WHO Drug Use Research Articles

Study on drug prescribing pattern in hypertensive patients in a tertiary care teaching hospital at Dehradun, Uttarakhand

Background: Irrational drug prescribing is a common practice globally; it results in increased morbidity, mortality & economic burden on society. Drug utilisation studies are an important tool to promote rational prescribing. Aims & Objective: To study on drug prescribing pattern in hypertensive patients. Materials and Methods: A drug utilisation study was conducted in hypertensive patients by the department of pharmacology in medicine OPD at SGRRIM & HS, Dehradun for 6 months. 645 prescriptions were evaluated for prescribing pattern by using WHO drug use indicators. Results: 645 prescriptions were analysed. A total of 1828 drugs were prescribed. 697 (38.13%) antihypertensives, 243 (13.30%) antidiabetics, 174 (9.52%) non-steroidal anti-inflammatory drugs (NSAIDs), 154 (8.44%) statins, 114 (6.24%) thyroid hormone, 54 (2.95%) anti-anxiety/antidepressants and 392(21.44%) miscellaneous drugs were prescribed. 697 antihypertensive drugs were prescribed. 234 (33.57%) angiotensin receptor blockers (ARBs), 117 (16.79%) angiotensin converting enzyme (ACE) inhibitors, 95 (13.63%) Beta blockers, 83 (11.91%) Calcium channel blockers 168 (24.10%) Fixed dose combinations (FDCs) of antihypertensives were included. 2.83 drugs were prescribed per prescription. 225 (32.28%) antihypertensives were prescribed from essential medicine list. Conclusion: Most commonly prescribed drugs were ARBs and ACE inhibitors. Rational prescribing requires consideration to dose and duration and interaction with other medications.

Prescribing Patterns and Cost of Antihypertensive Drugs in Private Hospitals in Dar es Salaam, Tanzania

Antihypertensive agents are used to prevent morbidity and mortality related to hypertension. Prescribing patterns and the cost of some antihypertensive were studied for 600 patients attending medical clinics in four private hospitals in Dar es Salaam using the WHO drug use indicator forms. The average number of drugs per prescription ranged from 1.9 to 4.2 while that of antihypertensives varied from 1.3 to 2.1. About 50 % of the prescriptions contained 2 to 3 drugs. The most frequently prescribed antihypertensives were diuretics (41 %), β-blockers (28.5 %), calciumchannel blockers (19.8 %), hydralazine/losartan (18.5 %) and angiotensinconverting enzyme inhibitors (11.5 %). Antihypertensives prescribed asmonotherapy included atenolol (23.2 %), bendrofluazide (22 %), frusemide (19 %), hydralazine (11.2 %), nifedipine (9.8 %), amlodipine (9.5 %) and enalapril (9.3 %). Among the combination therapy drugs were angiotensin converting enzyme inhibitor+diuretic (7 %), β-blocker+diuretic (4 %), calcium channel blocker+losartan (2.3 %), β-blocker+angiotensin converting enzyme inhibitor (2.2 %), calcium channel blocker+angiotensin converting enzyme inhibitor (1.8 %) and diuretic+hydralazine (1.7 %). The cost of nifedipine, bendrofluazide and frusemide was about five to six times higher in the private hospitals than at the governmentowned medical stores department. This study reveals a need for continuingeducation and standard treatment guidelines for rational prescribing ofantihypertensive drugs.

A Survey of Prescribing Practices of Health Care Workers in Kibaha District in Tanzania

Background: Previous studies in the public sector in Tanzania, have demonstrated major prescribing problems due to poly-pharmacy and irrational use of antibiotics and injections. Little is understood about prescribing in the private sector. Broad objective: This paper measures and compares prescribing practices in public and private dispensaries in Kibaha District Tanzania. Design and Sampling: This was a retrospective survey of patient records for the period January – December, 2002.One thousand patient records were randomly selected from public dispensaries and 1,000 from private dispensaries. WHO drug use indicators were used to assess prescribing in both sectors. Outcome measures: The following WHO indicators were measured; the average number of drugs per patient, percentage antibiotic prescriptions, percentage injection prescriptions, percentage of drugs prescribed in generic names and percentage of prescriptions according to national essential drug list of Tanzania (NEDLIT). Results: Prescribing of antibiotic and injections was significantly higher in private than in public dispensaries (P

Psychosocial correlates of substance use amongst secondary school students in south western Nigeria.

