Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: a cross sectional study

Evaluation of Rational Medicines Use Based on World Health Organization Core Indicators: A Cross-Sectional Study in Five Health Districts in Mauritania

Introduction

The rational use of medicines is essential for preventing adverse medicine reactions, achieving therapeutic outcomes, and optimizing treatment costs. While the irrational use of medicines is frequently reported in sub-Saharan Africa, to the best of our knowledge no formal studies have taken place in Mauritania thus far. The main objective of this study was therefore to analyze the rational use of medicines in public and private not-for-profit health facilities, in five health districts in Mauritania.

Methods

We conducted a cross-sectional study to assess the rational use of medicines. We used the standard indicators derived from the methodologies of the World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD). Data were prospectively collected from 1050 prescriptions/patients, in thirty-one public and private not-for-profit health posts/centers in 5 health districts. The data were analyzed using the Statistical Package for the Social Sciences. P value less than 0.05 at 95% confidence interval considered for significance of relationships for associations in statistical test.

Results

The average number of medicines per prescription was 2.21; 83.1% (1931/2325) of medicines were prescribed by generic name, but only 54% (1253/2325) were on the National Essential Medicine List (NEML). Antibiotics were prescribed in 62.4% (655/1050) of the consultations, and injectable medicines were prescribed in 15.6% (164/1050) of the consultations. The average consultation time was 16.32 minutes, and the average dispensing time was 97 seconds. Dispensed medicines were correctly labeled, and 83% (871/1050) of patients met the correct administration schedule. The NEML, and the "restricted NEML" for 76 commonly-used medicines, were available in all surveyed health facilities, but the National Therapeutic Guidelines were available in only 60.26% of them.

Conclusion

Our findings indicate a possible excess of antibiotics prescriptions, and a likely lack of knowledge of the National Therapeutic Guidelines. There is a need to investigate in more detail the prescription patterns versus disease-specific therapeutic guidelines, and to qualitatively investigate the factors that contribute to the observed irrational prescribing. Moreover, training local staff in the rational use of medicines seems important.

A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial

BACKGROUND

Irrational medicine use is a global problem that may potentiate antimicrobial resistance.

AIM

This study aims to assess prescribing practices and the effect of a prescription audit and feedback coupled with small-group education intervention on prescribing indicators.

SETTING

The study was conducted in public-sector healthcare facilities in Eswatini.

METHODS

A cluster quasi-randomised controlled study was conducted from 2016 to 2019 using the World Health Organization/ International Network for Rational Use of Drugs (WHO/INRUD) prescribing indicators at baseline, post-intervention and post-follow-up. A 6-month unblinded intervention was tested in 32 healthcare facilities, randomly allocated to intervention (16) and control (16) arms. Prescribing practices were assessed post-intervention, and 6 months after the intervention, through an audit of 100 randomly selected prescriptions from each facility. Comparisons of WHO or INRUD prescribing indicators were conducted using the intention-to-treat analysis at the two times.

RESULTS

At baseline, in both arms, rational prescribing standards were met by the number of medicines per prescription and the use of injections. Antibiotic use was above 50% in both arms. After adjustment for baseline antibiotics use, region and level of care, there were no significant differences in all prescribing indicators between the two arms, post-intervention and at 6 months follow-up.

CONCLUSION

In a lower middle-income setting with a high prevalence of irrational prescribing practices, a prescription audit, feedback and small-group education intervention had no benefits in improving rational prescribing.Contribution: Multifaceted strategies, strengthening of pharmacy and therapeutics committees, and holistic monitoring of medicine use are recommended to promote rational medicine use.

Assessing the impact of COVID-19 on prescription patterns and antibiotic use: Insights from three military health facilities

BACKGROUND

The COVID-19 pandemic disrupted health systems globally and there are suggestions it impacted antibiotics prescribing patterns in clinical practice.

OBJECTIVES

This study aimed to assess the effects of the COVID-19 pandemic on the prescribing patterns in three Nigerian military health facilities and investigate the factors associated with antibiotic prescriptions.

METHODS

This was a two-year cross-sectional retrospective study. Three hospitals and a total of 11,590 prescriptions were purposively and conveniently sampled respectively. The World Health Organisation (WHO) and International Network of Rational Use of Drugs (INRUD) prescribing indicators were used to assess for polypharmacy, injection use, use of antibiotics, use of generic drugs and prescriptions from essential drug lists for the periods of the pandemic and before the pandemic. Indicators from both periods were compared for statistical significance using the independent t-test. Generalized linear modelling was applied to assess the factors associated with antibiotic prescriptions. The relationship between the receipt of antibiotics and independent variables was presented using incident risk ratios (IRR).

RESULTS

Our findings showed that all five WHO/INRUD prescribing indicators were above the reference limit for the two-year study period. The study found there was a significant statistical difference between the COVID- and non-COVID-19 periods, with polypharmacy and antibiotic use indicators elevated during the pandemic compared to the latter. COVID-19 (IRR = 1.09), comorbidity (IRR = 1.74), pregnancy (IRR = 0.93), out-of-pocket payments (IRR = 1.10) and the inpatient department (IRR = 1.51) were associated with antibiotic prescriptions.

CONCLUSIONS

This provides insight on impact of the pandemic on prescription patterns and advocates for stewardship programs in clinical settings to ensure the rational use of drugs.

Assessment of prescription completeness and drug use pattern using WHO prescribing indicators in private community pharmacies in Addis Ababa: a cross-sectional study

BACKGROUND

Healthcare systems in both developing and developed countries were not free from prescription errors. One of the effects of prescription errors is irrational prescribing. According to the estimation of the World Health Organization (WHO), greater than 50% of medicines are prescribed and dispensed irrationally. On the other hand, research on drug use patterns in the private healthcare sector is scarce. This study aimed to assess prescription Completeness and Drug use Pattern using WHO prescribing indicators in Private Community Pharmacies in Lemi-Kura sub-city.

METHODS

Based on the WHO prescribing indicators, a retrospective cross-sectional technique was employed to examine the completeness and drug-prescription patterns. The study was conducted from April to May 2021. Prescriptions, kept for 1 year that was prescribed from March 2020 to March 2021, by private healthcare sectors, were analyzed. A systematic random sampling technique was employed to select prescriptions obtained from private health facilities. Data were analyzed using SPSS® version 26.0 software.

RESULTS

Of a total of 1000 prescriptions, 1770 drugs were prescribed and the average number of drugs per prescription was 1.77. Prescriptions for two drugs account for 38% of these, while prescriptions for three drugs account for 15%. Age, sex, and card number were written on 99.0%, 99.2%, and 41.8% of prescriptions, respectively. The patient's name was written on every prescription. Even though the availability of other therapeutic information on the prescription made it appear greater, only 44.2% of prescriptions included the dosage form of medications. The generic name was used for the majority of the medications (67.8%). Furthermore, assuming that each prescription was for a single patient, 71% of patients received antibiotics, and 2% received injectable medicines. The National List of Essential Medicines-Ethiopia was used in 99.6% of the prescriptions.

CONCLUSIONS

On the basis of the finding of this study, the prescribing and prescription completeness indicator showed deviation from the standard recommended by WHO. This situation could be critical since a similar pattern is reported from public healthcare sectors, which might imply the extent of non-adherence to WHO core drug use standards. Consequently, it could play a considerable role in increasing prescription errors in Ethiopia. Hence, in-service training for prescribers should be provided to improve adherence to basic prescription writing.

Evaluation of Rational Drug Use Based on WHO/INRUD Core Drug Use Indicators in a Secondary Care Hospital: A Cross-Sectional Study in Western Uganda

Purpose

Rational drug use (RDU) promotes safe, efficient, and cost-effective utilization of medicines in hospital settings. The aim of this study was to assess rational drug use based on the World Health Organization (WHO) and the International Network for Rational Use of Drugs (INRUD) core drug use indicators.

Patients and Methods

This prospective, descriptive, hospital-based cross-sectional study was conducted among patients attending the Outpatient Department of a secondary care hospital located in the Sheema District of Western Uganda. A total of 450 prescriptions were prospectively collected from eligible patients and subjected to evaluation by using the WHO/INRUD core drug use indicators (prescribing, patient care, and health-facility indicators).

Results

The average number of drugs prescribed per encounter was found to be 3.2 (optimal value=1.6-1.8). The percentages of drugs prescribed by their generic name (90.48%) and from the Essential Medicine List (96.23%) were close to the WHO reference (100%). The percentage of antibiotics (66.22%) and injections (25.22%) per encounter exceeded the WHO standards (antibiotics=20.0-26.8; injections=13.4-24.1). Among the patient-care indicators, the average consultation time (5.41 minutes), average dispensing time (131.03 seconds), percentage of medicines dispensed (76.11%), percentage of medicines adequately labeled (59.74%), and percentage of patients with dosage knowledge (49.50%) did not meet the WHO reference. Facility indicators such as the percentage of key medicines available in the stock (66.67%) did not conform to the WHO optimal value. The hospital made the EML hundred percent available to all practitioners.

Conclusion

The study concludes that the prescribing, patient care, and health facility indicators at Sheema District Secondary Care Hospital deviate from the optimal values recommended by the WHO. Therefore, this study indicates a need for improvement on these indicators and a requirement for the ongoing educational initiatives focused on rational drug prescribing, dispensing, and patient use in order to comply with the standards set by the WHO.

Prescribing Pattern and Associated Factors in Community Pharmacies: A Cross-Sectional Study Using AWaRe Classification and WHO Antibiotic Prescribing Indicators in Dire Dawa, Ethiopia

BACKGROUND

Antimicrobials are drugs that are more likely to trigger the development of resistance naturally. Thus, they need to be prescribed, dispensed, and administered with greater caution. To underline the significance of their proper usage, antibiotics are divided as AWaRe: Access, Watch, and Reserve. Timely evidence on medicine use, prescribing patterns, and the factors affecting prescribing of antibiotic and their use percentage from AWaRe classification would help decision-makers to draft guidelines that can enable more rational use of medicines.

