an informational basis. Conclusions: The paper deals with the processes and challenges in Georgia in the digital economy. Access to current resources in Georgia and current processes are described. Digital technology for the development of the required environmental conditions is described, how the Internet and communications are available for the population in the regions of Georgia. The pros and cons of the digital economy development and its impact on the country's economy are analyzed. The main difficulties of implementation of the digital economy in Georgia, government involvement, and future action plans are presented.

Keywords: digital economy, digital technologies, internet, communications, economic policy

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Authors: Gulnaz Erkomaishvili

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Introduction: The pandemic and the current economic crisis have created problems for entrepreneurship and, therefore for start-up entrepreneurs. The paper presents the challenges of start-up entrepreneurs in Georgia in the time of pandemic and the analysis of the state economic policy measures. Despite many problems, the study found that in 54.2% of start-ups surveyed under the pandemic, innovation opportunities were growing. It can be stated that the pandemic was a good opportunity to increase the innovative capacity of the enterprise. 52% of the surveyed start-up entrepreneurs managed to adapt to the current situation and increase the sale of their products/services through remote channels. As for the assessment of state support measures by start-up entrepreneurs, a large number of Georgian start-ups do not assess the measures implemented by the state positively. Methodology: The research process uses methods of analysis and synthesis, quantitative and qualitative, interview/survey, grouping, relative and average values, graphing, comparison, data analysis, and others. Main Findings: Studies have shown that for the start-up entrepreneurs, the main problem remains: inaccessible funding, workers' qualifications gap, inflation, taxes, regulation, political instability, inadequate provision of infrastructure, amount of taxes, and other factors. Conclusions: The state should take the following measures to support business start-ups: create an attractive environment for investment, availability of soft loans, creation of an insurance system, infrastructure development, increase the effectiveness of tax policy (simplicity of the tax system, clarity, optimal tax level ); promote export growth (develop strategy for opening up international markets, build up a broad marketing network, etc.).

Keywords: start-up entrepreneurs, startups, start-up entrepreneurs support programs, start-up entrepreneurs support economic policy

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Authors: Gulnaz Erkomaishvili

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Introduction. One of the most important issues of state economic policy in the 21st century is the problem of environmental protection. The Georgian government considers the green economy as one of the most important means of sustainable economic development and takes the initiative to implement voluntary measures to promote sustainable development. In this context, it is important to promote the development of ecosystem services, clean production, environmental education and green jobs.The development of the green economy significantly reduces the inefficient use of natural resources, waste generation, emissions into the atmosphere and the discharge of untreated water into bodies of water.It is, therefore, an important instrument in the environmental orientation of sustainable development. Objectives.The aim of the paper is to analyze the current status of the green economy in Georgia and identify effective ways to improve the environmental, economic policy of sustainable development. Methodologies: This paper uses general and specific methods, in particular, analysis, synthesis, induction, deduction, scientific abstraction, comparative and statistical methods, as well as experts’ evaluation. bibliographic research of scientific works and reports of organizations was conducted; Publications of the National Statistics Office of Georgia are used to determine the regularity between analytical and statistical estimations. Also, theoretical and applied research of international organizations and scientist-economists are used. Contributions: The country should implement such an economic policy that ensures the transition to a green economy, in particular, revising water, air and waste laws, strengthening existing environmental management tools and introcing new tools (including economic tools). Perfecting the regulatory legal framework of the environmental impact assessment system, which includes the harmonization of Georgian legislation with the requirements of the European Union. To ensure the protection and rational use of Georgia's forests, emphasis should be placed on sustainable forestry, protection and restoration of forests.

Keywords: green economy, environmental protection, environmental protection economic policy, environmental protection policy challanges

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Authors: Gulnaz Erkomaishvili

