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Manirakiza A, Gitonga Nyamu D, Maru SM, Bizimana T, Nimpagaritse M. Evaluating drug use patterns among paediatric outpatients in Burundi. J Pharm Policy Pract 2024; 17:2312369. [PMID: 38444527 PMCID: PMC10914302 DOI: 10.1080/20523211.2024.2312369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Background Rational prescribing is key to optimising therapeutic outcomes and avoiding risks associated with irrational use of medicines. Using WHO drug use indicators, this study evaluated drug use patterns among paediatric outpatient encounters at Primary Healthcare Centers (PHCs) in Bujumbura Mairie, Republic of Burundi. Methods Descriptive cross-sectional research assessed paediatric medicine use in 20 PHCs. From 8 February to 7 April 2023, 800 randomly selected paediatric encounters' 2022-year data were retrospectively collected. Data for specific facility indicators were prospectively collected. SPSS 23 was used to analyse data. Results 800 outpatient child encounters were analysed, 48.4% female and 51.6% male. The mean number of medicines per encounter was 2.4(±0.99). The injection rate was 9.9%. Overall, 78.8% of generics and 85.2% of essential medicines were prescribed. Results show drug prescribing differences between private and government PHCs (p < 0.001). All PHCs studied had no standard treatment guidelines (STGs), while 50% had an essential medicine list (EML) and 85% of key medicines were available. Conclusion Poor prescribing practices were found indicating the need for interventions to promote good drug use practices. A large study at a national scale is required to provide a more comprehensive understanding of the overall drug use practices.
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Affiliation(s)
- Audace Manirakiza
- Master of Health Supply Chain Management at the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David Gitonga Nyamu
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, Faculty of Health Sciences, University of Naïrobi, Nairobi, Kenya
| | - Shital Mahindra Maru
- Faculty of Health Sciences, Department of Pharmaceutical Chemistry, Pharmaceutics and Pharmacognosy, University of Naïrobi, Nairobi, Kenya
| | - Thomas Bizimana
- Master of Health Supply Chain Management at the East African Community Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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MORADI FARIDEH, BAZYAR MOHAMMAD, SOROUSH ALI, SEYEDIN HESAM, SOLEYMANI FATEMEH, ETEMADI MANAL, EZADI SAEED, SALIMI MEHDI, BEHZADIFAR MASOUD, MARTINI MARIANO, HUSSAIN REZWANA. Understanding conflicts of interest in rational drug prescription in a developing country: A stakeholder analysis, healthcare guidelines and ethical public health issues. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E358-E366. [PMID: 38126000 PMCID: PMC10730053 DOI: 10.15167/2421-4248/jpmh2023.64.3.3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 12/23/2023]
Abstract
Background Rational drug prescription (RDP) is one of the main components of the healthcare systems. Irrational prescribing can bring about numerous negative consequences for the patients and governmental agencies. This study aims to analyze the involvement of stakeholders in rational drug prescribing, their position (opponent or proponent), and the rationale behind it. Methods This was a qualitative study conducted in 2019. Semi-structured face-to-face interviews were conducted with 40 stakeholders. Purposive and snowball sampling techniques with maximum heterogeneity were adopted to select the interviewees. Data was analyzed by MAXQDA software using thematic approach. Results Iranian Food and Drug Administration employs the highest authority on the rational prescribing policy. Although the Ministry of Health and Medical Education, the Social Security Organization as one of the main health insurance organizations, pharmaceutical companies, and the Medical Council of the Islamic Republic of Iran, are among agencies that have great authority to improve rational prescribing, they fail to act professionally as they have conflicting interests. Remarkably, the Iran Food and Drug Administration, insurance organizations, family physicians, and patients, highly support the rational prescribing policy while the pharmaceutical companies display the least support for it. Conclusions To make the prescription and using drugs more rational, policy makers should focus on different sources of conflicts of interest that different actors have. They should devise legal, behavior and financial policies accordingly to lessen or at least neutralize these conflicting interests, otherwise achieving RDP would be impossible in short and long terms.
