World Health Organization Core Research Articles

Rational Drug-Use Evaluation Based on World Health Organization Core Drug-Use Indicators in a Tertiary Referral Hospital, Northeast Ethiopia: A Cross-Sectional Study.

BackgroundIrrational use of drugs is often observed in health-care systems throughout the world, particularly in developing countries. The World Health Organization estimates that more than half of all medicines are prescribed, dispensed, or sold inappropriately and that half of all patients fail to take them correctly. Therefore, the study was aimed at investigating the practice of rational drug use in a referral and teaching hospital in Northeast Ethiopia.MethodsA hospital-based cross-sectional design was employed to conduct the study from February 2019 to May 2019. Systematic random sampling was used to select prescriptions dispensed in outpatient pharmacies. Convenient sampling was employed to select patient attendants and their prescriptions in outpatient departments during the study period. Data were collected using a structured and technical observational checklist for prescribing, patient care, and health-facility indicators. Face-to-face interviews were also employed to assess patient knowledge of correct dosage among patient-care indicators. Data were analyzed using SPSS version 20. Descriptive statistics are given using frequency, proportions, and summary measures.ResultsAn average of 2.5 drugs per encounter were prescribed, with 34.64% and 13.80% of prescriptions being antibiotics and injections, respectively. Generics were used in 90.53% of prescription, and nearly 83% of drugs were prescribed from an essential-drug list. Average consultation and dispensing times were 1.57 minutes and 47 seconds, respectively. A total of 362 drugs were prescribed, with 82.6% actually dispensed and only 22.7% adequately labeled. The hospital had its own drug formulary and essential drug list, but no standard treatment guidelines. Moreover, except propyl thiouracil, all key essential drugs included in the study were available.ConclusionThe majority of World Health Organization–stated core drug-use indicators were not met by the referral hospital in this study, which is especially problematic regarding patient-care indicators.

A drug utilization study of psychotropic drugs in indoor patients of psychiatry department in a tertiary care hospital

Context: The rapidly expanding field of psychopharmacology is challenging the traditional concepts of treatment and constantly seeking new drugs to treat psychiatric disorders. There is a sparse work on the utilization of psychotropic drugs in indoor patients. Hence, the present study was planned to add to the existing knowledge of the utilization of psychotropic drugs. Aims: The aims of were to study the drug utilization of psychotropic drugs in the indoor patients of psychiatry department and to evaluate it according to the World Health Organization core drug use prescribing indicators. Settings and Design: This was an observational study in indoor patients of psychiatry department in a medical college. Materials and Methods: In this study, patients of all age groups diagnosed with psychiatric disorder admitted to the psychiatry department were included. The data were collected from 300 prescriptions over 6 months. Data were analyzed using descriptive statistics. Results: In 300 prescriptions, 61.98% were psychotropic drugs and average number of drugs per prescription was five. The percentage of drugs prescribed by generic name and from the essential drug list was 52.93% and 60.9%, respectively. The most common diagnosis was schizophrenia (55.6%), followed by mood disorders (26.6%). The most commonly prescribed drugs for schizophrenia, bipolar disorders, and depression were olanzapine (71.85%), sodium valproate (71.4%), and escitalopram (51.6%), respectively. Conclusion: Most of the drugs were used in accordance with standard guidelines given by the Indian Psychiatric Society. The percentage of drugs prescribed by generic names and from the National List of Essential Medicines (NLEM) needs to be increased. Olanzapine, which is not included in NLEM, was commonly prescribed psychotropic drug

Testing of the WHO Infection Prevention and Control Assessment Framework at acute healthcare facility level

