Abstract
BackgroundRational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015.MethodsSystematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines.ResultsForty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends.ConclusionsPrescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences.
Highlights
Rational medicine use is essential to optimize quality of healthcare delivery and resource utilization
The core drug use indicators include five prescribing indicators which are meant to detail particular prescribing characteristics related to poly-pharmacy, antibiotic use, injection use, generic prescribing and adherence to the essential medicines list (EML) [10, 11]
For the African region, the review reported the average number of medicines per patient encounter to be 2.6, percentage of encounters with antibiotics prescribed as 45.9 %, percentage of encounters resulting in prescription of injection as 28.4 %, percentage of medicines prescribed from EML to be 89.0 % and percentage of medicines prescribed in generic name as 65.1 % [15]
Summary
Rational medicine use is essential to optimize quality of healthcare delivery and resource utilization. Since the late 80's, the WHO together with the International Network for Rational Use of Drugs (INRUD) have been advocating proper documentation of medicines use and have developed core drug use indicators in three related areas of prescribing practices, patient care and facility specific factors [10]. The drug use indicators are regarded as objective measures that can be extended to describe patterns of medicines usage in any health facility, country or an entire region. For the African region, the review reported the average number of medicines per patient encounter to be 2.6, percentage of encounters with antibiotics prescribed as 45.9 %, percentage of encounters resulting in prescription of injection as 28.4 %, percentage of medicines prescribed from EML to be 89.0 % and percentage of medicines prescribed in generic name as 65.1 % [15]. A trend analysis showed ‘little progress over time’ [15]
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