Core Indicators Of Appropriate Drug Use At Public Primary Healthcare Centers In Kisii County, Kenya

Abstract

Background: Rational drug use requires that patients receive medications appropriate to their clinical needs, in doses that meet their requirements, for an adequate period, and at the lowest cost to them and their community. It is a complex matter which involves the; patient, prescriber, dispenser, and healthcare facilities. Budgets on drugs usually account for about 25-50% of the total health expenditure in most of the developing countries. Irrational drug use is a global problem; however, the extent of the matter is much higher in low-income countries like Kenya. Drug information gap, weak drug regulation measures, the heavy workload on the healthcare service providers and patient beliefs and preferences contribute to the irrational use of drugs. Since the inception of devolution in 2010, it is most likely that the Kisii County Government was wasting its resources on irrational drug use. This study was thus meant to examine the core indicators of appropriate drug use using the World Health Organization/ International Network for Rational Use of Drugs (WHO/INRUD) methodology at the public primary healthcare (PPHCCs) in Kisii County, Kenya Objective: The general objective of this study was to assess the patterns of drug use and the prevalence of irrational drug use at the public primary healthcare centers (PPHCCs) in Kisii County, Kenya in reference to the WHO/INRUD core drug use indicators methodology. Methods: The study was a hospital-based cross-sectional survey. Ten PPHCCs were selected by simple random sampling method. From each PPHCC, ninety prescription encounters, generated from 1st October to 31st December 2018, were systematically randomly sampled. Three-hundred (30/PPHCC) conveniently sampled patients and ten (1/PPHCC) dispensers were also observed and interviewed on the survey visit days. Data entry and analysis were conducted using Epi - inforTM version 7.2.2.16 and STATA version 14.2. Descriptive and inferential statistics were used in data analysis. Graphs and tables were used to represent the results. Results: Prescribing indicators deviated from the WHO/ INRUD optimal values except for encounters with injections prescribed. The findings were; average number of drugs prescribed per patient encounter = 2.9 (SD 0.5), percentage of prescribing drugs by generic names = 27.7% (SD 21.0), percentage of prescriptions with an antibiotic = 84.8% (SD 26.8), percentage of xvi prescriptions with an injection = 24.9% (SD 20.5) and percentage prescribing from KEML = 96.7% (SD 4.2) Regarding patient-care practices, average consultation time was short of the optimal time but dispensing time was in line with the WHO/ INRUD recommended time. Drug labeling was poor. Patients’ knowledge of dispensed drugs was average. The findings were; average consultation time = 4.1 min (SD 1.7), average dispensing time = 131 sec (SD 41.5), percentage of drugs actually dispensed = 76.3% (SD 10.9), percentage of drugs adequately labeled = 22.6% (SD 27.5) and percentage patients’ knowledge of dispensed drugs = 54.7% (SD 8.0).The facility-specific indicators deviated from the WHO/ INRUD optimal values especially the availability of copies of KEML where only two facilities had copies. Almost all essential drugs were available at the facilities. The results were; percentage availability of copies of KEML = 20% (SD 42.2) and percentage availability of essential drugs = 80.0% (SD 16.8). The differences among PPHCCs were statistically significant (p < 0.05) for all the indicators. Conclusion: The survey shows a trend toward irrational practices particularly; polypharmacy, non-generic prescribing, overuse of antibiotics, short consultation time, the inadequacy of drug labeling, and unavailability of KEML copies at most of the facilities.