Assessment of Rational Use of Eye Medication by Health Care Workers in Public Health Facilities in Machakos Town Subcounty.

Abstract

Background: Irrational use of medicines remains a significant global problem and more so in Low and Middle-Income countries where the burden is higher. It can cause serious harm to patients through suboptimal treatment outcomes. Broad Objective To assess the rational use of eye medications by health care workers in public health facilities in Machakos town sub – County using the WHO/INRUD core drug indicators. Study design: This study was a hospital-based descriptive cross-sectional study design to determine the rational eye medication use in public health facilities within Machakos town subcounty. Study site: The study was conducted in ten PHCFs in Machakos Town Sub- County in Machakos County, Eastern Kenya. Participants and Methods: The WHO/INRUD core indicators was used to explore drug use in PHCFs. These were categorized into 3 groups; prescription indicators, health facility indicators and patient-care indicators. A total of 690 prescriptions were analysed and the information obtained was used to provide information on the prescription indicators. Ten drug dispensers working at the public health care facilities (one per facility) were interviewed and their responses provided information on health facility indicators. 300 patients were interviewed and their responses provided information on patient care indicators. The data collected about the specific indicators was analyzed using STATA version 14.1. Results. An average of 1.2 eye medications were prescribed per patient encounter which was less than the WHO/INRUD recommended range of 1.6 – 1.8 drugs while 75.2% of the eye medications were prescribed from the KEML. The percentage of eye medications prescribed by generic names was 18.2%. The percentage encounters with an ophthalmic antibiotic prescribed was 62.2% which was above the recommended WHO/INRUD value of 20.0% – 26.8%. 13 In the 10 selected facilities only one facility had prescribers specialized in management of eye illnesses while two facilities had qualified drug dispensers. KEML copies were available in only 30% of the selected facilities while only two facilities had key eye medications available. The average consultation time was 5.5 minutes which was less than the WHO/INRUD optimal value of ≥10 minutes. The average dispensing time was 115 seconds which was within the WHO/INRUD optimal value of ≥ 90 seconds. 29.6% of the prescribed eye medications were actually dispensed of which 96% were adequately labelled and 94.7% of the patients had correct knowledge of eye medications dispensed to them. Conclusion Most of the prescribing indicators, facility-specific indicators and patient care indicators in this study deviated from the WHO/INRUD optimal values. Recommendations. The prescribers should be sensitized to prescribe drugs by their generic names, promote rational prescribing of ophthalmic antibiotics and prescribe eye medications adhering to the KEML. The county government should equip all health facilities with enough copies of the KEML and mobilize resources to supply all essential eye medications in the PHCFs.