Managerial Strategy for Changing Drug Use Behaviour
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International Network for Rational Use of Drugs (INRUD), Nepal has conducted
studies to test effects of intervention on Prescribing and Dispensing
Practices in Primary Health Care set-up in Nepal. A third study to identify
knowledge, attitude and practices (KAP) of the community with respect to five
problems (dirrrhoea, fever, cough, worm infestation and weakness) and commonly
used drugs was also carried out.
The study on prescribing included randomly selected 36 Health Posts (HPs) and
27 Sub-health Posts (SHPs) of nine Terai (Plains) districts of Nepal. The
study on dispensing included the same health facilities inaddition, 90
randomly selected private drug retailers from the same nine districts were
also included.
KAP study was carried out in randomly selected 900 households from the same
nine districts.
The intervention strategy for prescribing was supervision/monitoring but
incase of dispensing the strategy was only training and training plus
supervision/ monitoring. The supervision/monitoring in the health institutions
both for prescribing and dispensing practices was carried by District Health
Officer whereas supervision/monitoring for dispensing practices in private
sector was done by the Regional Drug Administration Authority.
The training to dispensers both from pubulic and private sector was given by
the Research Team.
The WHO Prescriber, Patient Care and Facility Indicators were applied to
evaluate the impact of intervention. The number of encounters in each facility
corresponded to numbers recommended by WHO Manual.
The main findings of these three studies:
1. Prescribing Practices
- significant decrease in injection practices (P<0.05)
- significant increase in consultation time (P<0.01)
- significant increase in prescribing in accordance with Standard Drug
Treatment Schedule (P<0.01).
2. Dispensing Practices
- significant increase in dispensing time in public sector with
training plus supervision/monitoring (P<0.05)
- significant increase in patient's knowledge of correct dosage in
public sector with training only.
- the private sector showed no significant change with any of the
intervention .
3. Community Drug Use
- fifty-nine percent of households used private sector for illness .
- twenty-four percent only used public sector during the illness.
- nine percent used traditional treatment including shamans.
- seventeen percent did not receive any medication.
- the private sector was used more by all economic groups.
- the private sector was used more by literate than illiterate
(illiterate mostly had no medication)
- no significant difference by sex in treatment practices.
- the households stock of drugs showed mainly antibiotics more than
ORS, antidiarrhoeals or vitamin/tonics.
- forty-two percent (majority) believed injection as most effective
dose form.
- about 45% (majority) believed liquid or tablet as most convenient
dosage form.
All these studies were funded by USAID/Nepal.
This article is prepared by INRUD/Nepal Core-group Members Kumud K.Kafle,
Yogendra M.S.Pradhan, Ananda D.Shrestha, Shiba B. Karkee, Radha R. Prasad,
Naveen Shrestha, Prabhakar L. Das.
Correspondance can be made:
E-mail: INRUD@npl.healthnet.org
Fax: 977-1-228496
(attn: Dr.K.K.Kafle, Institute of Medicine, T.U. Teaching Hospital, Kathmandu
Nepal.)