ADDIS ABABA UNIVERSITY

COLLEGE OF HEALTH SCIENCES

SCHOOL OF PUBLIC HEALTH

A research report on

Assessment of drug utilization using WHO

prescribing indicator at abosa health center

Investigator: BEREKET DEGAGA

January 2019
Addis Ababa, Ethiopia.
 List of abrvation and acronyms

ADRs: Adverse Drug Reactions

EDL: Essential Drug List

WHO: World Health Organization.

Abstract

Background:
Drug utilization research was defined by WHO in 1977 as «the marketing, distribution,
prescription, and use of drugs in a society, with special emphasis on the resulting medical, social
and economic consequences»(1).
Despite the fact that the most leading causes of death and disability in developing countries can
be prevented, treated or at least alleviated with cost effective drugs, many people do not have
regular access to essential drugs. On the top of that those who have access are using drugs
irrationally [1]

Method
A cross-sectional study was carried out by sampling 384 prescriptions from all
prescriptions of the pharmacy of the abosa health center from aprill 2018 to juanuary 2019.
A systematic random sampling technique was employed to select prescriptions during data
collection. Data processing and analyzing was done by scientific calculators and by using
computers software.

Result

Out of 384 prescriptions analyzed, a total of 836 drug products were prescribed. The average
number of drugs per prescription was 2.1. The total number of drugs prescribed by generic name
was (99.3%). Antibiotics were prescribed in 331(86.19%) encounters and injections were
prescribed in 76(19.7%) encounters. All drugs prescribed were from essential drug list of
Ethiopia

Conclusion
The finding of this study revealed that drug utilization pattern was not optimal in accordance
with the standard values of WHO prescribing indicators. There was over prescription of
antibiotics and a higher tendency of poly pharmacy

1.Background
Drug utilization research was defined by WHO in 1977 as «the marketing, distribution,
prescription, and use of drugs in a society, with special emphasis on the resulting medical, social
and economic consequences»(1).
Despite the fact that the most leading causes of death and disability in developing countries can
be prevented, treated or at least alleviated with cost effective drugs, many people do not have
regular access to essential drugs. On the top of that those who have access are using drugs
irrationally [1]

WHO developed Medication Use Indicators, including Prescription Indicators with aim to
evaluate the services provided to the population in regards to medications Prescription
Indicators allow the therapeutic actions taken in similar institutions to be ascertained, enabling
subsequent comparison of parameters between them, and to evaluate the population’s medication
needs and determine the most frequently used medications in a given place [1]. In addition, these
indicators enable the investigator to identify the prescription profile and quality of services
offered to the population.The prescription Indicators are as follows (2)
Average number of drugs per medical prescription This indicator helps in investigating poly-
medication, which is a major factor contributing to adverse drug reactions (ADRs) and drug-drug
interactions (DDIs). The educational quality informational level of the prescriber may also be
observed (2).

Percentage of drugs prescribed by generic name This indicator enables the investigator to
calculate the number of prescriptions in which the drugs are prescribed by the generic name. This
helps in controlling drug costs in the health service. It also evaluates the marketing influence on
the person prescribing drugs (2).

Percentage of prescribed injectable drugs This indicator helps to evaluate the injectables in
excess, administration of which may have serious consequences when prescribed or applied
wrongly, such as in the event of anaphylactic reactions, adverse reactions, necrosis, etc(2).
Percentage of encounters with an antibiotic prescribed This indicator evaluates the use of
antibiotics in excess which contributes to bacterial dissemination and resistance

Percentage of drugs prescribed from essential drug list or formulary This indicator helps in
measuring the degree to which practices conform to the current National Drug Policy (2)

2. Method and material

2.1. Study area and period

Cross-sectional study was conducted on January 2018 in abosa health center at Adamitulu
wereda eastern showa zone in oromia regional state. The capital of wereda is Zway town which
is found 156km from Addis Ababa capital city of Ethiopia in southern direction, the total
population is 59746 from the total population.28358 is female Majority of the population has
semi-urban living standard and their ethnicity is oromo. In this area there are one government
hospital, one privet hospital, 18 privet clinic 2 community pharmacy and 16 drug store are giving
health service
2.2 Study design
Cross-sectional study was carried out

2.3 Data collection method

The data was collected by simple observation of the patients prescriptions

recordings at specified period of time

2.4 Sampling and sampling size

The sampling method was systematic random sampling. The sample size was 384
prescription, which is found by calculating using simple proportion formula

2.5 Source of population

All prescription available in abosa health center from 1/1/10 to 30/12/10

2.6Study population
 Randomly selected prescription in abosa health center from 1/1/10 to 30/12/10

