E-drug: Use of priority and misused drugs in Nepal
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by Prof.Kumud,K.K, Bhuju,G.B, Shrestha,B.M, Rajbhandari,V,
Dangichhetri,G.B, Humagain,BR
Summary: A study including qualified prescribers and unqualified
practitioners from central, regional and district levels was
conducted to find out use of priority and misused drugs. The study
covered qualified prescribers from four central level hospitals, two
regional hospitals, three zonal hospitals and six district
hospitals, 18 health posts and 18 sub health posts. The number of
encounters from public sectors facilities was 3,742 whereas there were
975 encounters in the private sector. The number of unqualified
practitioners interviewed was 109. Twelve FGDs [Focus Group
Discussions? WB] were also conducted with unqualified practitioners.
Fifty one percent of prescribed drugs were priority drugs. Twelve
percent, 4%, 3% and 0.3% of drugs prescribed were inappropriate,
ineffective, needlessly expensive and harmful drugs respectively.
ORS alone was prescribed only to three percent of encounters in
public sector but none in private sector. Seventy percent of the encounters
received antibacterials combined with antipyretic/analgesic or cold
preparation or other drugs. Prescribing practices of qualified
prescribers in pregnancy showed about 30% encounters received iron
preparations in public sector but none in private sector. Usual
recommendation of 25% of unqualified practitioners for diarrhoea was
ORS. Usual recommendation of 55% of unqualified practitioners for
Pneumonnia was antibacterials. The usual recommendation of 50% of
unqualified practitioners for typhoid was Chloramphenicol and
ciprofloxacin. Usual recommendation of 80% of unqualified
practitioners for anaemia in pregnancy was iron preparations. The
usual recommendation of 65% of unqualified practitioners for weakness
was Vitamin B-Complex. Usual recommendation of about 60% of
unqualified practitioners for pulmunary tuberculosis was referral.
The usual recommendation of about 35% of unqualified practitioners
for Syphilis and gonorohhoea was penicillins.
The percentage of encounter receiving antibiotics was 50.7%.
PRIORITY DRUGS have been defined as the drugs categorized for
different level of health facilities in the Essential Drugs List of
Nepal.
INAPPROPRIATE DRUGS have been defined as the drugs, which are not
necessary or not useful.
INEFFECTIVE DRUGS have been defined as the drugs, which have been
claimed to be effective but are not effective.
NEEDLESSLY EXPENSIVE DRUGS have been defined as the drugs, which are
expensive, but having little therapeutic benefit or decreased side
effects. [? decreased side effects? WB]
HARMFUL DRUGS have been defined as the drugs banned in Nepal.
Contact Person: Prof.Kumud K.Kafle, Pharmaceutical Horizon of
Nepal(PHON), Post Box No:9566, Kathmandu, Nepal.
e-mail:INRUD@npl.healthnet.org
[message edited for language WB]
[interesting study! How did you assess the diagnosis? Were 'good' or
'bad' prescribing habits defines before the study? Overall conclusion?
Other countries with similar studies? WB]
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