METHODS

Prospective and cross-sectional study was conducted among seven community pharmacies in Dire Dawa to assess current prescribing practices related World Health Organization (WHO) indicators and AWaRe classification including antibiotic use and associated factors. Using stratified random sampling techniques, 1200 encounters were reviewed between 1 October and 31 October 2022, and SPSS version 27 was used for the analysis.

RESULTS

The average of medications per prescription was 1.96. Antibiotics were included in 47.8% of encounters, while 43.1% were prescribed from the Watch groups. In 13.5% of the encounters, injections were administered. In multivariate models, patient age, gender, and the number of medications prescribed were significantly associated to prescription of antibiotics. Antibiotics were about 2.5 times more likely to be prescribed to patients under the age of 18 years than to subjects 65 years and older [adjusted odds ratio (AOR): 2.51, 95% confidence interval (CI): 1.88-5.42; P < 0.001]. Men were also more likely than women to receive an antibiotic prescription (AOR: 1.74, 95% CI: 1.18-2.33; P = 0.011). Subjects who received more than two drugs were 2.96 times more likely to receive an antibiotic drug (AOR: 2.96, 95% CI: 1.77-6.55; P < 0.003). The probability of prescribing antibiotics was increased by 2.57 for every one-unit increase in the number of medications [crude odds ratio (OR): 2.57; 95% CI: 2.16-3.47; P < 0.002].

CONCLUSION

According to the present study, the amount of prescriptions with antibiotics at community pharmacies is much higher than the WHO standard (20-26.2%). The antibiotics prescribed from Access group were 55.3%, which is slightly lower than WHO recommended level (60%). The prescribing of antibiotics was significantly correlated to the patient's age, gender, and number of medications. The preprint version of the present study is available on Research Square with the following link: https://doi.org/10.21203/rs.3.rs-2547932/v1 .

Antibiotic utilization pattern in treatment of acute diarrheal diseases: the case of Hiwot Fana Specialized University Hospital, Harar, Ethiopia

BACKGROUND

The vast majority of acute diarrheal diseases are self-limiting and do not require treatment on a regular basis. Empirical antibiotics should only be used to treat dysenteric and invasive bacterial diarrhea. Antibiotic misuse in the treatment of acute diarrhea is widespread in clinical practice worldwide. Hence, the purpose of this study was to examine the pattern of antibiotic use for the acute diarrheal diseases at Hiwot Fana Specialized University Hospital, Harar, Ethiopia.

METHODS

A retrospective, institution-based cross-sectional study was conducted to investigate the antibiotic utilization pattern for the treatment of acute diarrheal diseases from September 1 to September 30, 2022. Data were obtained retrospectively from patient cards treated for diarrheal disorders from August 1, 2021 to August 31, 2022, using standardized questionnaires, and the analysis was performed using IBM SPSS Statistics version 27.

RESULTS

Among 332 patients in present study, 271 (81.63%) of them received nine different types of antibiotics, with the most commonly prescribed drugs were Cotrimoxazole (30.26%), Ciprofloxacin (19.19%), and Azithromycin (17.71%). Based on the presence of blood in the stools, 14.76% of the cases were invasive bacterial in nature. Antibiotics were prescribed about 2.55 times more frequently to patients under the age of 12 than to subjects 65 and older (AOR 2.55, 95% CI 1.45-3.87). Patients who received three or more medications were 2.77 times more likely to be prescribed antibiotics (AOR 2.77, 95% CI 1.84-7.56). For every unit increase in the number of drugs prescribed, the odds of prescribing antibiotics increased by 2.44 units (COR 2.44; 95% CI 2.06-4.32).

CONCLUSIONS

The current study found that antibiotics were overused in both adults and children with acute diarrheal diseases at Hiwot Fana Specialized University Hospital. The number of antibiotics prescribed was significantly associated with the patient's age and the number of medications prescribed. To reduce antibiotic overuse, health professionals have to follow the national standard treatment guidelines.

Antimicrobial prescription patterns in East Africa: a systematic review

BACKGROUND

Antimicrobial resistance is currently a recognized global health problem stemming from poor antibiotic stewardship by health workers and inappropriate antimicrobial use by patients. Data showing the extent of poor antimicrobial stewardship in low- and middle-income countries are scanty though high incidences of antimicrobial resistance are increasingly reported in many settings across the globe. The objective of the present study was, therefore, to evaluate prescriptions for antimicrobials in East Africa.

METHODS

A comprehensive literature search strategy that includes text words and medical subject headings was developed and applied to predefined electronic databases. Two authors independently screened the titles and abstracts of the outputs of the literature search. Full texts were then independently reviewed by the first and the second authors. Eligible studies were formally assessed for quality and risk of bias using a scoring tool. Extracted data from included studies were combined in a meta-analysis where appropriate and presented using forest plots and tables or in a narrative text. Where data were available, subgroup analyses were performed.

RESULTS

A total of 4284 articles were retrieved, but only 26 articles were included in the review. The majority of the included studies (30.8%) were retrieved from Ethiopia, followed by Sudan, Kenya, and Tanzania each contributing 19.2% of the included studies. The overall proportion of encounters with antimicrobials reported by the included studies was 57% CI [42-73%]. Ethiopia had an overall patient encounter with antimicrobials of 63% [50-76%] followed by Sudan with an overall encounter with antimicrobials of 62% CI [34-85%]. Included studies from Kenya reported an overall encounter with antimicrobials of 54% CI [15-90%], whereas included studies from Tanzania reported an overall patient encounter with antimicrobials of 40% CI [21-60%].

CONCLUSION

Prescription patterns demonstrated in this review significantly deviate from WHO recommendations suggesting inappropriate antimicrobial use in the East African countries. Further studies have to be pursued to generate more information on antimicrobial use in this region.

Antibiotic Prescribing Patterns for Outpatient Pediatrics at a Private Hospital in Abu Dhabi: A Clinical Audit Study

BACKGROUND

Antibiotics are commonly used in pediatrics. The aim and objectives were to evaluate the antibiotic prescribing patterns of pediatric outpatients at a private hospital in Abu Dhabi, UAE.

METHODS

A retrospective drug utilization review was conducted for pediatric patients aged 1-18 between June and December 2018. The prescriptions with inclusion criteria were reviewed and evaluated by using the WHO indicators.

RESULTS

419 encounters included were female (50.1%). Most pediatrics were aged 4-6 years (35.3%). The average number of drugs per prescription were 4.9 drugs. The percentage of parenteral medication prescriptions was 16.9%, and with antibiotic prescriptions was 43.0%, where cefaclor was the most prescribed antibiotic (31.1%). The average consultation time was 14 min, while the average dispensing time was 9.6 min. The most common diagnosis where antibiotics were prescribed was acute pharyngitis (33.4%). There were about 60.6% with lab investigation.

CONCLUSION

As per the WHO indicators, the pediatric outpatient department has a high rate of antibiotic use and polypharmacy, but adherence to the drug formulary and prescribing medicines using generic names was appropriate. The average time for consultation and dispensing were suitable. Irrational antibiotic use for inappropriate diagnoses such as acute otitis media and bronchiolitis were found.

Explore of the reasons of irrational prescribing in Iran: A qualitative study

Background

Irrational prescribing is highly prevalent in Iran, and it is under the impact of different factors.

Objective

This research aims to recognize the reasons for Irrational prescribing in Iran.

Methods

A qualitative approach and a conventional content analysis were employed to perform this research. The research community includes some experts and key specialists in medication prescribing. Semi-structured interviews were used for data collection. The intentional sampling method was applied, and theoretical saturation was reached by conducting 40 interviews with experts. The data analysis process was done following the steps suggested by Graneheim and Lundman.

Results

Four main categories and 12 subcategories appeared after analyzing the data. The main categories are organizational and management factors, legal factors, cultural factors, and economic factors.

Conclusion

Irrational prescribing can be prevented by reforming the referral system, overseeing pharmacies and physicians, raising public awareness and correcting their misconceptions about the medications, and creating an appropriate mechanism for pricing and selling medicines.

Assessment of WHO core drug use indicators at a tertiary care Institute of National importance in India

Rational prescribing of medicines is an important aspect of drug prescribing which helps in safe and efficacious and cost-effective drug treatment for patients. WHO Prescription indicators are intended to evaluate the services provided to the population concerning the rational use of medicines. The study aims to study prescription practices and rational use of medicines in the department of Internal medicine, using WHO prescribing indicators in a tertiary care teaching institute of national importance. A total of 50 prescriptions were digitally photographed and analysed for prescription practices and rational drug use, using standard WHO core prescribing indicators. A total of 301 drugs with multiple and diverse diagnoses were used. Statistical analysis was done using SPSS 22 version. The average number of drugs per prescription was 3.48%. It was found that only 13.79% of prescriptions have generic names, whereas 27.58% of patient encounters had at least one drug from the National List of Essential Medicine, 6.8% of prescriptions have antibiotics and 0.7% of prescriptions were injections. The number of prescriptions with fixed drug combinations was 27.55%. Indicators such as percentage of the National List of Essential Medicine, fixed drug combinations and prescribing with a generic name are used. Hence, we will suggest regular prescription audit practices and conducting CMEs and training workshops for clinicians for the rational use of medicines in all healthcare settings to succeed in the rational use of medicine.

Evaluation of prescription completeness, rational drug-use patterns using WHO prescribing, patient-care and facility indicators in Debre Tabor Comprehensive Specialized Hospital, Ethiopia: A cross-sectional study

Objective:

Irrational medicine use results in diseases worsening, disability, death, and wastage of limited resources. This study was predominantly aimed to evaluate the rationality of medicine use patterns by assessing prescribing, patient-care, and facility indicators at Debre Tabor Comprehensive Specialized Hospital by using World Health Organization core drug use indicators.

Methods:

A cross-sectional design was conducted to collect prescribing indicator data from 780 prescriptions retrospectively from 1 July 2020 to 30 June 2021 at outpatient pharmacy of the hospital and exit interview was held prospectively on 150 patients to evaluate patient-care indicators. In addition, indicators for health-facility were assessed by actual observation of the presence of different guidelines. Descriptive analysis of the collected data was computed using SPSS version 25.