Monitoring and evaluation are an essential part of infection prevention and control (IPC) implementation. The authors developed an IPC assessment framework (IPCAF) to support implementation of the World Health Organization (WHO) guidelines on core components of IPC programmes in acute healthcare facilities. To evaluate the usability and reliability of the IPCAF tool for global use. The IPCAF is a questionnaire with a scoring system to measure the level of IPC implementation according to the eight WHO core components. The tool was pre-tested qualitatively, revised and translated selectively. A convenience sample of hospitals was invited to participate in the final testing. At least two IPC professionals from each hospital independently completed the IPCAF and a usability questionnaire online. The tool's internal consistency and interobserver reliability or intraclass correlation coefficient (ICC) were assessed, and usability questions were summarized descriptively. In total, 46 countries, 181 hospitals and 324 individuals participated; 52 (16%) and 55 (17%) individual respondents came from low- and lower-middle income countries, respectively. Fifty-two percent of respondents took less than 1 h to complete the IPCAF. Overall, there was adequate internal consistency and a high ICC (0.92, 95% confidence interval 0.89-0.94). Ten individual questions had poor reliability (ICC <0.4); these were considered for revision according to usability feedback and expert opinion. The WHO IPCAF was tested using a robust global study and revised as necessary. It is now an effective tool for IPC improvement in healthcare facilities.

Outpatient prescription audit in a tertiary care hospital at Puducherry

Background: Rational use of medicines promotes good health practices and prevents inappropriate use of medicines, polypharmacy, unnecessary use of antimicrobials, injections, and also encourages use of medicines from essential medicine list and dispensing by generic names. The aim of the study was to analyze the outpatient prescriptions of a tertiary care centre by utilizing World Health Organization (WHO) core drug use prescribing indicators.Methods: A retrospective observational study was conducted in a tertiary care health setup at Puducherry, South India. Outpatient prescriptions from all the major clinical departments were analyzed using WHO prescribing indicators and they were compared with some similar studies.Results: The average number of drugs per prescription was 2.74. The percentage of prescriptions with antibiotics was 20.33% and the percentage of prescriptions with injections was 0.16%. The percentage of drugs prescribed by generic names and from essential medicine list was 83.13% and 87.9 respectively. Further antibiotic utilization was found to be higher in the department of ENT (56.67%), respiratory medicine (45%) and surgery (40%). Percentage of drugs prescribed by generic names in pediatrics and respiratory medicine were found to be 67.88% and 65.27% and percentage of drugs prescribed from essential medicine list in dermatology was 69.62%.Conclusions: Prescription pattern followed in our Institute almost adheres to the guidelines laid down by the WHO. Moreover, it is also implied that a routine audit of this type should be done in health care setups to ensure that they adhere to the WHO guidelines for better health care.

WORLD HEALTH ORGANIZATION DRUG PRESCRIBING INDICATORS AT A UNIVERSITY PRIMARY HEALTH-CARE CENTER IN OMAN

Objective: This study aimed at evaluating the prescribing patterns of drugs based on the World Health Organization (WHO) indicators at the primary health-care Family Medicine and Community Health Clinic in Sultan Qaboos University Hospital, Oman.&#x0D; Methods: This was a retrospective cross-sectional study covering a 6-month period in 2016 (January–June) for all patients attended Family Medicine and Community Health Clinic in Sultan Qaboos University Hospital, Oman. Data of 300 patients with 892 prescriptions were assessed during the study period.&#x0D; Results: The average number of drugs per encounter (2.82), the percentage of encounters with antibiotics (13.3%), and the percentage of encounters with an injection (7.6%) were within the optimal range set by the WHO. The percentage of drugs prescribed by generic name (80.1%) and the percentage of drugs prescribed from an essential drug list (EDL) (40.4%) did not reach the optimal 100% value set by the WHO.&#x0D; Conclusion: Most of the WHO core prescribing indicators in the study were within the optimal range. Prescribing from the WHO EDL was sub-optimal. These data will set ground to optimize rational drug prescribing in the primary health-care setting.

