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.

A PROSPECTIVE OBSERVATIONAL STUDY ON MEDICATION USE PATTERN IN PATIENTS WITH RISK FACTORS OF CHRONIC KIDNEY DISEASE

Objectives: The current study was undertaken to review and assess the medication usage pattern in patients with chronic kidney disease (CKD). Methods: A 12-month prospective observational study was carried out at Shadan Teaching and General Hospital, Peerancheru (Hyderabad), involving 384 CKD patients considering the inclusion and exclusion criteria. Medication evaluation for optimization was done using the World Health Organization (WHO) core prescribing indicators. Data collected were entered using Microsoft Excel. Descriptive statistics such as mean, percentage, and standard deviation (SD) were used to present sociodemographic characteristics of the study participants. Results: Out of the total of 384 patients, 249 (65%) were male and 135 (35%) were female with a mean age of 58.28 (SD: 13.12). A total of 384 prescriptions were scrutinized with a total of 3634 drugs, out of which drugs acting on the cardiovascular system were the most prescribed drugs (36.37%). The average number of drugs per prescription was found to be 9.08 considering the total number of prescriptions. The percentage of drugs prescribed by generic name was 15.57%. The percentage of encounters with antibiotics was 25%, whereas the percentage of encounters with injections was 86%. The percentage of drugs prescribed from the Essential Drug List or Formulary was found to be 26.36%. Conclusion: Assessment of medication usage patterns using the WHO core indicators in CKD patients helps to reinforce the current hospital guidelines for the optimal usage of medications. The introduction of a clinical pharmacist along with a multidisciplinary team provides intensive care to the patients and helps to improve the clinical outcome.

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.

Study of Drug Prescribing Pattern in Pediatric Outpatient Department at a Tertiary Care Teaching Hospital

Background: Infants and children suffer from frequent but usually non serious illnesses and are more vulnerable to various adverse events related to drugs and poor understanding of instructions on prescription by the patient or caretakers were likely to cause medication error. The correct identification of an illness and its management with medications is a vital aspect of patient care, especially for paediatric population. So, prescribing pattern studies are very helpful in promoting the appropriate use of drugs in population. Objectives: It aims to obtain data on the current prescribing pattern in pediatric OPD at a tertiary care teaching hospital with ultimate goal to promote appropriate use of drugs. Methods: This study was conducted in 62 pediatric patients of either sex visiting Pediatric out-patient department over a period of three months at NMCH and RC, Raichur, Karnataka. Results: Prescription analysis showed that the average number of drugs per prescription was 3.32. Drugs were mostly prescribed by brand name (98.06%), Injections (4.83%) were least prescribed, drugs prescribed from Essential Drug List was 48.54%. Antibiotics were most prescribed class of drugs (33.9%). Conclusion: The study concludes that polypharmacy was slightly seen in prescriptions. Diagnosis of the patient was recorded for most of the prescriptions. There is need to conduct many such studies at regular interval as it is useful for auditing large number of prescriptions to find out early signals of the irrational drug use. Our study evaluated drug use pattern only from the outpatients hence prescription pattern may vary among inpatients. Keywords: Prescribing pattern, Infants, WHO core prescribing indicators, Polypharmacy, Generic name

Assessment of prescription completeness and antibiotic consumption at a rural health and training centre, Delhi

Background: The prescription audit is a useful method to assess the doctors’ contribution to the rational use of drugs in a country. A prescription is considered complete when it covers all the parts of the prescription. The polypharmacy increased the risk of drug interaction, dispensing errors and confused the patients for dosage schedules. A prescription with the minimum number of drugs per prescription helps in rational pharmacotherapeutics. The objectives of this study were to describe the pattern and completeness of prescription at rural health and training center and to estimate antibiotic consumption at rural health and training center.Methods: A descriptive cross-sectional study was conducted to determine the current prescribing practice at RHTC. Data were collected in the two pharmacies of the rural hospital. A total of 612 prescriptions with the last refill were considered for the assessment.Results: The average number of drugs prescribed per prescription 3.53. The percentage of prescriptions in which an antibiotic was prescribed was 20%. The percentage of drugs prescribed by generic name and from an essential drug list was 71.5% and 98.7% respectively. The most commonly prescribed form of antibiotics was extended-spectrum penicillin.Conclusions: All the prescriptions were complete covered parts of prescriptions. The dosing errors were present in maximum prescriptions. The WHO prescribing indicators were within the limits, an average number of drugs per prescription suggests a practice of polypharmacy. The peak of the use of antibiotics was observed in September followed by January and November. The least use of antibiotics was in December followed by June.

