Abstract
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.
Highlights
Irrational drug use is a global problem
Drug use indicators have been established by the World Health Organization and the International Network for Rational Use of Drugs (WHO/INRUD) [6]. ey are broadly divided into two groups, namely, core and complementary indicators. e core indicators have been pretested and standardized and are grouped into three major categories, Advances in Pharmacological and Pharmaceutical Sciences namely, prescribing, patient-care, and facility-specific indicators [7]. ese drug-use indicators are usually used in assessing drug use in outpatient facilities, where they provide measures of the optimal drug use as well as identify areas of deviations from the expected standards
Since no study of this kind has ever been conducted in Kisii County since the inception of devolution of healthcare in 2010, it was most likely that the county government was wasting its resources on irrational drug use
Summary
Drugs are very significant components of any healthcare system and should be used rationally. In a study carried out in Eritrea’s community pharmacies, it was found that the percentage of antibiotics being prescribed at the community pharmacies in Asmara was 53%, which deviated significantly from the WHO recommended values. Since no study of this kind has ever been conducted in Kisii County since the inception of devolution of healthcare in 2010, it was most likely that the county government was wasting its resources on irrational drug use. Is study, sets out to use the WHO/INRUD core drug use indicators methodology to examine the patterns of drug use and the prevalence of irrational drug use at the public primary healthcare centers (level II and III facilities) in Kisii County, Kenya
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