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The article analyzes the modern level of industrial production in Georgia, shows the export-import of industrial products and evaluates the results of the activities of institutions implementing industrial policy. The research showed us that the level of development of industry in the country and its export potential are quite low. The article concludes that in the modern phase of industrial development, the country should choose a model focused on technological development and maximum growth of export potential. Objectives. The aim of the research is to develop an economic policy that promotes the development of industry and to look for ways to implement it effectively. Methodologies This paper uses general and specific methods, in particular, analysis, synthesis, induction, deduction, scientific abstraction, comparative and statistical methods, as well as experts’ evaluation. In-depth interviews with experts were conducted to determine quantitative and qualitative indicators; Publications of the National Statistics Office of Georgia are used to determine the regularity between analytical and statistical estimations. Also, theoretical and applied research of international organizations and scientist-economists are used. Contributions Based on the identified challenges in the area of industry, recommendations for the implementation of an active industrial policy in short and long term periods were developed. In particular: the government's priority orientation of industrial development; paying special attention to the processing industry sectors that Georgia has the potential to produce; supporting the development of scientific fields; Determination of certain benefits for those investors who invest money in industrial production; State partnership with the private sector, manifested in the fight against bureaucracy, corruption and crime, creating favorable business conditions for entrepreneurs; Coordination between education - science - production should be implemented in the country. Much attention should be paid to basic scientific research, which does not require purely commercial returns in the short term, science should become a real productive force; Special importance should be given to the creation of an environment that will support the expansion of export-oriented production; Overcoming barriers to entry into export markets.

Keywords: industry, sectoral structure of industry, exsport-import of industrial products, industrial policy

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Authors: Gulnaz Erkomaishvili

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Introduction: The paper assesses the impact of the COVID-19 pandemic on the activities of small and medium-sized enterprises in Georgia, identifies their problems, and analyzes the state economic policy measures. During the pandemic, entrepreneurs named the imposition of restrictions, access to financial resources, shortage of qualified personnel, high tax rates, unhealthy competition in the market, etc. as the main challenges. The Georgian government has had to take special measures to mitigate the crisis impact caused by the pandemic. For example - in 2020, they mobilized more than 1,6 billion Gel for various eventsto support entrepreneurs. Small and medium-sized entrepreneurship development strategy is presented based on the research; Corresponding conclusions are made, and recommendations are developed. Objectives: The object of research is small and medium-sized enterprises and economic-political decisions aimed at their promotion.Methodology: This paper uses general and specific methods, in particular, analysis, synthesis, induction, deduction, scientific abstraction, comparative and statistical methods, as well as experts’ evaluation. In-depth interviews with experts were conducted to determine quantitative and qualitative indicators; Publications of the National Statistics Office of Georgia are used to determine the regularity between analytical and statistical estimations. Also, theoretical and applied research of international organizations and scientist-economists are used. Contributions: The COVID-19pandemic has had a significant impact on small and medium-sized enterprises. For them, Lockdown is a major challenge. Total sales volume decreased. At the same time, the innovative capabilities of enterprises and the volume of sales in remote channels have increased. As for the assessment of state support measures by small and medium-sizedentrepreneurs, despite the existence of support programs, a large number of entrepreneurs still do not evaluate the measures taken by the state positively. Among the desirable measures to be taken by the state, which would improve the activities of small and medium-sized entrepreneurs, who negatively or largely negatively assessed the activity of the state, named: tax incentives/exemption from certain taxes at the initial stage; Need for periodic trainings/organization of digital technologies, marketing training courses to improve the qualification of employees; Logic and adequacy of criteria when awarding grants and funding; Facilitating the finding of investors; Less bureaucracy, etc.

Keywords: small and medium enterprises, small and medium entrepreneurship, economic policy for small and medium entrepreneurship development, government regulations in Georgia, COVID-19 pandemic

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Authors: Sait Ozsoy, Asude Gokmen, Mehtap Yondem, Hanife A. Alkan, Gulnaz T. Javan

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Deep neck infection often develops due to upper respiratory tract and odontogenic infections. Gastrointestinal System perforation can occur for many reasons and is in need of the early diagnosis and prompt surgical treatment. In both cases late or incorrect diagnosis may lead to increase morbidity and high mortality. A patient with a diagnosis of deep neck abscess died while under treatment due to sepsis and multiple organ failure. Autopsy finding showed duodenal ulcer and this is reported in the literature.

Keywords: peptic ulcer perforation, peritonitis, retropharyngeal abscess, sepsis

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Authors: G. Erkomaishvili

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This paper discusses small entrepreneurship development strategy in Georgia and the tools and regulations that will encourage development of small entrepreneurship. The current situation in the small entrepreneurship sector, as well as factors affecting growth and decline in the sector and the priorities of state support, are studied and analyzed. The objective of this research is to assess the current situation of the sector to highlight opportunities and reveal the gaps. State support of small entrepreneurship should become a key priority in the country’s economic policy, as development of the sector will ensure social, economic and political stability. Based on the research, a small entrepreneurship development strategy is presented; corresponding conclusions are made and recommendations are developed.