Result:

Totally, 1521 drugs were prescribed to 780 encounters. On average, 1.95 drugs were prescribed per prescription. Percentage of encounters by generic name, encounters with antibiotics and injection, and drugs from essential drug list were 99.9%, 35.4%, 15.3%, and 100%, respectively. From healthcare provider–related information, the names of prescribers and dispensers were correctly written in 93.59% and 77.69%, respectively. Frequency (97.18%) and route (86.15%) of drug administration were better stated in the reviewed encounters, whereas dosage form is poorly stated (7.44%). Labeling of dispensed medicine was obtained for only 10% of patients and patient knowledge for correct dose was 94%. Availability of facility indicators was 95%.

Conclusion:

From the results of this study, it is possible to conclude that the prescribing, patient-care, and facility indicators did not fulfill many World Health Organization standards. Therefore, it is important if all prescribers, dispensers, patients themselves, and the governing bodies take an action to improve the prescribing and patient-care indicators for the best of the end users.

Assessment of Polypharmacy, Drug Use Patterns, and Associated Factors at the Edna Adan University Hospital, Hargeisa, Somaliland

Polypharmacy is the use of multiple drugs by a patient at the same time and is common in the elderly. To our knowledge, drug use patterns in Somaliland are rarely studied. The purpose of this study was to evaluate polypharmacy, drug use patterns, and their predictors at the Edna Adan University Hospital in Hargeisa, Somaliland. A retrospective cohort analysis of 1140 medical records and prescriptions over a year from August 28, 2019, to August 27, 2020, was reviewed. The data completeness and consistency were checked and entered with the SPSS version 25.0. The association between total polypharmacy and different variables was analyzed using multivariable binary logistic regression and expressed as an odds ratio (OR) and 95% confidence interval (CI). In addition, the World Health Organization’s core drug use and facility indicators were used to assess the drug use patterns. The overall polypharmacy in this study was 71%. Statistically significant association was observed between the polypharmacy and variables such as age ( $P=0.01$ ; OR = 3.4, 95% CI = 1.9–6.1), chronic illness ( $P=0.01$ , OR = 8.6, 95% CI = 5.1–14.7), and comorbidity ( $P=0.01$ , OR = 5.2, 95% CI = 2.1–12.9). However, the ward admitted/visited and gender did not have a statistically significant association with polypharmacy. There was overuse of brand drugs (63.9%) and antibiotics (55.2%), while the use of injectables (19.9%) was within the acceptable range. Polypharmacy and overuse of brand drugs and antibiotics were prevalent in the study setting. Essential drugs list, formularies, and treatment and regulatory guidelines are needed in place to ensure appropriate drug use.

Drug prescribing and dispensing practices in regional and national referral hospitals of Eritrea: Evaluation with WHO/INRUD core drug use indicators

Rational use of medicine (RUM) for all medical conditions is crucial in attaining quality of healthcare and medical care for patients and the community as a whole. However, the actual medicine use pattern is not consistent with that of the World Health Organization (WHO) guideline and is often irrational in many healthcare setting, particularly in developing countries. Thus, the aim of the study was to evaluate rational medicine use based on WHO/International Network of Rational Use of Drugs (INRUD) core drug use indicators in Eritrean National and Regional Referral hospitals. A descriptive and cross-sectional approach was used to conduct the study. A sample of 4800 (600 from each hospital) outpatient prescriptions from all disciplines were systematically reviewed to assess the prescribing indicators. A total of 1600 (200 from each hospital) randomly selected patients were observed for patient indicators and all pharmacy personnel were interviewed to obtain the required information for facility-specific indicators. Data were collected using retrospective and prospective structured observational checklist between September and January, 2018. Descriptive statistics, Welch’s robust test of means and Duncan’s post hoc test were performed using IBM SPSS (version 22). The average number of medicines per prescription was 1.78 (SD = 0.79). Prescriptions that contained antibiotic and injectable were 54.50% and 6.60%, respectively. Besides, the percentage of medicines prescribed by generic name and from an essential medicine list (EML) was 98.86% and 94.73%, respectively. The overall average consultation and dispensing time were 5.46 minutes (SD = 3.86) and 36.49 seconds (SD = 46.83), respectively. Moreover, 87.32% of the prescribed medicines were actually dispensed. Only 68.24% of prescriptions were adequately labelled and 78.85% patients knew about the dosage of the medicine(s) in their prescriptions. More than half (66.7%) of the key medicines were available in stock. All the hospitals used the national medicine list but none of them had their own medicine list or guideline. In conclusion, majority of WHO stated core drug use indicators were not fulfilled by the eight hospitals. The results of this study suggest that a mix of policies needs to be implemented to make medicines more accessible and used in a more rational way.

Assessment of rational use of medicines for chronic non-communicable diseases: A cross-sectional design in a public access clinic in Jamaica

Background:

Rational use of medicines (RUM) offers a cost-saving strategy to maximize therapeutic outcomes. The aims of this study were to assess RUM for chronic non-communicable diseases (NCDs) using the World Health Organization’s (WHO) prescribing indicators in a public access facility and to evaluate the alignment of the use of drugs with therapeutic recommendations/guidelines.

Design and methods:

In this retrospective cross-sectional study, prescriptions of adult patients containing at least one drug for chronic NCDs, filled between January and July 2019 were reviewed using the WHO prescribing indicators for RUM. Data were analyzed and expressed as descriptive statistics. Associations were determined using chi-square tests, correlations using Pearson’s correlation and medians compared using Mann-Whitney U test. For all analyses, significance was determined at p < 0.05.

Results:

Of the 571 prescriptions reviewed, most were for female, elderly patients with mean age of 69 years, predominantly with hypertension and/or diabetes. Polypharmacy was noted for 53.6% of prescriptions, primarily in elderly patients (p < 0.001), with the median number of five drugs prescribed and three dispensed. Of the drugs prescribed, 76.6% used generic prescribing, 63.3% were dispensed as written and 3.9% were antibiotics prescribed mainly for asthmatic patients (χ² = 74.9, p < 0.001). Drugs prescribed for NCDs were aligned to therapeutic guidelines, but a significantly higher proportion of diabetes medications, (metformin and gliclazide), and cardiovascular medications (enalapril and losartan), were not dispensed as written (χ² = 40.0, p = 0.007).

Conclusion:

This research indicates that there is positive alignment with recommended therapeutic guidelines, however, based on WHO prescribing factors, strategies to improve RUM in this setting are highly recommended.

Evaluation of antibiotic prescribing patterns among inpatients using World Health Organization indicators: A cross-sectional study

Objective:

Even though antibiotic resistance is one of the most serious threats to global public health, it is becoming more common due to inappropriate antibiotic prescribing patterns. Thus, the purpose of this study is to assess antibiotic prescribing patterns among inpatients at an Ethiopian comprehensive specialized hospital.

Methods:

An institutional-based cross-sectional study was used. During the study period, data were collected from the charts of admitted patients in selected wards of Debre Tabor comprehensive specialized hospital. The World Health Organization’s developed questionnaire and conventional antibiotic prescribing indicators were used to assess rational drug usage, with an emphasis on antibiotic prescribing trends. The data were analyzed using SPSS 25.0 statistical software.

Results:

For 861 patients admitted to medical and pediatric wards, a total of 1444 antibiotics were prescribed. Overall, 60.6% of inpatients were prescribed at least one antibiotic, with an average (mean ± SD) number of antibiotics prescribed per patient of 1.7 ± 1.6. During their hospital stay, patients were given antibiotics for an average (mean ± SD) of 6.4 ± 2.7 days. Furthermore, 83.3% of antibiotics were prescribed for therapeutic purposes, whereas 100% were provided for empiric purposes. Ceftriaxone was the most commonly administered antibiotic in the study settings (49.2%). During the study period, Debre Tabor comprehensive specialized hospital had access to 67.5% of key antibiotics.

Conclusion:

The antibiotic prescribing pattern in our study diverged from the World Health Organization-recommended guidelines. Furthermore, all antibiotics were given without a culture or sensitivity test in every case. Setting up an antibiotic stewardship program, introducing antibiotic use based on culture and sensitivity tests, and adopting institutional guidelines could all help to address this issue.

Systematic review and meta-analysis of medicine use studies in Ethiopia using the WHO patient care indicators with an emphasis on the availability of prescribed medicines

OBJECTIVE

To collate the findings of studies on patient care indicators in Ethiopia using the WHO/International Network for Rational Use of Drugs indicators with a focus on the availability of medicines to patients.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Embase, Global Index Medicus, Google Scholar, Medline (via PubMed) and Web of Science.

ELIGIBILITY CRITERIA

Medicine use studies employing the WHO patient care indicators across health facilities in Ethiopia.

DATA EXTRACTION AND SYNTHESIS

Descriptive summary of the indicators and a random-effects meta-analysis were performed for quantitative synthesis of findings on the percentage of medicines actually dispensed. Meta-regression was performed to assess the moderator effects of different attributes of the studies.

RESULTS

A total of 25 studies conducted in 155 health facilities with 11 703 patient exit interviews were included. The median value of average consultation time was 5.1 min (25th-75th: 4.2-6.6) and that of average dispensing time was 78 s (25th-75th: 54.9-120.0). The median percentage of medicines with adequate labelling was 22.4% (25th-75th: 5.6%-50.0%). A concerning trend of decreasing dispensing times and adequacy of labelling were observed in more recent studies. The median percentage of patients with adequate knowledge of dosage schedules of medicines was 70.0% (25th-75th: 52.5%-81.0%). In the meta-analysis, the pooled estimate of medicine availability was 85.9% (95% CI: 82.1% to 89.0%). The multivariable meta-regression showed that geographical area and quality of study were statistically significant predictors of medicine availability.

CONCLUSION

Short consultation and dispensing times, inadequate labelling, inadequate knowledge of patients on medicines and suboptimal availability of medicines were identified in health facilities of Ethiopia. Studies aimed at further exploration of the individual indicators like problems of inadequate labelling and patients' knowledge of dispensed medicines are crucial to determine the specific reasons and improve medicine use.