A study on prescribing pattern of cephalosporins utilization and its compliance towards the hospital antibiotic policy in surgery ward of a tertiary care teaching hospital in India

Background: Extensive use of antibiotics is prevalent throughout India, and this is a matter of serious concern. There are several reports linking antibiotic usage to resistance. Towards addressing this problem, assessment of current prescribing pattern of antibiotics needs to be undertaken to monitor its appropriate use. This study was meant to assess the utilization of cephalosporins and its compliance towards the hospital antibiotic policy in surgery ward of a tertiary care teaching hospital.Methods: A prospective observational study was conducted with 250 inpatients of surgery ward. The demographic details, lab investigations, clinical diagnosis and current treatment were noted. The collected data was analysed for utilization of cephalosporin using World Health Organization (WHO) core prescribing indicators and defined daily dose per 100 bed-days. The hospital antibiotic policy was used as a benchmark for analyzing compliance of therapy.Results: Out of 250 patients, 69% was male and 31.2% was female population with mean age of 42.12±17.33 years. Majority of cases were clean-contaminated (36%) followed by clean (30.4%) and contaminated (17.6%) wounds. The average number of overall antibiotics and cephalosporins per encounter was 2.1 and 1 respectively. Among the total parenteral antibiotics, 63.9% were cephalosporins. Cephalosporins utilization was 2.68 DDD per 100 bed-days. Compliance with all the stated criteria was observed only in 124 (49.6%) patients.Conclusions: The rate of prescribing of cephalosporins has increased evidently which may result in the occurrence of bacterial resistance. A suboptimal rate of compliance recommends a strict monitoring in the usage of cephalosporins with periodical updation of policy.

Core Capacities for Public Health Emergencies of International Concern at Ground Crossings: A Case Study from North India.

International airports, ports, and ground crossings are required to have health units for undertaking public health measures during routine times and specific measures during the time of public health emergency of international concern (PHEIC). This study was conducted at a ground crossing of North India to assess the implementation status of International Health Regulations (IHR) (2005) at a ground crossing in the prevention and control of public health emergencies and to assess the risk of imported infections from a ground crossing. A qualitative study was conducted at the selected point of entry. The World Health Organization (WHO) core capacity assessment tool and in-depth interviews were used for data collection in the form of meetings and visits to isolation sites, and general observations were conducted regarding facilities on routine and other infrastructure and equipment that can be used during emergencies. Respondents were recruited using purposive methods. The findings reveal that there is lack of awareness among the travelers, which increases the risks of spreading diseases. The overall implementation status at the ground crossing according to the assessment conducted using WHO Tool was 76%. It showed the need for further strengthening of the implementation at the site. Gaps were identified regarding the local capacity for handling chemical, radiological and nuclear hazards, and shortage of regular staff through stakeholders. The findings from this study, as well as the suggestions and recommendations given by stakeholders, should help revise the current strategies of action. Hence, the gaps identified should be fulfilled to better respond to PHEIC at the ground crossings.

DRUG UTILIZATION STUDY AMONG GERIATRIC PATIENTS IN A TERTIARY CARE TEACHING HOSPITAL IN SOUTH INDIA

Objectives: The objective of our study is to evaluate the drug utilization pattern among geriatric patients in a tertiary care teaching hospital in South India and analyze the prescription pattern.&#x0D; Methods: Retrospective medical record analysis was performed for indoor cases of the geriatric patients (aged ≥65 years) admitted in medicine&#x0D; wards of Raichur Institute of Medical Sciences teaching hospital, Raichur, from June 2015 to May 2016. They were analyzed for demo graphics, disease pattern by system involved, disease diagnosed, comorbidity pattern, most commonly prescribed drugs, distribution of drugs according to their therapeutic class, evaluation of polypharmacy, route of administration, fixed-dose combinations, and the World Health Organization core prescribing indicators.&#x0D; Results: A total of 400 prescriptions of geriatrics patients admitted in inpatient medicine department were randomly selected and all the required data for the study were collected and evaluated. The majority of patients were found to be in the age group of 65–70 years (70.25%). It was noticed that females (51.75%) were more compared to males (48.25%). The drugs prescribed were analyzed. Ranitidine, ceftriaxone, theophylline, and salbutamol were prescribed to majority of the patients in this study group. The average number of drugs per prescription was 7.42; drugs prescribed by generic name were 33.62%. Among the drugs prescribed, 88.69% were from the National List of Essential Medicines. Total encounters having&#x0D; inject table preparations were 100% and total encounters having antibiotic prescribed were 91%. The prevalence of cardiovascular disorders (32.5%) was high followed by respiratory disorders (32.25%).&#x0D; Conclusion: This study provides insight into the patterns of drug use in our tertiary care hospital on geriatric patients as well as various diseases prevalent among geriatric patients. Widespread polypharmacy, high use of antibiotics and injections, and lack of generic prescribing are some concerns that need to be addressed to promote rational usage of drugs.