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Affiliation(s)
- FARIDEH MORADI
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - MOHAMMAD BAZYAR
- Department of Health Management and Economics, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - ALI SOROUSH
- Cardiovascular Research Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - HESAM SEYEDIN
- Associate Professor, Department of Health Disaster Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - FATEMEH SOLEYMANI
- Department of Pharmaco-economics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - MANAL ETEMADI
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - SAEED EZADI
- Department of Health and Social Medicine, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - MEHDI SALIMI
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - REZWANA HUSSAIN
- Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, St. Mary’s Hospital, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Antibacterial prescription and the associated factors among outpatients diagnosed with respiratory tract infections in Mbarara Municipality, Uganda. BMC Pulm Med 2021; 21:374. [PMID: 34781920 PMCID: PMC8591439 DOI: 10.1186/s12890-021-01739-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Respiratory tract infections (RTI) are the second most frequent diagnosis after Malaria amongst Outpatients in Uganda. Majority are Non pneumonia cough and flu which are self-limiting and often do not require antibacterials. However, antibiotics are continuously prescribed for these conditions and are a major contributor to antimicrobial resistance and wastage of health resources. Little is known about this problem in Uganda hence the impetus for the study. Objectives To determine the antibacterial prescribing rate and associated factors among RTI outpatients in Mbarara municipality Methodology This was a retrospective cross-sectional study on records of RTI outpatients from 1st April 2019 to 31st March 2020 (prior to the novel corona virus disease pandemic) in four selected public health facilities within Mbarara municipality. A pretested data caption tool was used to capture prescribing patterns using WHO/INRUD prescribing indicators. We used logistic regression to determine factors associated to antibacterial prescribing. Results A total of 780 encounters were studied with adults (18-59 years) forming the largest proportion of age categories at (337, 43.15%) and more females (444, 56.85%) than men (337, 43.15%). The antibacterial prescribing rate was 77.6% (606) with Amoxicillin the most prescribed 80.4% (503). The prescribing pattern showed an average of 2.47 (sd 0.72) drugs per encounter and the percentage of encounters with injection at 1.5% (24). Drugs prescribed by generic (1557, 79%) and drugs prescribed from essential medicine list (1650, 84%) both not conforming to WHO/INRUD standard; an indicator of possible irrational prescribing. Female gender (adjusted odds ratio [aOR] = 1.51, 95% confidence interval [CI]: (1.06–2.16); 18–59 years age group (aOR = 1.66, 95% CI: 1.09–2.33) and Individuals prescribed at least three drugs were significantly more likely to have an antibacterial prescribed (aOR= 2.72, 95% CI: 1.86–3.98). Conclusion The study found a high antibacterial prescribing rate especially among patients with URTI, polypharmacy and non-conformity to both essential medicine list and generic name prescribing. This prescribing pattern does not comply with rational drug use policy and needs to be addressed through antimicrobial stewardship interventions, prescriber education on rational drug use and carrying out more research to determine the appropriateness of antibacterial prescribed.
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Shi L, Chang J, Liu X, Zhai P, Hu S, Li P, Hayat K, Kabba JA, Feng Z, Yang C, Jiang M, Zhao M, Hu H, Fang Y. Dispensing Antibiotics without a Prescription for Acute Cough Associated with Common Cold at Community Pharmacies in Shenyang, Northeastern China: A Cross-Sectional Study. Antibiotics (Basel) 2020; 9:E163. [PMID: 32268530 PMCID: PMC7235837 DOI: 10.3390/antibiotics9040163] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 01/21/2023] Open
Abstract
: The inappropriate use of antibiotics is a major health issue in China. We aimed to assess nonprescription antibiotic dispensing and assess pharmacy service practice at community pharmacies in Shenyang, northeastern China, and to compare these practices between pediatric and adult cases. A cross-sectional study was performed from March to May 2018 using the standardized client method. Two different simulated scenarios were presented at pharmacies, namely, pediatric and adult acute cough associated with a common cold. Of 150 pharmacy visits, 147 visits were completed (pediatric case: 73, adult case: 74). A total of 130 (88.4%) community pharmacies dispensed antibiotics without a prescription, with a significant difference between pediatric and adult cases (pediatric case, 79.5% versus adult case, 97.3%, p = 0.005). Symptoms were asked in most visits (pediatric case: 82.2%, adult case 82.4%). Patients' previous treatment and history of allergies were both inquired more frequently in the pediatric cases than in the adult cases. Medication advice was provided more often in the adult cases than in pediatric cases. Antibiotics were easily obtained without a prescription in Shenyang, especially for adult patients. Adequate inquiries and counseling had not occurred in most pharmacies.
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Affiliation(s)
- Li Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Xiaoxi Liu
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang 110016 China;
| | - Panpan Zhai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Shuchen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Zhitong Feng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa 999078, Macao, China;
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (L.S.); (P.Z.); (S.H.); (P.L.); (K.H.); (J.A.K.); (Z.F.); (C.Y.); (M.J.); (M.Z.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
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