PROSPERO REGISTRATION NUMBER

CRD42020157274.

Assessment of private health sector prescribing patterns and adherence to prescription format using World Health Organization core drug use indicators in Addis Ababa, Ethiopia

Background

Currently, the private healthcare sector's role in healthcare delivery is growing in Ethiopia. However, there are limited studies on private healthcare sector drug use patterns. This study aimed to evaluate the private healthcare sector prescribing practices and adherence to prescription format, using some of the World Health Organization (WHO) core drug use indicators in Addis Ababa, Ethiopia.

Methods

A retrospective cross-sectional study design was used to collect quantitative data from prescriptions prescribed and dispensed by private healthcare sectors in the Lemi-Kura sub-city, Addis Ababa. The study was conducted from June to July 2021. The WHO criteria were used to evaluate prescribing and prescription completeness indicators. Prescriptions, kept for the last 1 year that were prescribed between January 1, 2020, to January 1, 2021, by private drug outlets, were analyzed. Simple random and systematic sampling procedures were employed in selecting drug outlets and prescriptions, respectively.

Results

Of a total of 1,200 prescriptions, 2,192 drugs were prescribed and the average number of drugs per prescription was 1.83. Generic names, antibiotics, injections, and drugs on the Ethiopian essential medicines list accounted for 77.4, 63.8, 11.5, and 80.6% of all prescriptions, respectively. Among the patient identifiers, the patient card number (54.3%), weight (2.3%), and diagnoses (31.7%) were less likely to be completed. In terms of the drug-related information, the dosage form (35.5%) was the least likely to be completed. Only 36.6 and 25.8% of prescriptions contained the names and qualifications of the prescribers, respectively. It was difficult to obtain prescription papers with the dispenser identifier.

Conclusion

The study findings indicated prescribing and prescription completeness indicators all considerably deviated from WHO standards and hence unsuitable. This situation could be critical since a similar pattern is reported from public healthcare sectors, which might imply the extent of non-adherence to WHO core drug use standards. Consequently, it could play a considerable role in increasing irrational medicine use in Ethiopia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40545-022-00408-0.

Seasonality and Annual Utilization Patterns of Antibacterials at Muhimbili National Hospital, Dar es Salaam, Tanzania: A 2015 Monthly Survey

Introduction

Antibacterial utilization studies can help identify areas of intervention of antimicrobial stewardship programs (ASP) to facilitate rational use and prevent the emergence of antimicrobial resistance (AMR). Assessment and comparison of antibacterial utilization depend on the Anatomical Therapeutic Chemical (ATC) classification system and Defined Daily Dose (DDD) recommended by the World Health Organization (WHO) collaborative center for international drug monitoring. This study aimed to determine the DDD of each prescribed antibacterial group and the proportions of wide-spectrum antibacterials used at Muhimbili National Hospital (MNH) in Tanzania to allow baseline data for hospital ASPs.

Methods

A retrospective analytical study using data collected from 1st January 2015 to 31st December 2015 was undertaken at MNH. Data on antibacterials prescribed and dispensed were obtained from the MNH database. The ATC/DDD system was used to classify and quantify the antibacterial utilization patterns.

Results

A total of 10,643.1 DDDs were used in thirteen ward units at the Kibasila, Mwaisela and Sewahaji blocks of the MNH. Eighteen different antibacterials were prescribed and dispensed to 1496 patients. Capsules were the most dispensed dosage form. The drug ciprofloxacin was the leading antibacterial prescribed, with a DDD of about 3780 (35.5%) per year. This was followed by metronidazole and amoxicillin. The proportion of wide-spectrum antibacterials was as high as 66%. Utilization peaks were noted in April, July and September. There was a significant monthly increase in antibacterials utilization between January and December 2015 (p-value = 0.002, R-square = 0.64). The trends forecasted increased through June 2016.

Conclusions

Utilization trends indicated a significant monthly increase in 2015 at MNH wards in Tanzania. The use of wide-spectrum antibacterials was widespread. This calls for continued antibacterial utilization surveillance and implementation of hospital-based ASP to mitigate the rapidly rising global threat of AMR.

The Pattern of Medicine Use in Ethiopia Using the WHO Core Drug Use Indicators

Introduction

Rational medicine use is an appropriate prescribing, dispensing, and patient use of medicines for the diagnosis, prevention, and treatment of diseases. It is affected by several factors. Irrational use of medicine is a widespread problem at all levels of care. This review is aimed at assessing the medicine use pattern in health facilities of Ethiopia using the medicine use pattern developed by WHO/INRUD.

Methods

Relevant literature was searched from Google Scholar, PubMed, Hinari, Web of Science, and Scopus using inclusion and exclusion criteria. A systematic review was used to summarize the medicine use pattern in health facilities of Ethiopia, and that WHO core drug use indicators were employed.

Result

From 188 searched studies, 30 literatures were reviewed. The average number of drugs per encounter was 2.11. The percentage of encounters with antibiotics and injection was 57.16% and 22.39%, respectively. The percentage of drugs prescribed by generic name and from an essential drug list was 91.56% and 90.19%, respectively. On average, patients spent 5.14 minutes for consultation and 106.52 seconds for dispensing. From prescribed drugs, 67.79% were dispensed, while only 32.25% were labeled adequately. The availability of key essential medicines was 64.87%. The index of rational drug use value was 7.26. Moreover, the index of rational drug prescribing, index of rational patient-care drug use, and index of rational facility-specific drug use were 3.74, 2.51, and 1.01, respectively.

Conclusion

Ethiopian health facilities were faced with antibiotic overprescribing, short consultation, and dispensing times, poor labeling of medicines, poor availability of key drugs, and nonadherence to the essential drug list. Routine, multidisciplinary awareness creation, and regulation should be implemented to promote rational medicine use at a national level.

Adverse drug reactions reporting practice and associated factors among community health extension workers in public health facilities, Southwest, Nigeria

Introduction

timely adverse drug reactions (ADRs) reporting has contributed immensely towards public health safety. Community health extension workers (CHEWs) provides basic medical care in rural areas. This study assessed the knowledge, attitude, practice, and determinants of ADRs reporting among CHEWs in public health institutions, Southwest, Nigeria.

Methods

a cross-sectional survey of 333 CHEWs randomly selected from public health facilities using self-administered questionnaires. The questionnaire sought information on the knowledge, attitude and practice of CHEWs towards ADRs reporting. The knowledge and attitude questions were scored and categorized. The association between dependent and independent variables assessed with bivariate and multivariate logistic regressions, and p < 0.05 considered statistically significant.

Results

among 333 respondents, 205 (61.6%) had encountered patients with ADRs but only 26 (12.6%) had reported it with yellow forms. About half, 169 (50.8%), and 191 (57.4%) respondents had a positive attitude and inadequate knowledge of ADRs reporting respectively. Sex (aOR: 2.84, 95% CI: 2.10-7.10; p < 0.0001), working in Ogbomoso area (aOR: 3.3, 95% CI: 1.34-8.21; p=0.01), and training (aOR: 2.01, 95% CI: 1.20-3.42; p = 0.01) were factors associated with adequate knowledge. The determinant of ADRs reporting was training (aOR: 3.63, 95% CI: 1.13-11.63; p = 0.03).

Conclusion

though CHEWs had a slightly positive attitude, they had inadequate knowledge and poor ADRs reporting. The determinant of inadequate ADRs reporting knowledge and under reporting was lack of training. There is an urgent need for educational intervention programmes towards improving knowledge and practices of ADRs reporting among CHEWs.

Analysis of the prescription pattern of psychotropics in an outpatient department of a general hospital psychiatry unit

BACKGROUND

World Health Organization has prescribed drug use indicators for evaluating rational prescribing. Very few studies have been conducted on rational prescriptions for psychotropic drugs; hence, this study was undertaken at a tertiary care center of North India.

METHODS

After obtaining approval of the Institutional Ethics Committee, all prescriptions deposited with the dispensary of the psychiatry department of the hospital between 01 October 2017 and 31 December 2017 were included in the study. The prescriptions were analyzed for drug use indicators, namely the average number of drugs per encounter, percentage of prescriptions with generic name, percentage of prescriptions from the essential drug list, percentage of prescriptions with antibiotics, and percentage of prescriptions with an injection. In addition, the prescriptions were analyzed for patterns of psychotropics prescribed.

RESULTS

A total of 3770 prescriptions were analyzed. On an average, 2.35 medicines were prescribed per prescription. Injectable comprised 2.39% of prescriptions and fixed drug combinations were 0.16% of the total. Of all prescriptions, 91.3% were by generic name, while 55.02% of prescriptions were from the essential drug list. Polypharmacy constituted 4.53% of prescriptions. Risperidone, escitalopram, sodium valproate, and clonazepam were the most commonly prescribed drugs.

CONCLUSION

While we fared well with respect to the percentage of prescriptions with injections and those with an antibiotic, we have not been able to achieve the prescribed standards in prescription with generic names, number of drugs per prescription, and prescriptions from the essential drug list. The study emphasizes that there is scope for improvement.

Prescription analysis and cost of antidepressant drugs in major depressive disorder outpatients at the tertiary care hospital of Pakistan: a prospective approach

OBJECTIVES

To assess prescribing care indicators, utilization pattern, cost per prescription, cost ratios, and percent cost variation of antidepressants (ADs).

METHOD

A prospective cross-sectional study was carried out at the tertiary care hospital of Peshawar, Pakistan among major depressive disorder (MDD) outpatients from July 2019 to February 2020. The ideal standards for World Health Organization (WHO) prescribing care indicators were used. The ePharma Guide was used to calculate the cost in Pakistani rupees (Rs) and United States dollar (USD) 2021 (exchange rate: 1 USD = 154.43 Rs).

RESULTS

A total of 296 MDD patients received 846 drugs (average 2.86; range:1-8), of which 366 were ADs (average number ADs/prescription; 1.23). About 23% (n = 68) of patients received more than one AD. Only 21 (5.7%) generic ADs were prescribed, and 346 (94.5%) ADs were prescribed from the hospital formulary list. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (67.5%). The average cost of ADs per prescription per month was 700.95 Rs (4.54 USD). Escitalopram (5.69 Rs; 0.04 USD) showed highest cost ratio and maximum percentage cost variation (468.97%).