A world health organization core drug use indicator based prescription study in the dermatology outpatient department of a tertiary care teaching hospital of central South India

Background: Irrational prescribing is a universal problem that may lead to inadequate response to medication therapy, poor patient compliance and increased adverse drug reactions ultimately leading to frequent hospital admissions. Hence this study was done to assess the drug utilization pattern using WHO core drug use indicators so that the recommendation can be made towards the rational prescribing.Methods: A sample of 3650 prescriptions was analysed prospectively to assess the drug utilization patterns in the dermatology OPD of a tertiary care teaching hospital of central south India.Results: The average number of drugs per prescription was 2.74 whereas 79.26% drugs were prescribed by generic names. Percentage of encounters with an antibiotic prescribed was 18.68%. Regarding use of injections, 3.26% prescriptions contains one or more injections. Percentage of drugs prescribed from essential drugs list was 78.37%. Average consultation time was lower (2.9 minutes) than recommended.Conclusions: The data from the present study indicates that prevalence of polypharmacy, inadequate consultation and dispensing time along with poor patient’s knowledge are the areas of medication therapy to be improved. Availability of essential drugs and key drugs in stock should be improved to achieve rational therapeutic goal. Further, continued medical education regarding the rational prescribing will definitely improve the standards of health care delivery.

Prescribing pattern of ophthalmological medication in geriatric inpatients of a tertiary care hospital

Background: Older people are potentially at greater risk of medication error. Gaining insight into the prescribing pattern especially in eye diseases as they are a common problem in elderly, in order to identify prescribing related problems is the fundamental step in improving the quality of prescription and patient care.Methods: Prescriptions fulfilling inclusion criteria were collected from hospital Medical record department (MRD) and analyzed using the World Health Organization (WHO) core prescribing indicators for rationality of prescriptions.Results: Among 811 prescriptions analysed, 52.7% (428) were of male patients, those aged 60-70 years were 77.2% (626) and patients with only cataract constituted 77% (625). Prescriptions with oral antibiotics were 57.1% (334); topical antibiotics were 35.8% (429) and topical analgesics 46.2% (553). Out of 1182 FDCs noted, 59% (479) were found to be rational and 34.6% (281) were from Essential Medicines List 2014. Only 2% (61) drugs were prescribed using generic name while 64.06% (1606) of drugs were from the WHO Model List of Essential Medicines (April 2015). Average number of drugs per encounter was 3.7. Percentage of encounters with antibiotics was found to be 43.8% and no prescriptions with injections were noted.Conclusions: Although usage of antibiotics and topical drugs was conforming to WHO recommended standards, there is a need to improve prescription pattern by using generic names and drugs from Essential Drug List.

