Assessment of drug use patterns in terms of the WHO patient-care and facility indicators at four hospitals in Southern Ethiopia: a cross-sectional study

Comparing pharmacy practice in health facilities with and without pharmaceutically trained dispensers: a post intervention study in Tanzania

Background

The critical shortage of comprehensively trained healthcare staff in Tanzania affects the capacity to deliver essential health services, attain universal health coverage and compromises health outcomes. There is a specific lack of suitably trained pharmaceutical professionals, thus, an increase in the use of unqualified or poorly trained staff. Following the introduction of a one-year pharmacy dispenser course intervention, this study explored the impact that the new cadre of graduates had on pharmacy practice compared to healthcare facilities with non-pharmacy trained dispensers (NPTDs).

Methods

A post intervention assessment was conducted in 2021 using questionnaires formulated to measure indicators of Good Pharmacy Practice, comparing 29 public health facilities employing pharmacy-trained dispensers (PTD) with 32 public health facilities with NPTDs in Dodoma, Shinyanga and Morogoro regions of Tanzania. Data were collected by experienced pharmacists or pharmaceutical technicians and subsequently aggregated and statistically analysed.

Results

The dispensing times for medicines were found to be the same for PTDs and the NPTDs (2 min). There were no statistically significant differences in the adequacy of labelling elements between PTDs and NPTDs. Patients' level of knowledge of the medicines dispensed to them, from both PTDs and NPTDs, showed no difference. Moreover, no differences were observed in storage practice and documentation performance, records of dispensed medicines, handling of medicines and the dispensing area cleanliness between both groups. Overall, facilities with PTDs averaged a higher availability of tracer medicines (77%) than those with NPTDs (70%), however, availability of health commodities in all health facilities in the three regions was low and there was no statistically significant difference between both groups.

Conclusion

The study showed no significant difference in performance of pharmacy practice between PTDs and NPTDs despite the former undertaking a one-year training course intended to improve knowledge and skills. Practice application not only depends on effective training but on the working environment. Clear job descriptions, appropriate tools and references to guide, Standard Operating Procedures, acceptance by management of the training undertaken to actively encourage recruits to apply these new skills could improve PTDs performance. Training and knowledge alone do not seem to lead to better practice and performance.

Assessment of drug use in primary health centers in Lagos State, Nigeria

Introduction

rational drug use prevents wastage of resources, loss of confidence in healthcare system and drug-related morbidity and mortality. This study aims to assess drug use in Primary Health Centers (PHCs) in Lagos State, Nigeria using the World Health Organization in collaboration with the International Network of Rational Use of Drugs core drug use indicators.

Methods

the study was conducted between February to October 2021 as a comparative observational survey of selected PHCs. It included a retrospective and prospective cross-sectional design for prescribing and patient care indicators assessing 2640 prescriptions and clients respectively. Data were analyzed and presented as frequency with percentage or mean with standard deviation, as applicable. The performances of the types of PHCs were compared using two-sample t-test. A 2-tailed p-value < 0.05 was considered statistically significant.

Results

average number of drugs per prescription, drugs prescribed by the generic name, percentage of encounters with prescribed antibiotics and injections were 3.6 ± 0.9%, 76.5 ± 18.5%, 63.3 ± 19.1% and 21.1 ± 24.1% respectively with no significance difference between the comprehensive and basic PHCs. For all the facilities, the average consultation and dispensing times were 10.5 ± 6.0 minutes, 244.9 ± 179.2 seconds respectively. In this study, the percentage of patients' knowledge of the correct dosage was 72.4 ± 38.3%. There is statistically significant difference in availability of key drugs in stock between the comprehensive and basic PHCs (p-value 0.0001).

Conclusion

irrational drug use practices exist in comprehensive and basic PHCs. There is a need to implement interventions aimed at strengthening good prescribing and patient-care practices across the PHCs in Lagos State.

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.

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.

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.

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.

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.

Examination of WHO/INRUD Core Drug Use Indicators at Public Primary Healthcare Centers in Kisii County, Kenya

Background

Irrational drug use is a global problem. However, the extent of the problem is higher in low-income countries. This study sets out to assess and characterize drug use at the public primary healthcare centers (PPHCCs) in a rural county in Kenya, using the World Health Organization/International Network for the Rational Use of Drugs (WHO/INRUD) core drug use indicators methodology.

Methods

Ten PPHCCs were randomly selected. From each PPHCC, ninety prescriptions from October to December 2018 were sampled and data extracted. Three hundred (30 per PPHCC) patients and ten (1 per PPHCC) dispensers were also observed and interviewed. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use.