Keywords: economic policy for small entrepreneurship development, small entrepreneurship, regulations, small entrepreneurship development strategy

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Authors: G. Erkomaishvili

Abstract:

The paper discusses economic policy of Georgia aiming to increase national competitiveness as well as the tools and means which will help to improve the competitiveness of the country. The sectors of the economy, in which the country can achieve the competitive advantage, are studied. It is noted that the country’s economic policy plays an important role in obtaining and maintaining the competitive advantage - authority should take measures to ensure high level of education; scientific and research activities should be funded by the state; foreign direct investments should be attracted mainly in science-intensive industries; adaptation with the latest scientific achievements of the modern world and deepening of scientific and technical cooperation. Stable business environment and export oriented strategy is the basis for the country’s economic growth. As the outcome of the research, the paper suggests the strategy for improving competitiveness in Georgia; recommendations are provided based on relevant conclusions.

Keywords: competitive advantage, competitiveness, competitiveness improvement strategy, competitiveness of Georgia

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Authors: G. Erkomaishvili, E. Kharaishvili, M. Chavleishvili, N. Sagareishvili

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This paper discusses the current condition of tourism and its economic policy in Georgia. It analyzes and studies wellness tourism, as one of the directions of tourism; the newest niche in the wellness industry – triggering wellness resorts with medical ideology. The paper discusses the development tendencies of medical wellness resorts in Georgia and its main economic preferences. The main finding of the research is that Georgia is a unique place in the world according to the variety of medical recourses. This makes the opportunity to create and successfully operate medical wellness resorts, as well as develop it as a brand for Georgia in the world. The research represents the development strategies of tourism and its medical wellness resorts in Georgia, and offers recommendations based on the relevant conclusions.

Keywords: tourism, economic policy of tourism, wellness industry, medical wellness resorts

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Authors: E. Kharaishvili, G. Erkomaishvili, M. Chavleishvili

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The importance of agribusiness development is proved in accordance with the trends in the agricultural sector of Georgia. Agribusiness environment and the consequences of the agricultural reforms are evaluated. The factors hindering the development of agribusiness are revealed and the ways for overcoming these problems are suggested. SWOT analysis is done in order to identify the needs of agribusiness. The needs of agribusiness development in Georgia are evaluated by priorities: prevention of diseases and reduction of the harm caused by these diseases, accessibility of long-term agricultural loans with low interest rates, improving qualification of farmers, the level of education and usage of modern technologies, changes in legislation, accessibility to high quality agricultural machinery, and the development of infrastructure. Based on the outcomes of the research, agribusiness development strategies in Georgia are suggested and appropriate priorities of economic policy are determined. Conclusions are made and based on these conclusions, some recommendations are suggested.

Keywords: agribusiness development, agribusiness strategy, agribusiness in Georgia

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Authors: G. Erkomaishvili, R. Gvelesiani, E. Kharaishvili, M. Chavleishvili

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The topic reviews the situation existing currently in Georgia in the field of tourism in conditions of globalization: Touristic resources, the paces of development of the tourism infrastructure, tourism policy, possibilities of development of the Wellness industry in Georgia that is the newest direction of the medical tourism. The factors impeding the development of the industry of tourism, namely-existence of the conflict zones, high rates of the bank credits, deficiencies associated with the tax laws, a level of infrastructural development, quality of services, deficit in the competitive staff, increase of prices in the peak seasons, insufficient promotion of the touristic opportunities of Georgia on the international markets are studied and analyzed. Besides, the levels of development of tourism in Georgia according to the World Economic Forum, aspects of cooperation with the European Union etc. are reviewed. As a result of these studies, a strategy of development of tourism and one of its directions-Wellness industries in Georgia is introduced with the relevant conclusions, on which basis the recommendations are provided.