Evaluation of cephalosporins utilization and compliance with reference to the hospital antibiotic policy of an Indian tertiary care hospital

Background: Emergence of bacterial resistance in hospital settings due to the liberal use of antibiotics which led to an altered impact on its therapeutic efficacy and outcome, thereby increasing the treatment costs in patients. In this regard the study aims to evaluate the cephalosporins utilization and compliance to the hospital antibiotic policy in general medicine ward.Methods: A prospective observational study was carried out over an eleven-month period in patients prescribed with cephalosporins. Clinical data of inpatients were collected and evaluated by using World Health Organization (WHO) core prescribing indicators and defined daily dose per 100 bed-days. The comparison between the cephalosporins prescribed in the chart records to the recommendations mentioned in the institutional antibiotic policy v.2.0, help to determine the deviations in their usage pattern.Results: A total of 370 patients were enrolled in the study, of which 54.6% were females. Cephalosporins were empirically prescribed in 240 (64.9%) cases. The average number of total antibiotics and cephalosporins per encounter was 1.6 and 1 respectively. Among the total antibiotics, 63.7% were cephalosporins. Third generation cephalosporins (98.4%) were commonly prescribed, with ceftriaxone (93%) in parenteral form for respiratory tract infections (31.9%). Total parenteral antibiotics prescribed were found to be 68.8% of which 88.6% were cephalosporins. Utilization pattern of cephalosporins amounted to be 4.95 DDD/100 bed-days. Overall compliance was achieved in 191 (51.6%) prescriptions.Conclusions: The rate of prescribing of cephalosporins was marginally high. There was a low rate of compliance towards policy which reflects the urgent need for repetitive intervention to comply antibiotic policy.

Factors associated with health care seeking behavior for musculoskeletal pain in Indonesia: A cross-sectional study.

To assess the factors defining healthcare-seeking behavior of people with musculoskeletal pain in the urban community of Malang City, East Java, Indonesia. A cross-sectional survey was performed in Malang City, East Java, Indonesia. In total, 2067 participants aged 16-93years were interviewed. The sociodemographic and socioeconomic factors of healthcare seeking behavior, musculoskeletal pain, disability, and adverse drug reactions were assessed using the validated Indonesian version of Community Oriented Program for the Control of Rheumatic Disease (COPCORD) protocol by International League of Associations for Rheumatology and the World Health Organization core questionnaire. Chi-square test was applied to assess the determinants of health-seeking behavior for musculoskeletal pain. Slightly more than one-third of the respondents (36%) with musculoskeletal pain, described as osteoarthritis, low back pain, gouty arthritis, soft tissue rheumatism, and autoimmune arthritis, were assessed for their health-seeking behavior. About 73% of all those participants sought treatment for their musculoskeletal symptoms. Treatment modality used was modern healthcare, traditional healthcare, self-treatment using traditional medication, self-treatment using modern medication with the proportions of 20.94%, 25.23%, 33.95%, 25.77%, respectively. Disability significantly affected health-seeking behavior as the major determinant (prevalence ratio [PR] 1.087, 95% CI 1.031-1.146, P=0.002), followed by age (PR 1.043, 95% CI 1.000-1.087, P=0.049). Healthcare-seeking behavior was associated with the presence of adverse drug reactions (P<0.001). Factors associated with musculoskeletal pain health-seeking behavior were disability and age. Self and traditional healthcare treatment were further associated with an adverse drug reaction.

Implementation of infection prevention and control in acute care hospitals in Mainland China \u2013 a systematic review

BackgroundHealthcare-associated infections (HAIs) and antimicrobial resistance (AMR) affect patients in acute-care hospitals worldwide. No systematic review has been published on adoption and implementation of the infection prevention and control (IPC) key components. The objective of this systematic review was to assess adoption and implementation of the three areas issued by the “National Health Commission of the People’s Republic of China” in acute-care hospitals in Mainland China, and to compare the findings with the key and core components on effective IPC, issued by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO).MethodsWe searched PubMed and the Chinese National Knowledge Infrastructure for reports on the areas “structure, organisation and management of IPC”, “education and training in IPC”, and “surveillance of outcome and process indicators in IPC” in acute-care facilities in Mainland China, published between January 2012 and October 2017. Results were stratified into primary care hospitals and secondary/tertiary care hospitals.ResultsA total of 6580 publications were retrieved, of which 56 were eligible for final analysis. Most of them were survey reports (n = 27), followed by observational studies (n = 17), and interventional studies (n = 12), either on hand hygiene promotion and best practice interventions (n = 7), or by applying education and training programmes (n = 5). More elements on IPC were reported by secondary/tertiary care hospitals than by primary care hospitals. Gaps were identified in the lack of detailing on organisation and management of IPC, education and training activities, and targets of surveillance such as central line-associated bloodstream infections, ventilator associated pneumonia, catheter-associated urinary tract infections, and Clostridium difficile infections. Information was available on adoption and implementation of 7 out of the 10 ECDC key components, and 7 out of the 8 WHO core components.ConclusionTo variable degrees, there is evidence on implementation of all NHCPRC areas and of most of the ECDC key components and the WHO core components in acute care hospitals in Mainland China. The results are encouraging, but gaps in effective IPC were identified that may be used to guide future national policy-making in Mainland China.