Results

The average number of drugs per prescription was 2.9 (SD 0.5) (recommended: 1.6–1.8), and the percentage of drugs prescribed by generic names was 27.7% (recommended: 100%); the percentage of prescriptions with an antibiotic was 84.8% (recommended: 20.0–26.8%), and with an injection prescribed was 24.9% (recommended: 13.4–24.1%). The percentage of prescribed drugs from the Kenya Essential Medicines List was 96.7% (recommended: 100%). The average consultation time was 4.1 min (SD 1.7) (recommended: ≥10 min), the average dispensing time was 131.5 sec (SD 41.5) (recommended: ≥90 sec), the percentage of drugs actually dispensed was 76.3% (recommended: 100%), the percentage of drugs adequately labeled was 22.6% (recommended: 100%), and the percentage of patients with correct knowledge of dispensed drugs was 54.7% (recommended: 100%). Only 20% of the PPHCCs had a copy of KEML available, and 80% of the selected essential drugs assessed were available.

Conclusion

The survey shows irrational drug use practices, particularly polypharmacy, nongeneric prescribing, overuse of antibiotics, short consultation time, and inadequacy of drug labeling. Effective programs and activities promoting the rational use of drugs are the key interventions suggested at all the health facilities.

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.

Evaluation of Drug Use Pattern in Emergency Department of Dilchora Referral Hospital, Dire Dawa, Ethiopia

Background

Drug use evaluation is a system of continuous, systematic, criteria-based drug evaluation that ensures the appropriate use of drugs. Rationalization of drug therapy in emergency medicine would be useful in managing the broad array of conditions that present for emergency care. High-quality drug utilization is associated with the use of a relatively limited number of essential medicines. The World Health Organization developed core drug use indicators for conducting drug utilization studies in healthcare setting. WHO core drug use indicators including prescribing indicators, patient care indicators, and health facility indicators are used nowadays.

Objective

The aim of this study was to evaluate the drug use pattern in the Emergency Department of Dilchora Referral Hospital, Dire Dawa, Ethiopia, 2018.

Methods

A retrospective cross-sectional descriptive study was conducted in the emergency department (ED) of Dilchora Referral Hospital from July 20 to August 19, 2018, using structured data collection format.

Result

Out of 344 prescriptions analyzed, a total of 753 medications were prescribed. The average number of drugs per prescription was 2.19. Of drugs prescribed, 685 (90.97%) were in their generic names. Antibiotics were prescribed in 95 (27.62%) of encounters, and injections were prescribed in 154 (44.77%) of encounters. Among 753 medications prescribed, the name and strength of drugs are indicated in 100% and 95.22%, respectively. 679 (90.17%) of drugs were prescribed from the essential drug list of Ethiopia.

Conclusion

The findings of this study revealed that the drug utilization pattern was not optimal in accordance with the standard values of WHO prescribing indicators. Some of the prescribing indicators like overprescribing of antibiotics and injections were a problem. Therefore, it is very imperative for the concerned stakeholders and healthcare providers to work toward ensuring drug use according to the standard.

Prescribing practices using WHO prescribing indicators and factors associated with antibiotic prescribing in six community pharmacies in Asmara, Eritrea: a cross-sectional study

Background

Antibiotics require more prudent prescribing, dispensing and administration than other medicines because these medicines are at a greater risk of antimicrobial resistance (AMR). Studying the current medicine use practices and factors affecting the prescribing of an antibiotic would help decision makers to draft policies that would enable a more rational use of medicines.

Methods

A prospective, descriptive, and cross-sectional study was conducted to assess the current prescribing practices including antibiotics use in six community pharmacies in Asmara. A total of 600 encounters were reviewed using the WHO core prescribing indicators between May 5 and May 12, 2019 using stratified random sampling technique. Descriptive statistics and logistic regression were employed using IBM SPSS® (version 22).

Results

The average number of medicines per prescription was 1.76 and 83.14% of the medicines were prescribed using generic names while 98.39% of the medicines were from the National Essential Medicines List (NEML). The percentage of prescriptions containing antibiotics was 53%. The number of encounters containing injections was 7.8%. Patient age, gender and number of medicines prescribed were significantly associated with antibiotic prescribing at bivariate and multivariable models. Subjects under the age of 15 were approximately three times more likely to be prescribed antibiotic compared to subjects whose age is 65 and above (Adjusted Odds Ratio (AOR): 2.93, 95%CI: 1.71–5). Similarly, males were more likely to be prescribed antibiotic than females (AOR: 1.57, 95%CI: 1.10–2.24). Subjects to whom three to four medicines prescribed were two times more likely to be prescribed an antibiotic compared to those who were to be prescribed one to two medicines per encounter (AOR: 2.17, 95%CI: 1.35–3.5). A one-unit increase in the number of medicines increased the odds of antibiotic prescribing increased by 2.02 units (COR: 2.02; 95%CI: 1.62–2.52).

