E-DRUG: New article - Paediatric Prescribing using WHO/INRUD indicators-Sierra Leone
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E-Druggers,
I have recently read an article titled An evaluation of the prescribing patterns for under-five patients at a
Tertiary Paediatric Hospital in Sierra Leone by Christine Princess Cole, Peter Bai James and Alusine Tommy Kargbo from the Department of Clinical Pharmacy and Therapeutics, 1Department of Pharmacognosy and Phytochemistry, Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
Address for correspondence: Dr. Christine Princess Cole, Email: cpcole2003@yahoo.co.uk
Reference Journal of Basic and Clinical Pharmacy Vol. 6 | Issue 4 | September-November 2015
www.jbclinpharm.org DOI: 10.4103/0976-0105.168051
The article is available at
http://jbclinpharm.org/article.asp?issn=0976-0105;year=2015;volume=6;issue=4;spage=109;epage=114;aulast=Cole;type=3
The Abstract reads
Purpose: There is limited information on paediatric prescribing in Sierra Leone. This study evaluated prescribing patterns for under-five patients at Ola During Children's Hospital (ODCH) and assessed the extent of rational prescribing.
Methods: A descriptive, cross-sectional, retrospective study of 294 prescriptions, selected by systematic random sampling was conducted at the outpatient department of ODCH. The World Health Organisation prescribing indicators were analyzed using the SPSS package 16.0. The index of rational drug prescribing (IRDP) was calculated to assess rational prescribing.
Results: The average number of medicines per prescription was 3.77. The percentage of medicines prescribed by generic names was 71.0%, while 74.8% and 21.1% of prescriptions had an antibiotic and injection, respectively.
The percentage of medicines prescribed from the national essential medicines list was 70.6%. The most
commonly prescribed pharmacological groups of medicines were vitamins (85.37%) and antibiotics (82.99%). The IRDP was 2.71, instead of the ideal value of 5.
Conclusion: Paediatric prescribing patterns at the outpatient department of ODCH cannot be said to be entirely rational, especially with regards to antibiotic and injection prescribing.
..........
What is interesting about this article is the use of an index that groups five WHO/INRUD indicators into a single indicator. This is not their idea but that of a Chinese team who have published a large study involving 690 facilities. The reference for the study is
Dong L, Yan H, Wang D. Drug prescribing indicators in village health
clinics across 10 provinces of Western China. Fam Pract 2011;28:63‑7.
Here is the abstract.
Background. The irrational use of drugs was a global problem, especially in developing countries.
However, there are no studies available on irrational use of drugs in rural Western China.
Objective. To assess the drug prescribing patterns using World Health Organization Drug Use
Indicators at village health clinics in rural areas of Western China.
Methods. A total of 20 125 prescriptions were collected from 680 primary health clinics in villages
from 40 counties in 10 provinces of Western China. Five measurements were used to assess
the irrational drug use: percentage of encounters with an antibiotic prescribed, average
number of drugs per encounter, percentage of encounters with an injection prescribed, percentage
of drugs prescribed by generic name and percentage of drugs prescribed from National
Essential Medicines List or Formulary. Index of Rational Drug Prescribing (IRDP) was used as
an indicator of rational drug use.
Results. The percentage of prescriptions containing antibiotics was 48.43%,while the average number
of drugs per prescription was 2.36, and the percentage of injection prescriptions was 22.93%.
The percentage of drugs prescribed by generic name was 64.12%, and the percentage of drugs prescribed
from the National Essential Drug List was 67.70%. The IRDP of the present study was 3.32
with the optimal level of 5. There are also some regional variations in these measurements.
Conclusions. The study provides some evidence of irrational use of drugs to a great extent in
rural areas of Western China. Overuse of injection and overuse of antibiotics were the most
prominent manifestations of such irrational drug prescribing.
(Available full article T http://fampra.oxfordjournals.org/content/28/1/63.full.pdf+html free)
The index is calculated from the following indicators with the optimal measures identified
% Prescriptions including antibiotic <30
% Polypharmacy prescription defined as more than 5 items
% Prescriptions including injection <10
% Drugs prescribed by generic name 100
% Drugs prescribed from essential medicines list or formulary 100
The Sierra Leone paper has a very good discussion section though they do not mention the original Lancet 1993 paper by Hogerzeil and others that reported on the first 12 countries.
But if anybody is thinking of doing a study using these indicators these two recent papers would be worth reviewing and citing,
Richard Laing
Professor International Health
Boston University School of Public Health,
801 Massachusetts Avenue Boston MA 02118
Tel 617 414 1445 (Office) 617 435 7860 (Mobile)
E mail richardl@bu.edu