Keywords: about tourism, tourism policy, wellness industry, business, innovation, technology

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Authors: M. Chavleishvili, E. Kharaishvili, G. Erkomaishvili

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The article presents the development trends of farms, estimates on the optimal scope of farming, as well as the experience of local and foreign countries in this area. As well, the advantages of small and large farms are discussed; herewith, the scales of farms are compared to the local reality. The study analyzes the results of farm operations and the possibilities of diversification of farms. The indicators of an effective use of land resources and land fragmentation are measured; also, a comparative analysis with other countries is presented, in particular, the measurements of agricultural lands for farming, as well as the indicators of population ensuring. The conducted research shows that most of the farms in Georgia are small and their development is at the initial stage, which outlines that the country has a high resource potential to increase the scale of the farming industry and its full integration into market relations. On the basis of the obtained results, according to the research on the scale of farming in Georgia and the identification of hampering factors of farming development, the conclusions are presented and the relevant recommendations are suggested.

Keywords: farm cooperatives.farms, farm scale, land fragmentation, small and large farms

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Authors: G. Erkomaishvili, M. Kobalava, T. Lazariashvili, M. Saghareishvili

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The article discusses the consumer market of agricultural products and agricultural policy in Georgia. It is noted that development of the strategic areas of the agricultural sector needs a special support. These strategic areas should create the country's major export potential. It is important to develop strategies to access to the international markets, form extensive marketing network etc., which will become the basis for the promotion and revenue growth of the country. The Georgian agricultural sector, with the right state policy and support, can achieve success and gain access to the world market with competitive agricultural products. The paper discusses the current condition of agriculture, export and import of agricultural products and agricultural policy in Georgia. The conducted research concludes the information that there is an increasing demand on the green goods in the world market. Natural and climatic conditions of Georgia give a serious possibility of implementing it. The research presents an agricultural development strategy in Georgia and the findings and based on them recommendations are proposed.

Keywords: agriculture, export-import of agricultural products, agricultural cooperative society, agricultural policy, agricultural insurance

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Authors: E. Kharaishvili, G. Erkomaishvili, M. Chavleishvili

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The paper evaluates the natural and resource potential of agriculture, a traditional sector for Georgia. It is concluded that despite favorable conditions the rate of development of the sector is lower compared to other sectors of the economy, self-sufficiency rate for locally produced agricultural products is low; on average, import of food is 4 times higher compared to export, and the country faces considerable challenges in this regard. Tendencies of self-sufficiency rates are studied, and it is concluded that the indicators of export and import of agro-food products increase in accordance with the tendency of increasing production in agricultural sector. The paper substantiates stimulating impact of international trade on agricultural development. Two alternative strategies are assessed in this respect: 1) export stimulation, and 2) import replacement strategies. It is concluded that significant tendencies are observed in agro-food sector of Georgia; in particular, productivity is low; import volume significantly exceeds the export volume. It is considered that the growth of export will allow Georgia to overcome limited opportunities of local market and encourage increasing competitiveness. Various tools of economic policy are suggested for achieving these goals; in particular to subsidize export, optimize trade barriers, manage exchange rates effectively, offer special financial services, provide insurance for export, etc.

Keywords: agro-food sector, trend of production, export stimulation, economic policy

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Authors: Zhazira Shemsheyeva, Zhanara Suleimenova, Olga Shemshura, Gulnaz Mombekova, Zhanar Rakhmetova

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Bacteria that colonize plant roots and promote plant growth are referred to as plant growth-promoting rhizobacteria (PGPR). They not only provide nutrients to the plants (direct plant growth promotion) and protect plants against the phytopathogens (indirect plant growth promotion) but also increase the soil fertility. Indirectly PGPRs improve the plant growth by becoming a biocontrol agent for a fungal pathogen. The antifungal activities of the PGPrhizobacteria were assayed against different species of phytopathogenic fungi such as Fusarium tricinctum, Fusarium oxysporum, Sclerotiniasclerotiorum, and Botrytis cinerea. Pseudomonas putidaSM-1, Azotobacter sp., and Bacillus thuringiensis AKS/16 strains have been used in experimental tests on growth inhibition of phytopathogenic fungi infecting Kidney beans. Agar well diffusion method was used in this study. Diameters of the zones of inhibition were measured in millimeters. It was found that Bacillus thuringiensis AKS/16 strain showed the lowest antifungal activity against all fungal pathogens tested. Zones of inhibition were 15-18 mm. In contrast, Pseudomonas putida SM-1 exhibited good antifungal activity against Fusarium oxysporum and Fusarium tricinctum by producing 29-30 mm clear zones of inhibition. The moderate inhibitory effect was shown by Azotobacter sp. against all fungal pathogens tested with zones of inhibition from24 to 26 mm. In summary, Pseudomonas putida SM-1 strain demonstrated the potential of controlling root rot diseases in kidney beans.

