Abstract
Background: Periodic assessment of morbidity and drug use at various levels of healthcare delivery system is important to recognize common prevalent morbidities and rationalize the use of medicines. The study was conducted to determine the common morbidities and audit prescription using WHO prescribing indicator in government operated tertiary hospitals of eastern Nepal.
 Methods: A cross-sectional study was carried out in government tertiary hospitals of Province 1, Nepal, from March 2019 to August 2019. For analysis, descriptive statistics were used. Prescribing characteristics were evaluated using recommended guidelines of the World Health Organization (WHO) prescribing indicators.
 Results: Six hundred prescriptions were analyzed. The most prevalent morbidity was endocrine, nutrition & metabolic diseases (21.5%) followed by diseases of the respiratory system (19.8%), circulatory system (17.6%), and digestive system (12.8%). The most frequently encountered individual disease entity were hypertension (18.7%), diabetes (15.5%), acid peptic disorders (14%). A total of 2072 drugs were prescribed with an average of 3.45 (± 1.39) drugs per consultation. About 30.2% of prescriptions encountered contain at least one antibiotics, whereas injectable were prescribed in 1.8%. Only 3.9% of total medicines were prescribed in generic name and 31.7% of drug prescribed were from essential medicine list.
 Conclusion: Among the prescriptions evaluated, diseases of the endocrine, respiratory, cardiovascular, and gastrointestinal systems were the most common morbidities. Polypharmacy was prevalent to some extent whereas prescribing in generic and essential medicine list was poor relative to standard WHO recommendations. However, the overall prescribing of antibiotics and injection were found to be satisfactory.
Highlights
Since the last few decades, Nepal has had an epidemiological transition from communicable diseases to non-communicable diseases (NCD), which contributes to increasing morbidities and mortalities
According to the report of Nepal burden of Diseases 2017, NCDs was responsible for two-thirds (66%) of all mortality, with injuries accounting for 9% and remaining 25% of all death was due to communicable, maternal, neonatal, and nutritional (CMNN) disease or disorders.[3]
Patients coming for Directly Observed Treatment Short-course (DOTS), leprosy, pregnant and lactating women, patients for prophylaxis, immunization, chronically ill patients requiring in-patients care or admission, and those who were not willing to participate in the study were excluded from the study
Summary
World Health Organization Southeast Asia Region (WHO SEAR) consists of one-fourth of the world’s population, which has about 30% of the global burden of disease, and the highest proportion of global mortality (26%).[1,2] Since the last few decades, Nepal has had an epidemiological transition from communicable diseases to non-communicable diseases (NCD), which contributes to increasing morbidities and mortalities. 4 studies on prescribing patterns are essential to estimate the patterns of drug use and patient’s exposure to medicine It is an important means of assessing the rational use of drugs.[5,6] Province 1 is the easternmost province of Nepal, consisting of about 17.5% of the country’s total area. This study was undertaken to determine the morbidity and prescribing pattern in government tertiary hospitals of Province 1, Nepal. The study was conducted to determine the common morbidities and audit prescription of general medicine outpatients using the WHO prescribing indicator in government-operated tertiary care zonal hospitals of eastern Nepal. Bivariate analysis showed that there was a significant difference in prescription encounters with antibiotics and generic prescribing between the two hospitals (p < 0.001).
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