CONCLUSION

This study observed low generic prescribing, a higher prescribing trend of SSRI, wide differences in cost ratio and percentage cost variation among ADs.

Are antibiotic prescription practices in Eastern Uganda concordant with the national standard treatment guidelines? A cross-sectional retrospective study

OBJECTIVES

To evaluate the antibiotic prescription patterns of health workers in Eastern Uganda and more specifically whether they are not in accordance with the Uganda standard treatment guidelines and other indicators of appropriate antimicrobial drug prescription.

METHOD

Data on variables of the patients was obtained from the health management information system records of the outpatient department registers of Soroti and Mbale Regional Referral Hospitals from 2016 to 2018.

RESULTS

The prevalence of non-adherence to treatment guidelines when prescribing antibiotics was 82.6% (95%CI: 81.4% - 83.7%). Guidelines were likely to be adhered to when prescribing antibiotics for individuals aged 13 - 19 years compared to their counterparts aged 0 - 12 years (13 - 19 years: adjusted odds ratio (AOR) =0.55, 95%CI: 0.40-0.74). When prescribing antibiotics for males, health workers were twice as likely not to adhere to guidelines compared to when prescribing for females (AOR=2.09, 95%CI: 1.61-2.72). When prescribing cephalosporins and nitroimidazoles, health workers were likely not to adhere to guidelines compared to when prescribing penicillin (cephalosporins: AOR=1.92, 95%CI: 1.28 - 2.86; nitroimidazoles: AOR=1.70 95%CI: 1.09-2.65). Health workers were most likely not to follow guidelines when prescribing antibiotics in combinations with another antibiotic (2 antibiotics: AOR=1.27, 95%CI: 1.03 - 1.56) CONCLUSION: Non-adherence to treatment guidelines for an indicated diagnosis and inappropriate antibiotic prescription is significantly prevalent in Eastern Uganda. Health workers were more likely not to follow guidelines when prescribing for male patients, children up to 12 years of age and when prescribing cephalosporins, nitroimidazoles or antibiotics in double combination.

Evaluating antimicrobial prescribing in a Tertiary Healthcare Institution in Nigeria

Background

Regular evaluation of antimicrobials prescriptions is important for optimal use.

Objective

This study determined the prescription patterns, class and costs of antimicrobials in the adult out-patient pharmacy of a Teaching Hospital in Nigeria.

Methods

A 1-year retrospective study from 1st January to 31st December 2018. The data, which included identification code, age, sex, antibiotics prescribed, number of antibiotics per prescription, number of medicines per prescription, dosage form, generic prescribing, drug on the essential drug list, and cost, were used in the analysis. The Chi-square test and Analysis of Variance were used to compare our data with the WHO–developed antimicrobial prescription Guidelines for Anatomical Therapeutic Chemical and Defined Daily Dose assignment of 2019.

Results

From 450 patient records, significantly more females (70%) were prescribed with antimicrobials (P = 0.0038). The prescription pattern showed that antimicrobials selection by class was significantly different (P < 0.0001) (top three being Amino-penicillin > Nitroimidazoles > Fluoroquinolone). In addition, age differed significantly (P < 0.0001) with 46–50 as the highest class. Dosage forms profile showed that the percentage of encounter with injections prescribed (1.8%) was less than WHO recommendation (13.4–24.1%). Most of the prescriptions (84.22%) were from the Essential Drug List. The average cost of prescriptions with two antimicrobials was the highest ($14.0807), then three ($10.7949), and one ($6.39858). The average number of drugs per prescription that had one (4.28), two (4.46), and three (5.55) antimicrobials, respectively, were more than double the average (2) recommended by WHO.

Conclusion

The study showed that most of the patterns are within limit, however, highlights the need for frequent evaluation.

Drug utilization pattern and rational drug use at orthopedics and traumatology outpatient clinics: A cross-sectional study

Objectives

The aim of the present study was to assess the prescriptions of patients who were admitted to the orthopedics and traumatology outpatient clinic of a tertiary care hospital according to the WHO prescribing indicators.

Patients and methods

Between January 2020 and March 2020, a total of 1,024 patients (273 males, 751 females; mean age: 51.9±13.9 years; range, 19 to 103 years) were included in the study. Only patients who were prescribed drugs and 18 years of age or older were included in the study. The WHO core prescribing indicators were utilized for the assessment of rational drug use. The WHO prescribing indicators percentages between the age categories were analyzed. The average number of drugs between the age categories was also examined.

Results

The average number of drugs per encounter was 2.9. The percentage of encounters with an antibiotic prescribed was 2.6% and with an injection prescribed was 10.7%. The percentage of drugs prescribed from essential drugs list was 33.8%. There were no prescriptions consisting generic name of drugs (0%). Polypharmacy was significantly higher in the ≥65 age group compared to the 18-44 age group (p=0.001).

Conclusion

The percentage of encounters with an antibiotic and injection prescribed were optimal according to WHO standards, while the average number of drugs per encounter was higher than the WHO ideal ranges. Unfortunately, the parameters such as the percentage of prescribing with generic name and from essential drug list was far more behind the optimal range.

Assessment of drug use pattern using WHO core drug use indicators in selected general hospitals: a cross-sectional study in Tigray region, Ethiopia

OBJECTIVE

Inappropriate use of medicine is a global challenge with greater impact on developing countries. Assessment of drug use pattern is used to identify gaps in medicine utilisation to implement strategies for promoting rational drug use. This study aimed to assess drug use pattern using the WHO drug use indicators in selected general hospitals in Tigray region, Ethiopia.

DESIGN

A cross-sectional study was conducted using WHO drug use indicators in two public hospitals located in Tigray.

SETTING

Prescriptions recorded from 1 January 2017 to 1 June 2019 were randomly selected, and participants who visited the public hospitals from 1 March 2019 to 30 August 2019 and hospital pharmacies were interviewed.

PARTICIPANTS

100 patients who visited both outpatient clinics and hospital pharmacy departments of the public hospitals.

RESULTS

The average number of medicines per prescription was 1.69 (±0.81). Prescriptions containing antibiotics and injectables were 58.2% and 15.9%, respectively. The percentages of medicines prescribed with a generic name from essential medicines list of Ethiopia were 97.5% (974) and 88.1% (970) in Mekelle Hospital and Quiha Hospital, respectively. The patients spent an average of 6.6(±3.5) min with their general practitioners, while only 22.8 (±21.7) s with their pharmacists. Of the patients interviewed, 56.9% knew their dosing regimen and 32.7% of them had their medication labelled.

CONCLUSION

The finding of the present study revealed deviation of drug use pattern from the WHO optimal levels suggesting the hospitals had limitations in appropriate utilisation of medicines. Understanding the factors attributed to the observed gaps and implementing corrective measures are required to conform with the recommended standards of appropriate drug utilisation.

Rational Drug Use Evaluation Based on World Health Organization Core Drug Use Indicators in Ethiopia: A Systematic Review

Background

Rational use of medicines plays a vital role in avoiding preventable adverse drug effects, maximizing therapeutic outcomes with promoting patient adherence, and minimizing the cost of drug therapy. Irrational use of drugs is often observed in countries with weak health care systems. No review has been done that systematically expresses rational drug use practice based on the three WHO core drug use indicators in Ethiopia. Thus, this study was aimed to review systematically the prescribing, health-facility, and patient-care indicators based on WHO core drug use indicators in Ethiopia.

Methods

A systematic article search was conducted in different electronic databases including PubMed/ MEDLINE, the Cochrane Library, EMBASE, Web of Science, POPLINE, the Global Health, and Google scholar. Quality assessment was conducted using Newcastle-Ottawa quality assessment scale. Studies were synthesized and grouped in to prescribing, patient care and health facility indicators.

Results

From a total of 6239 articles, 21 studies were found suitable for the review. The highest average number of drugs per encounter was 2.5 while the lowest was 0.98. The percentage of generic drug use was ranged from 70.5% to 100%. The highest percentage of encounters with an antibiotic was 85%. The lowest percentage of drugs prescribed from essential drugs list was 81.4%. The highest percentage of drugs actually dispensed and adequately labeled was 96.16% and 96.25%, respectively.

Conclusion

This study showed that the practice of rational drug use varied across region of the country. The average number of drugs per prescription, percentage of drugs encounter with antibiotics, drugs prescribed by their generic name, average consultation time, average dispensing time, percentage of drugs adequately labeled, and availability of essential drugs showed deviation from the standard recommended by WHO. Thus, provision of regular training for prescribers and pharmacists, and ensuring the availability of essential drugs should be encouraged.

Drug use pattern using WHO core drug use indicators in public health centers of Dessie, North-East Ethiopia

Background

Rational drug use requires that patients receive and take medication appropriately. Though the process of diagnosis and pharmaceutical care is complex, World Health Organization (WHO)/international network for rational use of drugs (INRUD) core drug use indicators investigate drug use to minimize the hazardous effect of the drug and enhance the wise use of scares resources. This study assessed drug use patterns in health centers of Dessie town using WHO/INRUD indicators.

Methods

A cross-sectional study was conducted in public health centers of Dessie town. Data were retrospectively collected from 1500 prescriptions dispensed from January 1, 2018, to December 31, 2018 using WHO data collection tool to assess prescribing indicators. For patient care and health facility indicators, 600 patients and 3 health centers were prospectively reviewed. Systematic random sampling was used to select samples. Data were analyzed using the Statistical Package for the Social Sciences version 20.

Results

The average number of drugs per encounter was 2.1. The percentage of encounters with antibiotics and injection was 44% and 13.9%, respectively. The percentage of drugs prescribed by generic name and from an essential drug list was 98% and 100%, respectively. On average, patients spent 4.7 min for consultation and 105 s for dispensing. From 1305 prescribed drugs, 92% were dispensed, while only 4% were labeled adequately. More than half (54.8%) of patients had adequate knowledge of their medication. None of the health centers had an essential drug list. The availability of key essential medicines was 64.10%.