Keywords: PGPR, pseudomonas putida, kindey beans, antifungal activity

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Authors: G. Erkomaishvili, M. Kobalava, T. Lazariashvili, N. Damenia

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Current state of foreign direct investment (FDI) in Georgia is analyzed and evaluated in the paper, the existing legislative background for regulating investments and stimulating policies to attract investments are shown. It is noted that in developing countries encouragement of investment activity, support and implementation are of the most important tasks, implying a consistent investment policy, investor-friendly tax regime and the legal system, reducing administrative barriers and restrictions, fare competitive conditions and business development infrastructure. The work deals with the determining factor of FDIs and the main directions of stimulation, as well as prospective industries where new investments are needed. Contributing and hindering factors and stimulating measures are analyzed. As a result of the research, the direct and indirect factors attracting FDI have been identified. Facilitating factors to FDI inflow are as follows: simplicity of starting business, geopolitical location, low taxes, access to credit, ease of ownership registration, natural resources, low burden of regulations, low level of corruption and low crime rates. Hindering factors to FDI inflow are as follows: small market, lack of policy for attracting investments, low qualification of the workforce (despite the large number of unemployed people it is difficult to find workers with necessary special skills and qualifications), high interest rates, instability of national currency exchange rate, presence of conflict zones within the country and so forth.

Keywords: foreign direct investment, investor, investment attracting marketing policies, reinvestment

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Authors: Gulnaz Khan, Meha F. Aftab, Munazza Murtaza, Rizwana S. Waraich

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Advanced glycation end products (AGEs) precursor and its abnormal accumulation cause damage to various tissues and organs. AGEs have pathogenic implication in several diseases including diabetes. Existing AGEs inhibitors are not in clinical use, and there is a need for development of novel inhibitors. The present investigation aimed at identifying the novel AGEs inhibitors and assessing their mechanism of action for treating insulin resistance in mice model of diabetes. Novel derivatives of benzylidene of indan-1,3-dione were synthesized. The compounds were selected to study their action mechanism in improving insulin resistance, in vitro, in human hepatocytes and murine adipocytes and then, in vivo, in mice genetic model of diabetes (db/db). Mice were treated with novel derivatives of benzylidene of indane 1,3-dione. AGEs mediated ROS production was measured by dihydroethidium fluorescence assay. AGEs level in the serum of treated mice was observed by ELISA. Gene expression of receptor for AGEs (RAGE), PPAR-gamma, TNF-alpha and GLUT-4 was evaluated by RT-PCR. Glucose uptake was measured by fluorescent method. Microscopy was used to analyze glycogen synthesis in muscle. Among several derivatives of benzylidene of indan-1,3-dione, IDD-24, demonstrated highest inhibition of AGESs. IDD-24 significantly reduced AGEs formation and expression of receptor for advanced glycation end products (RAGE) in fat, liver of db/db mice. Suppression of AGEs mediated ROS production was also observed in hepatocytes and fat cell, after treatment with IDD-24. Glycogen synthesis was increased in muscle tissue of mice treated with IDD-24. In adipocytes, IDD-24 prevented AGEs induced reduced glucose uptake. Mice treated with IDD-24 exhibited increased glucose tolerance, serum adiponectin levels and decreased insulin resistance. The result of present study suggested that IDD-24 can be a possible treatment target to address glycotoxins induced insulin resistance.

Keywords: advance glycation end product, hyperglycemia, indan-1, 3-dione, insulin resistance

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Authors: Kieren Wilson, Gulnaz Majeed