Conclusions

This study found that the percentage of antibiotics being prescribed at the community pharmacies in Asmara was 53% which deviated significantly from the WHO recommended values (20–26.8%). Furthermore, the percentage of encounters with an injection was 7.8% lower than the WHO value of 13.4–24.0%. Patients’ age, gender and number of medicines were significantly associated with antibiotic prescribing.

Assessment of inpatient antibiotic use in Halibet National Referral Hospital using WHO indicators: a retrospective study

Objective

Inappropriate use of antibiotics in primary care and hospital settings is a major contributing factor to the spread of antibiotic resistance. Many microorganisms were tested in Eritrea and have proven resistant to ampicillin. The aim of this study was to investigate the prescription pattern, hospital indicator and patient care indicator of antibiotics among hospitalized patients in Halibet National Referral Hospital, Asmara, Eritrea.

Results

The data on prescription patterns showed 79% of hospitalizations had at least one antibiotic prescribed and on average 1.29 antibiotics were prescribed per hospitalization; prescribing using generic name was at 97%; all (100%) of the antibiotics were prescribed from the Eritrean National List of Medicines. On average an antibiotic was prescribed for 6.36 days (SD = 6.06). Ampicillin was the most commonly prescribed antibiotic (42.1%) and parenteral was the most common route prescribed (81.4%). The data on hospital indicators showed key antibiotics were out of stock on average for 78.18 days; 87.5% of key antibiotics were available on the day of the study. The data on patient care indicator showed patients taking antibiotics stayed in the hospital for 9.97 days (± 7.33 days).

Electronic supplementary material

The online version of this article (10.1186/s13104-018-4000-7) contains supplementary material, which is available to authorized users.

Pattern and Appropriateness of Medicines Prescribed to Outpatients at a University Hospital in Northwestern Ethiopia

The study assessed the pattern and appropriateness of medicines prescribed to outpatients at Gondar University Referral Hospital in northwestern Ethiopia. An institution-based cross-sectional study was employed, through interviews and prescription reviews, among 346 patients at the outpatient pharmacy, from 2nd to 20th of May 2016. Data on sociodemographic profile of patients and medicines prescribed to them were collected. A mean of 1.72 medicines per encounter was prescribed, over a third of the total being anti-infectives. Patients were able to get about 85% of these medicines. An unskilled government employee would be required to work more than one and a half day to be able to afford the average priced medicine. Among prescriptions with two or more medicines, more than a third had at least one potential drug-drug interaction (PDDI), the commonest pair containing amoxicillin and doxycycline. Being male, being older (50–59 years), and increased number of medicines were associated with higher likelihood of PDDIs. In conclusion, the number of medicines prescribed per encounter was up to accepted standard. However, their availability fell short, together with considerable cost. Regarding appropriateness, a significant proportion of potential drug-drug interactions is identified and associated with patient's sex, age, and number of medicines prescribed.

Essential Medicine Utilization and Situation in Selected Ten Developing Countries: A Compendious Audit

Medicine improves the quality of life and increases mean age of human beings as it fights against diseases. Accessibility to medicines is the fundamental right of every person. The principle of the essential medicines (EMs) is that a limited number of availability of medicine will promote to a better supply chain and rational prescribing to the rural and remote health centers for any developing countries. Furthermore, it was also expected that this concept will also ensure better procurement policy at lower costs, more in amount, with easier storage. Thereby, EMs will safeguard and improve distribution and dispensing of medicine. Correspondingly, motivational and dedicated training program regarding drug information and adverse drug reactions will boost up access to medicine and health-care. In addition, the selection of medicine from EM is the first step in the direction of the rational use of medicine and progress and ensuring the quality of health care. Thereafter, selection needs to be followed by appropriate use. Everyone should receive the right medicine, in an adequate dose for an adequate duration, with appropriate information and follow-up treatment, and at an affordable cost. The acceptance and implementation of World Health Organization-promoted EM policies in deferent countries have improved quality use of medicine in terms of accessibility and affordability, predominantly in developing countries. The corporations and teamwork among various participants of health care are instantly obligatory to progress equitable access to medicines in low- and middle-income countries.