A survey of drug use in pregnancy at the Kenyatta National Hospital

Abstract

Background: The study set out to establish the appropriateness of drug use practices among mothers and prescribers at the Obstetrics and Gynaecology department of Kenyatta National Hospital. Since it is very difficult to determine the effects on the foetus before marketing new drugs due to ethical reasons, most drugs are not recommended to be used during pregnancy. The dilemma is that while avoidance of most drugs is recommended, especially in the first trimester, pregnancy itself is often a cause of need for drug use. A careful balance between the risks of medications to the foetus and the benefits to the mother is therefore necessary. This requires good prescribing and good drug use practices among pregnant women to achieve Objectives: The objectives of the study were to establish the factors influencing the level of knowledge of mothers concerning safe use of drugs in pregnancy and their self medication practices during pregnancy, to determine which drugs are used by mothers during pregnancy for self medication and to determine which drugs are prescribed to mothers during pregnancy and the peri-natal period. Setting: The study was carried out at the Obstetrics and Gynaecology wards of Kenyatta National Hospital, a Tertiary National Referral and Teaching Hospital in Kenya. This site was appropriate for the study because, being a National Referral Hospital, patients at the Hospital were a better representation of the situation of drug use in pregnancy in the whole Country. Design: The study was conducted as a cross sectional survey. Data collection: Data was collected by the investigator alone for the purposes of uniformity. The questionnaires were administered in English or Kiswahili depending the respondents' preferences. Research authorisation was obtained from the Kenyatta National Hospital Ethics and Research Committee and informed consent was obtained from every respondent before the interview. Data analysis: Data was analysed using Statistical Package for Social Scientists (SPSS) version 11.5 and STATA 11 computer softwares. Knowledge was measured by a knowledge score generated by combining ten variables indicating knowledge into a single variable. Thirty per cent of the respondents had used self medication during pregnancy. Results: Paracetamol was the drug used by most of the respondents (30%) for self medication during pregnancy while antibiotics were the most prescribed class of drugs with Augmentin® being the drug most prescribed. Most drugs prescribed (43.6%) belonged to FDA category B. When examined alone (univariably) there was significant relationship between level of knowledge and age greater than 35 years, employment whether in the formal or informal sector compared to not being employed or self employed and level of education. However, in the multivariable analysis which adjusted for other factors only level of education was significant for having knowledge of drug use in pregnancy. Conclusion and recommendations: The level of education and hence the level of knowledge of drug use in pregnancy of a woman is the single most important factor that significantly influences their self medication practices while pregnant. This implies that a lot of effort should be put toward improving level of education of women as this will improve their reproductive health outcomes.