Morbidity and drug prescribing patterns at a rural primary health care center of Bangladesh

Background and objectives: World Health Organization (WHO) and the National Health Policy of Bangladesh have repeatedly been emphasizing on the use of essential drugs prescribed by generic names. The prescription monitoring studies provide a bridge between areas like rational use of drugs and evidence based medicine. Knowledge on distribution and burden of diseases in a community is essential for planning rational use of drugs in a community. The present study tried to determine the morbidity profile and drug prescribing practices of healthcare providers in a rural primary health care.&#x0D; Methods: The study was conducted at a rural health center located 50 Km north of capital city Dhaka. A semi-structured questionnaire was used for collecting data on socio-demographic conditions, clinical complaints and types of drugs prescribed. WHO prescribing indicators was used to find out the drug prescribing pattern.&#x0D; Results: A total of 583 patients were enrolled. Problems related to respiratory system (21.1%), musculoskeletal system (17.3%) and skin diseases (11.1%) were common reasons for visiting health centre. Oral drugs were prescribed with highest proportion (96.1%). More than half (62.6%) of the drugs were prescribed from essential drug list. About half (49.1%) were antibiotics and 45.6% of the drugs were prescribed in their generic name. Anti-microbial (64.5%), anti-peptic ulcer (43.1%) and NSAIDs (42.5%) were most frequently prescribed. Out of five WHO core prescription indicators, four were below the acceptable values.&#x0D; Conclusion: The study demonstrated that there is an urgent need to promote rational use of drugs among the healthcare providers.&#x0D; IMC J Med Sci 2018; 12(2): 50-56

A prescription audit using the World Health Organization-recommended core drug use indicators in a rural hospital of Delhi.

INTRODUCTION:The inappropriate use of drugs is a global health problem, especially in developing country like India. Irrational prescriptions have an ill effect on health as well as health-care expenditure. Prescription auditing is an important tool to improve the quality of prescriptions, which in turn improves the quality of health care provided. The present study was conducted to investigate the rational use of drugs for completeness, legibility, and against the World Health Organization (WHO)-recommended core drug use indicators.MATERIALS AND METHODS:A cross-sectional, outpatient department-based study was carried out in a rural hospital of Delhi wherein 120 prescriptions were randomly sampled, irrespective of patient characteristics and diagnosis over a period of 1 month. All the prescriptions were analyzed for general details, medical components, and WHO core drug use indicators. The data obtained were summed up and presented as descriptive statistics using the Microsoft Excel and were analyzed using SPSS version 16.RESULTS:All the prescriptions had general details mentioned in it. The diagnosis was mentioned in 64.2% of prescriptions, and 85.8% of drugs were prescribed by generic name. An average of 3.02 drugs per encounter was prescribed. The average consultation time and dispensing time were 2.8 min and 1.2 min, respectively. Only half of the patients had correct knowledge of dose.CONCLUSIONS:Our study highlights the need to train our prescribing doctors on writing rational prescriptions for quality improvement.