Conclusion

This study demonstrated irrational drug use practices in all healthcare facilities. Polypharmacy, antibiotics over-prescribing, short consultation and dispensing times, inadequate labeling of medicines, inadequate level of patients' knowledge about prescribed medicines, and unavailability of key drugs in stock were found to be the major problems. Continuous refreshment trainings on rational use of drugs and WHO recommendations should be given for prescribers and pharmacists. Further, we recommend studies involving large number of facilities to estimate overall prescribing practices.

Assessment of medicine use among outpatients at healthcare facilities in Ethiopia using the WHO's prescribing indicators with a focus on antibiotics: a systematic review and meta-analysis

OBJECTIVES

To summarize studies on prescribing medicine to general outpatients through the WHO/International Network for Rational Use of Drugs (INRUD) prescribing indicators with a focus on antibiotic prescription.

METHODS

A systematic review and random-effects meta-analysis of studies on the WHO prescribing indicators with a focus on the percentage of encounters with antibiotics prescribed (PEAP) was performed. The databases PubMed, Web of Science, EMBASE and Global Index Medicus were searched.

RESULTS

Twenty-six studies with a total of over 34 000 prescription encounters were included in the systematic review, showing a mean of two medicines per encounter. In each meta-analysis, a range of 19 to 25 studies was included. The percentages of medicines prescribed with an international non-proprietary name (INN) and from the essential medicines list (EML) were 91% and 96% of the total number of medicines, respectively, while 19% of encounters contained injections. Studies with over 25 000 prescription encounters reported an average PEAP of 58% and PEAP showed an increasing trend over the years included in this review. Multivariable meta-regression showed that PEAP increased with the average number of medicines per encounter (estimate = 0.83, P value = 0.0005). The number of medicines, study design and year of prescription explained over 40% of the variation in PEAP across studies.

CONCLUSIONS

Patterns of medicine use within and close to the WHO reference values were reported for the number of medicines, INN prescribing, prescription of injections and compliance with the EML, on average. Prescription of antibiotics requires attention as amounts much higher than the reference values were prescribed, which were even higher with polypharmacy and increasing over the years included in this review.

Evaluation of Rational Use of Medicine Using WHO/INRUD Core Drug Use Indicators at Teda and Azezo Health Centers, Gondar Town, Northwest Ethiopia

Background

Despite medicines are a major contributor to the health and well-being of the community, irrational use of medicines is being a serious public health crisis with significant harmful implications for patients, healthcare systems, and communities as a whole.

Objective

This study was aimed at evaluating the rational use of medicine using the World Health Organization/Network of Rational Use of Drugs (WHO/INRUD) core drug use indicators at Teda and Azezo health centers of Gondar town, northwest Ethiopia.

Methods

A cross-sectional study was conducted among 1200 prescription papers retrospectively, and 60 patients prospectively at two health centers of Gondar town, northwest Ethiopia from May 01/2019 to April 30/2020. The data were collected using a standard data collection checklist. Data were analyzed using SPSS^® version 24. The data were analyzed descriptively by using mean, frequency, and proportion.

Results

Prescribing indicators: From a total of 2595 prescribed medicines, 94% of them were prescribed by generic name; percent encounters with injection was 9.5±0.28%, percent encounters with antibiotics was 73.85±0.35%, and 100% of medicines were prescribed from the essential medicine list of Ethiopia. Patient care indicators: Only 16.7% of the patients knew the correct dosage of their medications, and 17.5% of dispensed medicines were adequately labeled. From the prescribed medications, only 77.17% were actually dispensed. Average consultation and dispensing time were 5.35 minutes and 40.24 seconds, respectively. Facility-specific indicators: Only 83.5% of key medicines were available in the health centers.

Conclusion

According to the WHO/INRUD core drug use indicators, rational medicine use is not achieved in terms of most components of the prescribing, patient care, and facility-specific indicators. Therefore, both health centers should work towards promoting the rational use of medicines.

Irrational drug use and its associated factors at Debre Markos Referral Hospital's outpatient pharmacy in East Gojjam, Northwest Ethiopia

Objectives:

Half of all drugs are used irrationally around the world, and about half of patients take their medications correctly. Inappropriate use of drugs leads to antibiotic resistance, medication therapy problems, and an increase in drug costs. This study aimed to assess irrational drug use and its associated factors at the outpatient pharmacy of Debre Markos Referral Hospital.

Methods:

A hospital-based cross-sectional study was used. Systematic random sampling was used as a sampling technique. The data were collected with a structured checklist. The data were entered into EPI Data Version 3.1 and analyzed using SPSS version 20. Descriptive statistics and logistic regression analysis were used for data analysis.

Results:

The average number of drugs per patient encounter was 2.14. The prevalence of antibiotics use per encounter was 39.3%. Polypharmacy was detected in 62.2% of prescriptions, and injections were prescribed in 13% of prescriptions. The percentage of drugs prescribed with a generic name was 95.5%. In multivariable logistic regression, comorbidities, professionals’ training, and prescribers’ experience were significantly associated with polypharmacy. Patient age, comorbidity, presence of chronic disease, professionals training, and type of diseases were significantly associated with antibiotic prescribing.

Conclusion:

Our findings revealed there were practices of polypharmacy and antibiotics overuse. Continuous seminars and training on rational prescribing and periodic prescription surveys are recommended to prevent irrational drug use.

Antiprotozoal Drug Handling and Management Practices in Asella District, Central Oromia, Ethiopia

Results

The preliminary survey comprising 70 animal health professionals and animal owners was undertaken through observation, interview using a structured questionnaire, and discussion with key informants to evaluate their handling and management practices of antiprotozoal drugs. According to the finding of this preliminary survey, there was inadequate antiprotozoal drug distribution and only few drugs, namely, diminazene diaceturate, amprolium, and sulfa drugs, were available with different trade names being imported from different manufacturing countries. Among the current available antiprotozoal drugs circulating in the area, those manufactured and imported from China were highly distributed in the majority of veterinary drug shops. The assessment showed that there was a gap in achieving the required knowledge and practice of proper handling and management issues in the professionals and awareness problems in the community. The study indicated that there were inappropriate transportation and storage practices. Moreover, selling drugs without prescription, ignoring farmers without properly informing the drug withdrawal period, and administration of drugs by nonprofessionals were the other most critical and unethical practices in the area. It is emphasized that this inappropriate handling and management practice, scarcity of antiprotozoal drugs, easy accessibility, and distribution by nonprofessionals could potentially affect the quality, safety, and effectiveness of antiprotozoal drugs which may lead to drug resistance development.

Conclusion

Hence, continuous awareness creation in the community, capacity building, training, and upgrading programs to the professionals, as well as strict enforcement of drug control and administration regulation of the country, are essential in the overall effort of improving animal health and productivity through the control of protozoan diseases in and around Asella.

Evaluation of drug prescription pattern using World Health Organization prescribing indicators in public health facilities found in Ethiopia: systematic reviews and meta-analysis

BACKGROUND

Drug use evaluation is a structured, methodological, and criteria-based drug assessment system that helps to evaluate the actual trend of drug use in a particular setting. If drug prescription practices are inappropriate, need to examine the patterns of drug use is necessary to change prescribing patterns accordingly. Therefore, this review aimed to determine the drug prescription pattern in public health facilities found in Ethiopia using prescribing indicators developed by the World Health Organization.

METHODS

This review was conducted as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Extensive searching to identify articles was conducted in PubMed, Medline, Web of Science, Research Gate, Africa Journal of Online, and Google scholar. Finally, 10 eligible articles were selected for analysis based on inclusion and exclusion criteria. The median value, as well as the 25th and 75th percentiles for each WHO prescribing indicator, were computed.

RESULT

The pooled median value of WHO prescribing indicators was reported as follows: the average number of drugs prescribed per encounter = 2.14 (IQR 1.79-2.52), the percentage of encounters with antibiotics prescribed = 43.46% (IQR 30.01-58.67), the percentage of encounters with an injection prescribed = 13.20% (6.47-40.7), percentage of drugs prescribed by generic name = 93.49% (89.13-97.96), and the percentage of medicines prescribed from essential medicines list = 92.54% (85.10-97.7). The forest plots determined for each prescribing indicator indicated that there is a high degree of heterogeneity across articles.

CONCLUSION

All of the prescribing indicators were not consistent with the standard values recommended by the World Health Organization. Therefore, public health facilities should take appropriate measures for improving the prescription patterns as per the recommendation set by the World Health Organization.

Assessment of Drug Use Pattern Using WHO Core Prescribing Indicators at Outpatient Settings of Governmental Hospitals in Dessie Town

Background

Enhancing the standards of medical treatment at all levels of the healthcare delivery system can improve the quality of life in developing countries. One method to promote rational drug use is an assessment of drug use pattern based on drug use indicators.

Objective

To evaluate prescription patterns at the outpatient pharmacy of Dessie Referral Hospital and Boru Meda Hospital at Dessie town.

Methods

An institution-based retrospective cross-sectional study was conducted to assess the prescribing patterns in governmental hospitals of Dessie town from April 1 to May 30, 2019. Six hundred eligible prescriptions were selected from each hospital through a systematic random sampling technique.

Results

The result of this study showed that both hospitals used standard prescriptions (100%). Age (99.0%) and name (94.7%) of patients were the most commonly recorded patient information while weight, address of patients and diagnosis were recorded only in 1.1%, 39.2% and 61.3% of the studied prescription papers, respectively. A total 2409 drugs were prescribed in the 1200 prescription papers and the percentage of encounters with injection(s) and antibacterial(s) was 9.0% and 42.6%, respectively. At each hospital, all drugs were prescribed from the Ethiopian essential drug list.

Conclusion

The present study revealed the use of standard presecription papers at both hospitals. None of the patient-related information was completely written in all prescrptions. For drug-related information, only the name of the drug was written in all prescription papers. There is also a significant deviation from the acceptable WHO standard for prescribing antibiotics.

Assessment of Prescription Completeness and Drug Use Pattern in Tibebe-Ghion Comprehensive Specialized Hospital, Bahir Dar, Ethiopia

Introduction

Irrational medicine use is a global problem, and one of its manifestation is inappropriate prescribing that occurs when medicines are not prescribed in accordance with the guideline.