To determine the psychosocial correlates of substance use among secondary school students in rural and urban communities in south western Nigeria. A cross-sectional survey of secondary school students using questionnaire eliciting substance use by students (WHO drug use questionnaire) and a well designed questionnaire on psychosocial variables. Six secondary schools selected from two local government areas in Ilesa, Osun State, South Western Nigeria. The study population comprised 600 randomly selected senior secondary school students from six schools. A total of 562 questionnaires were analysed. Current stimulant use was significantly associated with lower socio-economic status, coming from a polygamous family and self-rated poor academic performance. Current alcohol use was associated with being a male, polygamous family background, living alone or with friends, not being religious and self-rated poor academic performance. Current hypnosedatives use was commoner in students living alone or with friends and in those with self-rated poor academic performance. There was also significant positive relationship between current tobacco use and the male sex, not being religious and self-rated poor academic perfomance. Lifetime use of these substances had similar association with the psychosocial variables with slight differences. The similarity between the psychosocial correlates highlighted in this study and those reported in previous studies from other parts of Nigeria makes these observations useful enough for the planning of preventive strategies.

Prescribing habits in church-owned primary health care facilities in Dar Es Salaam and other Tanzanian coast regions.

To assess prescribing practice of Primary Health Care (PHC) workers in church owned health care facilities using WHO drug use indicators. A cross-sectional study in which twenty primary health care facilities were randomly selected. Prescribing indicators were obtained by analysing outpatient records retrospectively for the past 14 months between January 1997 and February 1998. This period was chosen because of compete records of outpatient attendances. Patient care and facility indicators were recorded prospectively during the study period. The study was conducted in the Coast and Dar es Salaam regions of Tanzania. Six districts were randomly selected from both regions. The selected districts included Ilala, Temeke and Kinondoni in Dar es Salaam, Kibiti, Bagamoyo and Kisarawe in Coast region. Twenty primary health care facilities were randomly selected from the chosen districts. Patient registers were collected and patients' characteristics including age, sex, diagnosis, and drugs prescribed for the period January 1997 to February 1998 were recorded on data collection forms. Patient care indicators were measured by recording consultation time, dispensing time, per cent of drugs actually dispensed and adequately labelled whereas patients' knowledge of correct drug dosage was obtained using exit interviews. Verification of facility indicators was done by direct observation. The average number of drugs per prescription was 2.3 (range 1.8-2.8). Generic prescribing prevailed with a mean of 75.5% of all drugs. Antibiotic and injection encounters per prescription was 35.4 and 19%, respectively. Most drugs were prescribed according to the essential drug list of Tanzania (NEDLIT). Patient's average consultation time was 3.6 minutes whereas average dispensing time was 39.9 seconds. On average, 87% of all drugs dispensed were adequately labelled and patients' knowledge of correct dose was adequate. All facilities possessed drugs for treating important illnesses, all had reference educational materials. The study shows that there is an overuse of injections 19% +/- 1.7 (range 0.73%) compared to the recommended figure of 15%. The use of antibiotics appears appropriate when compared with the morbidity patterns in the study areas. A focus group discussion with prescribers in these facilities to address the question of overuse of injections is needed in order to plan an appropriate intervention.

Drug use profile in a Nigerian city hospital.

The newly introduced WHO Drug Use Indicators enable the delineation of drug use patterns, identification of inappropriate use and evaluation of interventional strategies. This study highlights the drug use pattern in a city hospital and further identifies areas of inappropriate use that need to be addressed. Records of 614 patient encounters (January-December 1993) were obtained by systematic random sampling at the Central Hospital, Benin City. The WHO prescribing indicators were calculated and detailed review in various therapeutic categories was carried out. The average number of drugs per encounter was 3.7. The percentage of encounters with injection and antibiotics were 37.0% and 54.2% respectively. Forty-eight per cent of drugs were prescribed by generic name and 94.4% of all prescribed products were in the National Essential Drug List. Drugs were not prescribed in 2.8% of encounters. Of injections, 74.1% were for treatment of febrile illness, usually presumed to be malaria. Analgesics/antipyretics, mainly paracetamol, were prescribed in 72.3% of encounters. In 57.8% of encounters vitamin preparations were prescribed. Certain differences were observed between children and adults with children receiving more vitamins and antimalarials. These findings suggest some inappropriate use of drugs which may in turn reflect current practice throughout Nigeria. Proper case management of febrile illness is likely to promote more rational use of drugs.