Assessment of drug use pattern of nonsteroidal anti-inflammatory drugs using the World Health Organization core indicators in a tertiary care teaching hospital - A cross-sectional study

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the management of pain and inflammation. The previous studies suggest that the prescribing pattern of NSAIDs was not in accordance with the current guidelines mentioned by regulatory agencies. Irrational use of drugs can lead to ineffective treatment, adverse drug reactions, and economic burden on patients and society. To overcome this, rational use of drugs should be imperative in health-care system. Furthermore, drug utilization data can help in the formulation of guidelines on clinical use of the drugs and facilitate its rational use. The World Health Organization (WHO) prescribing indicators are used as effective tools in the assessment of drug prescribing practices in health-care facilities. Aims and Objectives: The objective of this study is to assess drug utilization pattern NSAIDs in a tertiary care teaching hospital using the WHO core prescribing indicators. Materials and Methods: This was a prospective cross-sectional, study of 3 months duration conducted in the outpatient departments (OPDs) of a tertiary care hospital during the months of March to May 2019. Patients visiting the pharmacy with the OPD drug prescriptions during the study period were randomly chosen. The data were analyzed using the SPSS software and comparison was done using Chi-square test. Results: A total of 600 prescriptions were analyzed, among which 253 had NSAIDs prescribed. The average number of drugs per prescription was 3.15 ± 1.2. NSAIDs were prescribed as an injection in only 9.5% prescriptions. Percentage of drugs prescribed from the National List of Essential Medicines was 41.1%. Percentage of NSAIDs prescribed by generic name was 26.5%. Conclusions: Periodic monitoring of prescription pattern is mandatory to promote the rational use of drugs. There is a need for increase in generic prescribing and also to improve the adherence of prescribing drugs from the essential medicine list.

Drug utilization evaluation of anticancer drugs in a charitable hospital

Abstract Background: Evaluating the prescribing patterns of anticancer and supportive care drugs is necessary for ensuring effectiveness and patient's quality of life. Aim: This study aims to evaluate the prescribing patterns in patients receiving chemotherapy. Settings and Design: A prospective observational study was conducted in the Department of Medical Oncology at Justice K. S. Hegde Charitable Hospital. Methods: The study was conducted for 8 months from September 2017 to April 2018. Cancer patients who were above 18 years and are on chemotherapy along with supportive care medications were enrolled. Statistical Analysis: Data were analyzed using descriptive statistics. Continuous data were expressed as mean ± standard deviation, and the nominal data were expressed as frequency and percentages. Results: Among 230 patients, majority of patients were in the age group of 45–60 years (47%), females (51.7%), Stage III (51.3%), solid tumor (85.5%), breast cancer (21.7%), doublet regimen (60.4%), who received doxorubicin and cyclophosphamide (36%) in breast cancer while paclitaxel and carboplatin (16.52%) were mostly prescribed among the different cancer types. The most commonly prescribed supportive care medications were dexamethasone (100%), ranitidine (100%), filgrastim (67.4%), tramadol and paracetamol (23.91%), and levofloxacin (9.56%). The percentage of drugs prescribed from the National List Essential Medicine and the World Health Organization (WHO) model list was 80.84% and 78.92%, respectively. Conclusion: According to the WHO core prescribing indicators, the average number of drugs per prescription was 9.63. Majority of the cancer patients were prescribed with paclitaxel and carboplatin (16.52%); dexamethasone and ranitidine (100%) were coadministered in all patients during their chemotherapy cycles.

