Prescription of medicines for the management of childhood acute watery diarrhoea at a tertiary hospital in Ebonyi state, Nigeria

Abstract

Background: The burden of childhood diarrhoea in Nigeria is huge and has been persistently high over the years with an estimated 205 under-fifives dying daily. Asimple combination of oral rehydration salts (ORS) and zinc tablets (ORS/Zinc) has been approved for its treatment by the WHO since it is benefificial for rehydration which is the goal of therapy. However, huge resources are spent on antibiotics and other medications which are not benefificial for rehydration, thereby exposing children to unnecessary medications and other drug therapy problems. This study was set to evaluate the prescription of medicines for acute watery diarrhea (AWD) in under-fifive children and to determine the appropriateness of these prescriptions. Method: This study was conducted in a tertiary hospital in Abakaliki, Ebonyi State. It was a retrospective review of prescriptions of medicines for AWD in under-fifives for a period of 28 months (January 2019 to April 2021). All available cases of AWD (338) were extracted from the prescription registers. Data were entered into SPSS version 24.0 and descriptive analysis was done. The guideline set by WHO for the management of AWD was followed for evaluating the prescriptions. Results: Out of the 338 cases of AWD, 190 (56.2%) occurred in male children and 265 (84.4%) in children under 24 months. Of the total cases, 291 (86.1%) received prescriptions containing ORS, zinc, and probiotics either alone or in difffferent combinations with only 154 (45.6%) containing ORS and zinc together. Of these prescriptions with ORS/Zinc, 47 (30.5%) also contained antibiotics, antimalarials and infusions. In total, there were 99(29.3%) and 48 (14.2%) prescriptions containing antibiotics and antimalarials respectively. The most frequently prescribed antibiotic classes were sulfonamides (41; 40.6%), cephalosporins (29; 28.7%) and flfluoroquinolones (13; 12.9%). Less prescribed antibiotic classes include macrolides, penicillins and nitroimidazoles. Other groups of medicines prescribed were analgesics, anthelmintics, oral potassium and antacids, and antihistamines. Overall, only 107 (36.8%) prescriptions were appropriate for the management of AWD. Conclusion: This study revealed that only 36.8% of AWD cases received appropriate prescriptions according to guideline. Therefore, there is urgent need for intervention in the study setting to improve appropriate treatment of AWD.