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NHS constitution gives rights to the patient with suspected cancer to be seen by a cancer specialist within 2 weeks of referral. Guys and St Thomas Hospital (GSTT) is one of the largest cancer centres in London. NICE guidelines have provided guidance for health professionals to refer patients appropriately to RAC. In GSTT suspected gynae cancer referrals are mostly by NHS e-Referral Service with some fax, emails as well as paper referrals. The objective of this study was to evaluate compliance with 2-week referral pathway with emphasis on one stop diagnostic service with supporting efficient pathways. A prospective evaluation over 3 months (1 Jan 2017 to 31 Mar 2017) was undertaken. There were 26 clinics, 761 patients were booked in the clinics with a DNA rate of 13% (n=101) hence 606 patients were seen. Majority of referrals were for post menopausal bleeding (PMB) 25% (n=194) followed by cervical, vaginal, vulval reasons 23% (n=179) (abnormal cytology excluded as patients directly referred to colposcopy unit in GSTT), ovarian 7% (n=54) and endometrial 5% (n=41). Women with new or previous established diagnosis of cancer were 24, cervical (n=17), vulva (n=6) and vagina (n=1). Multifocal preinvasive disease vulva (VIN), vagina (VAIN) and cervix (CIN) was confirmed in twenty-six patients 4% (high prevalence in HIV patients). Majority of cervical referrals: PCB (n=14), cervical erosion (n=7), polyps (n=9) and cervical cyst were benign. However, two women with PMB had cervical cancer. Only 2 out of 13 referrals with vaginal concerns had VAIN. One case with non-cervical glandular cytology was confirmed to have endometrial cancer. One stop service based on the diagnostic support of ultrasound, colposcopy and hysteroscopy was achieved in 54% (n=359). Patients were discharged to GP, benign gynaecology, endometriosis, combined vulval/dermatology clinic or gynae oncology. 33% (n=202) required a second visit, 12% (n=70) third visit, 3% (n=19) fourth visit, 1% (n=4) fifth visit and 1% (n=6) sixth visit. Main reasons for follow ups were the unavailability of diagnostic slots, patient choice, need for interpreters, the discussion following gynae MDM review for triage to benign gynae, delay in availability of diagnostic results like histology/MRI/CT. Recommendations following this study are multi disciplinary review of pathways with the availability of additional diagnostic procedure slots to aim for one stop service. Furthermore, establishment of virtual and telephone consultations to reduce follow ups.

Keywords: multifocal disease, post menopausal bleeding, preinvasive disease, rapid access clinic

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Authors: Maureen Kamau, Gulnaz Mohamoud, Adelaide Lusambili, Njeri Nyanja

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Life expectancy has increased over the last century amongst older individuals, and in particular, those 60 years and over. The World Health Organization estimates that the world's population of persons over 60 years will rise to 22 per cent by the year 2050. Ageing is associated with increasing disability, multiple chronic conditions, and an increase in the use of health services. These multiple chronic conditions are managed with polypharmacy. Polypharmacy has numerous adverse effects including non-adherence, poor compliance to the various medications, reduced appetite, and risk of fall. Studies on polypharmacy and ageing are few and poorly understood especially in low and middle - income countries. The aim of this study was to explore the knowledge, attitudes and beliefs of older people towards polypharmacy. A qualitative study of 15 patients aged 60 years and above, taking more than five medications per day were conducted at the Aga Khan University using Semi-structured in-depth interviews. Three interviews were pilot interviews, and data analysis was performed on 12 interviews. Data were analyzed using NVIVO 12 software. A thematic qualitative analysis was carried out guided by Braun and Clarke (2006) framework. Themes identified; - knowledge of their co-morbidities and of the medication that older persons take, sources of information about medicines, and storage of the medication, experiences and attitudes of older patients towards polypharmacy both positive and negative, older peoples beliefs and their coping mechanisms with polypharmacy. The study participants had good knowledge on their multiple co-morbidities, and on the medication they took. The patients had positive attitudes towards medication as it enhanced their health and well-being, and enabled them to perform their activities of daily living. There was a strong belief among older patients that the medications were necessary for their health. All these factors enhanced compliance to the multiple medication. However, some older patients had negative attitudes due to the pill burden, side effects of the medication, and stigma associated with being ill. Cost of healthcare was a concern, with most of the patients interviewed relying on insurance to cover the cost of their medication. Older patients had accepted that the medication they were prescribed were necessary for their health, as it enabled them to complete their activities of daily living. Some concerns about the side effects of the medication arose, and brought about the need for patient education that would ensure that the patients are aware of the medications they take, and potential side effects. The effect that the COVID 19 pandemic had in the healthcare of the older patients was evident by the number of the older patients avoided coming to the hospital during the period of the pandemic. The relationship with the primary care physician and the older patients is an important one, especially in LMICs such as Kenya, as many of the older patients trusted the doctors wholeheartedly to make the best decision about their health and about their medication. Prescription review is important to avoid the use of potentially inappropriate medication.

Keywords: polypharmacy, older patients, multiple chronic conditions, Kenya, Africa, qualitative study, indepth interviews, primary care

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