Prescription analysis based on the World Health Organization core prescribing indicators in pediatric population having respiratory tract infections

Background: Data regarding local drug prescribing are scarce, especially in pediatric population. Evaluation of prescriptions will be helpful in promoting rational prescribing, minimizing adverse effects and should also provide cost-effective care. Aims and Objectives: The objectives of this study were as follows: (i) To analyze the prescriptions based on the World Health Organization (WHO) core prescribing indicators and (ii) to suggest modifications, if necessary in prescribing patterns. Materials and Methods: A prospective and observational study was conducted for a period of 1 year after obtaining institutional ethical committee approval. A total of 210 prescriptions of children aged 0–18 years were analyzed according to the WHO prescribing indicators. Results: Average number of drugs prescribed per prescription was 1.89 and average number of antibiotics prescribed per prescription was 0.70. About 23.80% of drugs were prescribed by generic name. About 18.09% of drugs were given through injectable route. All drugs (100%) were prescribed from the National List of Essential Medicines, 2015. About 87.89% of children received monotherapy (single antibiotic), whereas polytherapy (more than one antibiotic) was prescribed only in 12.11% of the prescriptions analyzed. Conclusion: This study indicates that prescriptions in pediatric population having respiratory tract infections were found to be in accordance with the WHO indicators. However, there is under usage of generic drugs.

The prescribing pattern for the management of dengue fever in pediatric patients of a tertiary care hospital: an observational study

Background: Dengue fever is a mosquito borne viral infection which has become a global health hazard, especially in tropical and subtropical areas. Children have higher risk of developing severe forms of dengue fever, however, studies show that paediatric complications/fatalities from dengue fever are potentially avoidable by proper management. Data about drug usage patterns for dengue are particularly lacking, especially in the paediatric age group, therefore this study will help facilitate the rational use of drugs and aid in establishing a more specific management for dengue fever. The objective of the present study was to identify the prescribing pattern of dengue fever in paediatric inpatients admitted to RajaRajeswari Medical College and Hospital and assess according to the WHO core prescribing indicatorsMethods: This prospective observational study took place from March 2017 to September 2017 in the paediatric general wards. Data was collected from case files of NS1 positive patients of both genders between 1-18years. Data was analysed using descriptive statistics and expressed as percentages, means and standard deviations. The prescription pattern was analysed using the prescribing indicators mentioned in the World Health Organization core drug use indicators.Results: Total of 300 drugs were prescribed for 110 prescriptions that were analysed excluding IV fluids and blood products. Mean number of drugs prescribed was 2.7±0.8. Drugs prescribed by a generic name was 7.33%. Patients prescribed an antibiotic was 12.73%. Patients prescribed with an injection was 62.72% Majority of drugs prescribed in this study come from essential medicines list created by regulatory bodies. Intravenous fluids were administered to all patients with majority receiving normal saline (60.9%).Conclusions: Mainstay of treatment of dengue fever for paediatric patients is symptomatic along with focus on fluid management. Majority of drugs prescribed are from essential medicines lists formed by regulatory bodies. With dengue infections being a worldwide health hazard, more studies are needed to facilitate rational use of drugs in this disease.

Assessment of Drug Use Pattern Using WHO Prescribing Indicators

Background: In order to promote rational drug use in developing countries, assessment of drug use pattern using the World Health Organization drug use indicators is important. The aim of this study was to assess the drug prescription patterns at Kathmandu Medical College Teaching Hospital, using some of the World Health Organization core drug use indicators.Methods: A prospective cross-sectional study was carried out in order to determine current prescribing trends at Kathmandu Medical College Teaching Hospital. A total of 605 prescriptions were collected and analyzed in the study.Results: The average number of drugs per prescription was 5.85 considering the total amount of prescriptions. Furthermore, assuming each prescription as an individual patient, 64.1% of patients received antibiotics, and 71% of patients received injectable form of drugs. Among antibiotics the most common antibiotics prescribed were Ceftriaxone, Amoxicillin/Cloxacillin, Azithromycin, Cefixime, and Cloxacillin. Only 16.94% of the medicines were prescribed in generic names with the rest 83.06% of the medicines being prescribed in brand names and 47.55% of medicines prescribed were from the National List of Essential Medicines-Nepal.Conclusions: The current study revealed that polypharmacy and prescription writing using brand names were common. Prescriptions writing in generic nameneeds to be promoted and encouraged. There appears to be a crucial need for the development of prescribing guidelines when it comes to antibiotics.