Assessment of veterinary drugs dispensing practices in veterinary clinics in Gondar town, North West Ethiopia: a cross sectional study

<p class="abstract"><strong>Background:</strong> Dispensing practice plays a major role in the provision of rational drug therapy. This study aimed to assess the veterinary drug dispensing practice by pharmacists and other veterinarian assistance in veterinary clinic Gondar town.</p><p class="abstract"><strong>Methods:</strong> A cross-sectional prospective descriptive study was carried out in the OPD of three public veterinary clinics in Gondar town for three months. The health facility indicators were examined by ensuring the good dispensing practices in three veterinary clinic and availability of essential drug list.</p><p class="abstract"><strong>Results:</strong> The average consultation time was 13 min and 50 sec. The average dispensing time was 5 min and 3 sec calculated from 100 prescriptions. The percentage of drugs dispensed was 97.50% and percentage of drugs adequately labeled was high from the dispensed drugs (74.4%). The average patients with drug dosage knowledge were very low (25%). The result of the study revealed that the two veterinary clinic health facilities do not have any essential drug list. Out of three, one of them has a key drug from the WHO list 1 (30%) drug was available.</p><p class="abstract"><strong>Conclusions:</strong> The overall good dispensing practices at three veterinary clinics is low. Training, supportive supervision through continuous medical education, regular up-to-date medicine information and standard treatment guideline, and therapeutic audit are required for improvement of medicine use by prescriber and dispensers.</p>

PRESCRIBING PATTERN OF DRUGS USED IN PAEDIATRIC PATIENTS IN OUTPATIENT DEPARTMENT OF A TERTIARY CARE INSTITUTION

Background: Paediatric prescription is a major concern in terms of public health since infections are the most frequent cause of childhood disease. The aim of this hospital-based observational prospective study was to assess the pattern of drug use in the paediatric outpatient department attached to government medical college, Amritsar. Methods: A prospective study of six months duration was carried out for the month of October 2020 to March 2021. A total number of 201 patients case sheets were utilized for our study from paediatric out-patients department of GNDH, Amritsar. The data collected was then analysed for various prescribing indicators as laid down by world health organisation (WHO) for analysis of drug use parameters. Results: The average number of drugs per encounter was 2.52. In present study antibiotic were 18% of total drugs prescribed. Antihistaminics prescribed were 25%. Syrup was the most prescribed dosage form. %age of drugs prescribed from essential drugs list was 60.3%. Polypharmacy was evident from the study. Conclusions: Drug prescribing in children is relatively high in GNDH, Amritsar. This study revealed deviation in prescribing pattern from WHO core prescribing indicators. Possible reasons are heavy patient load, lack of essential drug list, insufficient government supply of generic drugs and lack of regular prescription audits. Keywords: prescription pattern, observational study, Paediatric, WHO core prescribing indicators.

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.

Monoclonal antibodies for cancerous conditions in essential medicine list: An experience from a tertiary hospital in Bengaluru, India

Globally, cancer is emerging as a major public health problem. Monoclonal antibodies are extensively used for cancerous conditions at tertiary hospitals. Many of these are not easily available for patients seeking treatment from public sector. It is difficult for poor patients to afford these drugs on individual basis.The aim of our study is to calculate the prescribed daily dose of monoclonal antibody in cancerous conditions, to know the number of monoclonal antibody present in the essential drug list and to know the average total number of drugs prescribed in generic names. The average dose of the monoclonal antibody used is calculated and the common conditions for which it is used is tabulated and the drug usage is noted for both genders. The number monoclonal antibody present in the list of essential medicine of India and WHO is compared. The average total number of drugs prescribed in generic names is calculated.Average prescribed dose calculated was 382 mg for Trastuzumab, 455mg for rituximab. Only a few monoclonal antibodies were found in who essential drug. Only Trastuzumab and rituximab monoclonal antibody were found in the essential drug list of India. While, Trastuzumab is the most commonly (61%) prescribed drug in the generic form. The study concludes that Trastuzumab is the commonly used monoclonal antibody followed by Rituximab and Bevacizumab. Only Trastuzumab and rituximab were found in Indian essential drug list. Measures for Inclusion of other monoclonal anti bodies can be made by the policy decisions.

PRESCRIBING TRENDS IN ASTHMA IN PEDIATRICS: A LONGITUDINAL, OBSERVATIONAL STUDY

Objectives: In recent years, the prevalence of asthma has globally increased. Despite intensive treatment, many children with asthma are not achieving good symptom control. The present study aims to analyze the prescribing trends in pediatric asthma according to the World Health Organization (WHO) prescribing indicators. Methods: This was an observational, longitudinal study conducted for the duration of 6 months with a sample size of 62. Children with age 1–14 years with asthma, who fulfilled the inclusion criteria, were enrolled after obtaining the written informed consent. Data were collected from outpatient department prescription slips for 2 times, one at 1st enrollment and the next after 1 month and changes in the prescription were noted. Peak expiratory flow rate (PEFR) was measured on both visits and the change in PEFR was noted. Results: Male predominance was seen (67.74%) with age of 5–9 years (40.32%). Average number of drugs per prescription was 1.96. The most commonly prescribed anti-asthmatic drug was inhaled corticosteroids (ICS) (78.22%). Only 1.5% drugs were prescribed by generic names and 22.22% drugs from the essential drug list. Inhalational route (38.71%) was preferred over the oral route (20.97%). After 1 month of treatment, change in PEFR was found to be statistically significant. Conclusion: The study concluded that average number of drugs per prescription and use of antibiotics was conforming to the WHO prescribing standards but prescribing from essential medicines list and by generic name need to be encouraged.