Objective

The aim of the study was to assess prescription completeness and drug use pattern of the hospital using the WHO core drug use indicators.

Methods

1000 prescriptions were collected retrospectively from prescriptions written for 1 year from outpatient pharmacies of the hospital. Exit interview was employed to assess patient care indicators. The health facility indicators were checked by assessing the presence of drug formulary and availability of key medicines at the facility. Data were analyzed using SPSS version 20.

Results

It was found that only name of the patients was filled in all the prescriptions. Other informations were below the standard. The average number of drugs per prescription was 1.65. Percentages of encounter by generic name, with antibiotic and injections, were 85.78%, 41%, and 25%, respectively. The percentage of drugs prescribed from an essential drug list was 98.48%. The mean consultation time and dispensing time were 14.49 and 2.16 minutes, respectively. More than half patients had knowledge on drug dispensed to them (68%). The percentage of drugs actually dispensed was 65%, but none of the drugs dispensed were adequately labelled. A copy of EDL and 84% of the key drugs were available in the hospital.

Conclusion

From the results of our study, it can be concluded that all prescriptions were not complete, and except the average number of drugs prescribed per encounter, the other drug use pattern indicators were out of the WHO recommendation. Therefore, effective intervention program, like training, for promotion of rational drug use practice was recommended.

Evaluation of Medicine-Use Pattern Using World Health Organization's Core Drug-Use Indicators and Completeness of Prescription at University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia: Cross-Sectional Study

Background

Rational use of medicines is patients receiving medicines appropriate to their diagnosis in doses that meet their requirements for an adequate period of time at an affordable price. Irrational prescribing practices result in ineffective, unsafe treatment, prolong prognosis, and increase health-care costs, and this is a common phenomenon in Ethiopia. The aim of this study was to evaluate medicine-use pattern using World Health Organization core drug-use indicators and completeness of prescription at the University of Gondar Comprehensive Specialized Hospital.

Methods

A retrospective and prospective cross-sectional descriptive study was conducted at the dispensing pharmacy units of the health facility from March 2019 to May 2019 using a systematic random sampling technique. Data were analyzed using SPSS version 24.0, and results are presented using tables.

Results

A total of 1,128 medicines were covered in the analyzed sample. The response rate, using standard prescription paper was found to be 100%. Mean number of medicines per prescription was 1.88. The proportion of medicines actually dispensed was 74.56%, and 91.4% medicines were prescribed by their generic names. Among prescribed medicines, antibiotics accounted for 37.5%, and 20% of the prescribed medicines were injectable. Prescriptions containing patient name, identification number, age, and sex comprised 99.8%, 99.5%, 91.8%, and 94.5%, respectively of the total. Prescriptions signed by prescribers accounted for 96.2%, however, only 75.8% of prescribers wrote their name. Moreover, only 4.8% of dispensers printed their name, and 32.7% of prescriptions were signed by pharmacists. Patient-care indicators were found to be below standard.

Conclusion

Most prescriptions were incomplete, and prescribers by far completed their role than dispensers. The health facility has standard prescription paper and updated pharmaceuticals list. Percentages for encounters with antibiotics, prescribing by generic name, and patient-care indicators deviated from the standard. The dispensing and counseling time also far from the standard, and most medicines were not labeled.

Evaluation of Drug Use Based on the WHO Prescribing Indicator in Mizan-Tepi University Teaching Hospital, South Western Ethiopia: A Cross-sectional Study

Background:

Rational drug use comprises aspects of prescribing, dispensing, and patient use of medicines for different health problems. This study is aimed to assess drug prescribing practices based on the world health organization prescribing indicators in Mizan-Tepi University teaching hospital.

Methods:

An institutional-based, retrospective, cross-sectional study was conducted to evaluate the prescribing practices in Mizan-Tepi University teaching hospital. Data were collected based on the World health organization's drug use indicators using prescription papers. A total of 600 prescriptions, written for a 1-year time, dispensed through the general outpatient pharmacy of the hospital were collected by a systematic random sampling method from Mizan-Tepi University teaching hospital.

Results:

The present study found that the average number of drugs per prescription was 2.04 ± 0.87 in Mizan-Tepi University teaching hospital, with a range between 1 and 5. Prescribing by generic name was 97.6%, and 47.8% of prescriptions contained antibiotics in the hospital. 27.7% of prescriptions contained at least one injectable medication in Mizan-Tepi University teaching hospital. From prescribed drugs, 96.7% of them were prescribed from the Ethiopian essential drug list.

Conclusion:

: Present study indicated that the average number of drugs prescribed per encounter, the percentage of generic prescribing, and prescribing from the EDL were close to the optimal value. However, the percentage of encounters with antibiotics and injections prescribed was found to be very high. Thus, the study highlights some improvements in prescribing habits, particularly by focusing on the inappropriate consumption of antibiotics and injections.

Prescribing Pattern of Antibiotics Using WHO Prescribing Indicators Among Inpatients in Ethiopia: A Need for Antibiotic Stewardship Program

Background

Irrational prescribing of antibiotics is a universal public health problem, leading to antibiotic resistance. Understanding the prescribing pattern of antibiotics is crucial to tackling irrational prescription. Yet, comprehensive studies regarding the prescribing pattern of antibiotics among inpatients and the need for an Antibiotic Stewardship Program (ASP) are lacking in Ethiopia. This study aimed to evaluate prescribing patterns of antibiotics and the need for an ASP.

Methods

A hospital-based prospective observational study was carried out from February 2019 to December 2019. This study was conducted among patients admitted to Aksum University Comprehensive Specialized Hospital, Ethiopia. Data were collected using a data abstraction format generated by World Health Organization (WHO) prescribing indicators. Data analysis was carried out using SPSS version 25.0.

Results

A total of 1653 antibiotics were prescribed for 822 inpatients. Overall, 52.3% of patients had at least one oral and/or injectable antibiotic prescribed, for a mean duration of 4.2 (SD=2.3) days. The average number of prescribed antibiotics per patient was 2.01 (SD=1.9). The majority (97.6%) of antibiotics were prescribed by their generic name, and all prescribed antibiotics were from the national Essential Medicine List (EML). Frequently prescribed injectable and oral antibiotics were ceftriaxone (24.5%) and azithromycin (12.9%), respectively. Culture and sensitivity testing were not performed in any of the cases. During the study period, 65.2% of key antibiotics were available in stock.

Conclusion

In this study, more than half of patients were on at least one antibiotic, and all antibiotics were prescribed from the national EML. However, all antibiotics were prescribed empirically. This result shows that the prescribing pattern of antibiotics in the hospital deviates from and is non-compliant with the standard endorsed by WHO. This study provides evidence for the necessity and a way forward for the establishment of an ASP in the hospital that may help to introduce the prescribing of antibiotics with the aid of culture and sensitivity tests, and to develop institutional guidelines.

Practice towards Rational Drug Use at Finotselam and Asirade Zewudie Hospitals Based on WHO Core Drug Use Indicators, Northwest Ethiopia

Background

The rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community with full information and with the lowest possible cost. If one of these is not met, it is referred to as irrational drug use. Many drugs have been sold or prescribed inappropriately in the world, and a significant part of the world population lacks access to essential medicine. The aim of this study was to assess practice towards rational drug use at Finoteselam and Asirade Zewudie hospitals.

Methods

A cross-sectional study design was used for this study, and the study was conducted from October 11 to November 30, 2019. A total of 770 prescriptions were selected as per WHO criteria by using systematic random sampling and reviewed with the help of an observational checklist. The data were entered and processed with SPSS version 25 and evaluated using the WHO criteria.

Result

The average number of drugs per prescription was 1.8 and 2.05, antibiotics encountered were 77.7% and 72.5%, injections encountered were 5.97% and 7.01%, percentage of drugs prescribed by generic names was 97% and 93.4%, counseling time was 1.6 minutes and 2.25 minutes, and dispensing time was 51.3 seconds and 62.72 seconds at Finoteselam and Asirade Zewudie hospitals, respectively.

Conclusion

The majority of WHO core drug use indicators were not met in the two hospitals. The average number of drugs encountered in Asirade Zewudie hospital was slightly higher than the WHO recommended range, whereas the average number of drugs encountered in Finoteselam hospital was exactly equal. The percentage of antibiotics encountered was very high compared with WHO recommendation, but the percentage of injections encountered was below the WHO recommended range and time spent on counseling and dispensing was too short when compared with WHO recommendation. In addition to this, both hospitals had no essential drug list or formulary as well as a key drug list.

Prevalence of potential drug-drug interactions and associated factors among outpatients and inpatients in Ethiopian hospitals: a systematic review and meta-analysis of observational studies

BACKGROUND

Drug-drug interaction is an emerging threat to public health. Currently, there is an increase in comorbid disease, polypharmacy, and hospitalization in Ethiopia. Thus, the possibility of drug-drug interaction occurrence is high in hospitals. This study aims to summarize the prevalence of potential drug-drug interactions and associated factors in Ethiopian hospitals.

METHODS

A literature search was performed by accessing legitimate databases in PubMed/MEDLINE, Google Scholar, and Research Gate for English-language publications. To fetch further related topics advanced search was also applied in Science Direct and HINARI databases. The search was conducted on August 3 to 25, 2019. All published articles available online until the day of data collection were considered. Outcome measures were analyzed with Open Meta Analyst and CMA version statistical software. Der Simonian and Laird's random effect model, I² statistics, and Logit event rate were also performed.

RESULTS

A total of 14 studies remained eligible for inclusion in systematic review and meta-analysis. From the included studies, around 8717 potential drug-drug interactions were found in 3259 peoples out of 5761 patients. The prevalence of patients with potential drug-drug interactions in Ethiopian hospitals was found to be 72.2% (95% confidence interval: 59.1, 85.3%). Based on severity, the prevalence of major, moderate, and minor potential drug-drug interaction was 25.1, 52.8, 16.9%, respectively, also 1.27% for contraindications. The factors associated with potential drug-drug interactions were related to patient characteristics such as polypharmacy, age, comorbid disease, and hospital stay.

CONCLUSIONS

There is a high prevalence of potential drug-drug interactions in Ethiopian hospitals. Polypharmacy, age, comorbid disease, and hospital stay were the risk factors associated with potential drug-drug interactions.

Medication utilization pattern among outpatients during the Hajj mass gathering

Background

The Kingdom of Saudi Arabia (KSA) provides free healthcare, including medications, for the over 2 million Muslim pilgrims who attend Hajj every year. Information on drug utilization patterns at the Hajj is important to strengthen the supply chain for medicines, avert stock-outs, identify inappropriate use, and support public health planning for the event.

Method

We investigated drug utilization pattern among outpatients in eight seasonal Holy sites hospitals in Makkah, KSA, during the 2018 Hajj. Data on medication prescribed and dispensed were retrieved from the hospitals' electronic records. Data were also used to calculate six of the WHO indicators for drug use at these facilities.

Results

A total of 99,117 medications were prescribed for 37,367 outpatients during 37,933 encounters. Outpatients were mainly older males and originated from 134 countries. Twenty medications accounted for 72.8% of the 323 different medications prescribed. These were mainly nonsteroidal anti-inflammatory drugs, analgesics and antipyretics, and antibacterial medicines for systemic use. Outpatients were prescribed an average of 2.6 (SD = 1.2) drugs per consultation and polypharmacy (≥5 medications) was observed in 4.8% of the encounters. Antibiotics and an injection were prescribed in 46.9% and 6.5% of encounters, respectively. Nearly 90% of the prescribed drugs were actually dispensed. On average, medications were dispensed 16.4 (SD = 119.8) minutes from the time they were prescribed for the patient. All hospitals had a copy of the essential drugs list available and all of the prescribed drugs appeared on that list.

Conclusion

Nonsteroidal anti-inflammatory drugs, analgesics and antibiotics are the most common medications prescribed to outpatient during Hajj. Our results, including the calculated WHO drug use indicators, can form a basis for further investigations into appropriate drug use at the Hajj and for planning purposes. These results could also guide the development of reference values for medications prescribing and use indicators at mass gatherings.

Patient Knowledge of Correct Dosage Regimen; The Need for Good Dispensing Practice

Background: The inappropriate use of medicine is a widespread problem, especially in developing countries. Proper dispensing practices as part of medication therapy increase benefits and minimize risks to the consumers. Objective: The purpose of this study was to assess patient knowledge of dosage regimen and the pharmacists dispensing practice. Method: A cross-sectional study design was conducted at Jimma Medical Center from March 1, 2018 to April 29, 2018. Data were collected prospectively using checklists and structured questionnaires. Results: Of the total prescribed drugs, 689 (74.25%) were actually dispensed, and 239 (34.7%) drugs were adequately labeled. The average dispensing and consultation times were 41.45 ± 12.1 and 49.13 ± 12 seconds, respectively. Of the total participants on exit interview, 267 (74.8%) correctly reported the dosage schedule of dispensed medicines. From the multivariate logistics regression analysis, language barrier (adjusted odds ratio [AOR] = 32.6, 95% confidence interval [CI] = 12.23-87.15), severity of health condition (AOR = 7.3, 95% CI = 2.70-19.56), and the number of drugs dispensed (AOR = 0.41, 95% CI = 0.18-0.87 [1 drug], AOR = 0.16, 95% CI = 0.61-0.42 [2 drugs]) have shown significant association with patient knowledge of dosage regimen. Conclusions: Majority of the patients did not receive the prescribed medicines from the outpatient pharmacy of Jimma Medical Center. Plus, only a few of the dispensed drugs contain all the necessary information. However, a large portion of the participants correctly reported the dosage schedule of their drugs.

Evaluation of Medication Use Pattern Among Patients Presenting to the Emergency Department of Hiwot Fana Specialized University Hospital, Using WHO Prescribing Indicators

Background

Ensuring rational drug use requires ongoing evaluation of drug prescribing, dispensing, and use by patients. Health care providers working in an emergency department face unique challenges, including making urgent decisions, patient overload, and limited resources, which contribute to inappropriate drug use. Rational medication use should be an important aspect of emergency care to improve patient outcomes. Thus, this study was conducted to assess medication utilization patterns using World Health Organization (WHO) prescribing indicators in the emergency department.

Methods

A cross-sectional study design was implemented among patients presenting at the emergency department of Hiwot Fana Specialized University Hospital (HFSUH) from January to March 2018. The data were collected from the medical charts of a total of 342 patients using a pre-prepared structured format according to WHO recommendations. The data were analyzed using SPSS version 21 software and presented in tables and figures.

Results

The most commonly reported clinical diagnosis was found to be soft tissue laceration or abrasion, in 75 patients (21.9%), followed by dyspepsia, in 50 (14.6%), and severe pneumonia, in 44 (12.9%). A total of 810 drugs were prescribed for the 342 patients. The main category of drugs prescribed were analgesics, constituting 125 (29.2%), followed by antibiotics, 120 (28.0%). Regarding WHO prescribing indicators, the average number of drugs prescribed per encounter was 2.36, the number of encounters at which antibiotics were prescribed was 127 (37.13%), and injections were prescribed at 300 (87.7%) encounters. All of the drugs prescribed were from the National Essential Medicine List (NEML) of Ethiopia, and 780 (98.1%) of the drugs were prescribed by international nonproprietary name.

Conclusion

Overall, there were inflated use of antibiotics and injection drugs, whereas prescribing by international nonproprietary name and prescribing from NEML were according to the recommendations. Hence, the hospital should work to ensure the judicious use of antibiotics and injection drugs.

Evaluating current practices and policies in the use of injectable medicines for treating myalgia in a primary care center in Pamekasan, Indonesia

Background Myalgia in patients can be associated with a large array of conditions, including injuries, infections and inflammations. Treatment for myalgia may include the use of oral, topical and injectable medicines (IM). However, the use of IM has been restricted by the World Health Organization due to the common hazards associated with inappropriate medicine use, risks of disease transmission and more expensive spending for using IM. Accordingly, the Ministry of Health of Indonesia (MoH) has limited the use at the level of ≤1% in every primary care center (Puskesmas) across the nation. The aim of this study was to report and evaluate rational drug use injection in myalgia in a Puskesmas in Pamekasan, Indonesia. Methods This study reviewed official documents, such as rational drug use report, medicine use databases and drug request report. The documents were obtained from the district health office or public domain from 2014 to 2018. Data were then collated, extracted and presented as frequencies. Results The average rate of use of IM for myalgia in Pamekasan was 36.15%. All 20 Puskesmas in Pamekasan conducted injection practice above the recommended level, thus reflecting a major gap between practice and policy implementation. This study implies that a substantial effort is needed to enforce the policy. Conclusions The use of IM for myalgia treatment in Pamekasan from 2014 to 2018 was significantly higher than the recommended level, thus reflecting a major problem in the practice. This is an alarming call for the local healthcare stakeholders to improve such a situation.

Evaluation of rational drug use based on World Health Organization prescribing indicators in a primary care center in Pamekasan East Java, Indonesia

Background The Government of Indonesia has put in place many interventions for rationalizing drug use at all levels of the health services including in primary care centers (puskesmas). One of the programs for the rational use of drugs at the puskesmas is the monitoring and evaluation of drug use conducted by pharmacists. The purpose of this research was to evaluate the rationality of drug use in Pamekasan puskesmas that use World Health Organization (WHO) prescribing indicators and to find the difference in the percentage of rationality of drug use between puskesmas in Pamekasan. Methods This study reviewed official documents considering reporting of rational drug use. The documents were obtained from the district health office or from the public domain from 2014 to 2018. Data were then collated, extracted, and presented as frequencies. Results The percentage prescribed for antibiotics for acute respiratory infection (ARI) non-pneumonia was 47.27% and percentage prescribing antibiotic drugs in a non-specific diarrhea was 59.85%. The percentage prescribed for injection was 36.15%. The average number of drugs prescribed per treatment was 2.61. Conclusions The majority of WHO guidelines stated that prescribing indicators were not met by the puskesmas in Pamekasan, except for the parameters for the average number of drugs prescribed per consultation. This shows an alarming clarion call for the local healthcare stakeholders to improve such situations.

Rational Drug-Use Evaluation Based on World Health Organization Core Drug-Use Indicators in a Tertiary Referral Hospital, Northeast Ethiopia: A Cross-Sectional Study

Background

Irrational use of drugs is often observed in health-care systems throughout the world, particularly in developing countries. The World Health Organization estimates that more than half of all medicines are prescribed, dispensed, or sold inappropriately and that half of all patients fail to take them correctly. Therefore, the study was aimed at investigating the practice of rational drug use in a referral and teaching hospital in Northeast Ethiopia.

Methods

A hospital-based cross-sectional design was employed to conduct the study from February 2019 to May 2019. Systematic random sampling was used to select prescriptions dispensed in outpatient pharmacies. Convenient sampling was employed to select patient attendants and their prescriptions in outpatient departments during the study period. Data were collected using a structured and technical observational checklist for prescribing, patient care, and health-facility indicators. Face-to-face interviews were also employed to assess patient knowledge of correct dosage among patient-care indicators. Data were analyzed using SPSS version 20. Descriptive statistics are given using frequency, proportions, and summary measures.

Results

An average of 2.5 drugs per encounter were prescribed, with 34.64% and 13.80% of prescriptions being antibiotics and injections, respectively. Generics were used in 90.53% of prescription, and nearly 83% of drugs were prescribed from an essential-drug list. Average consultation and dispensing times were 1.57 minutes and 47 seconds, respectively. A total of 362 drugs were prescribed, with 82.6% actually dispensed and only 22.7% adequately labeled. The hospital had its own drug formulary and essential drug list, but no standard treatment guidelines. Moreover, except propyl thiouracil, all key essential drugs included in the study were available.

Conclusion

The majority of World Health Organization-stated core drug-use indicators were not met by the referral hospital in this study, which is especially problematic regarding patient-care indicators.