2.7 Eligibility.

Inclusion criteria

Prescription only with drugs

Exclusion criteria

Prescriptions that have medical fluids and medical supply

2.8 Data analysis

First the collected data were check for completeness. Then the collected data where interred on
software (EpiData) then I convert the entered data to Microsoft excel and I analyzed the data..
Variables considered in the data analysis include
1. Average number of drugs per encounter
2. Percentage of encounters with an antibiotic prescribed.
3. Percentage of encounters with an injection prescribed.
4. Percentage of drugs prescribed from essential dru

2.9 Ethical approval

Ethical clearance will be obtained from the ethical review board of School of public health,
College of Health Sciences, Addis Ababa University. Information obtained from all data
collection techniques in the course of study will only be handled by research team, and data will
be analyzed in aggregates.

Result

Out of 384 prescriptions analyzed, a total of 836 drug products were prescribed. The average
number of drugs per prescription was 2.1. The total number of drugs prescribed by generic name
was (99.3%). Antibiotics were prescribed in 331(86.19%) encounters and injections were
prescribed in 76(19.7%) encounters. All drugs prescribed were from essential drug list of
Ethiopia (Table 1).
Table 1:drug prescribing indicator in abosa health center from aprill 2018 to juanuary 2019.
(N=384)

Prescribing indicators Number Average/ WHO Ideal

Percentage Values

Average number of drugs 836 2.1 (1.6-1.8)

per encounter

Percentage of encounter 331 86.2% (20.0-26.8%)

with antibiotics
Percentage of encounters 76 19.7% (13.4%-24.1%)
with injection
Percentage of drugs 830 99.2% 100%
prescribed by generic
Percentage of drugs from 836 100% 100%
essential drug list

Table 2: top five prescribed drugs from aprill 2018 to juanuary 2019. (N=384)

Name of the drug Totall number Percentage

Paractamol 155 18.5%

Amoxcilin 148 17.7%

Diclofenac 80 9.5%

Ciprofloxacin 56 6.6%

Doxycycline 47 5.6%

Table 3: top three antibiotics prescribed from aprill 2018 to juanuary 2019. (N=384)

Name of antibiotics Totall number Percentage amoung antibiotics

Amoxicillin 148 36.7%

Ciprofloxcillin 56 13.8%

Doxycycline 47 11.6%
DISCUSSION

The WHO core indicators of prescribing practice measure the performance of

health care providers in several key dimensions related to the appropriate use of
drugs. In the present study, the average number of drugs per prescription, which is
an important index of the standard of prescribing, was 2.1. this value is higher
than the WHO recommended value of 1.6-1.8. this implies that there is a poly
pharmacy but not in significant amount
Appropriate antibiotic use has both clinical and economic significance to any
health system and should be given adequate attention. Inappropriate use of
antibiotics can potentially leads to antimicrobial resistance and increase the
necessity to use more expensive antibiotics to treat common and life threatening
infections. In the present study, percentage of encounter with antibiotic is 86.2%
which is higher by three fold than the WHO standard value of 20.0%-26.8%. this
number is extremely large when compared to other studys done in ethiopia, for
instance a research done in ayder hospital (mekele) the percentage of encounter
with antibiotic is 32% and a research conducted in hawassa university hospital is
58%, while a research done in southern India it is only 22%. But it is difficult to
compare the present study findings with the above mentioned because this study
is done in rural health center which is very different setting from the others study
however a high prevalence of communicable disease in this area the result is still
to high, from the antibiotics amoxcilin takes 36.7% followed by ciprofloxclin
13.8% which are notorious in developing resistance to so many pathogens and
also it increase the risk of crss-resistance in case of fluoroquinolones
Over use of injection leads to economic cost and health hazard, in this study the
percentage of encounter with injection was 19.7% that almost in range of WHO
standard 13.4%--24.1%. from the total of 90 injection diclofenac IM stat,
accounts for 67(74.4%) that leads to a question or further investigation about the
rational use of this medication.
Prescribing by generic name is known to reduce the cost of drug treatment and
rationalizing drug therapy. A relatively encouraging result was found with regard
to generic prescribing as it was found to be 99.2% still less than the WHO
standard 100% however almost all drug are prescribed by generic name except
one drug metoclopramide which was prescribed as plasil.
From the five top prescribed drugs paractamol take the lead 18.5% followed by
amoxicillin 17.7% from all the prescription, both accounts about 36.2% from all
the drugs analyzed, it implies there is irrational use of these medicine that may
need further investigation

CONCLUSION

The finding of this study revealed that drug utilization pattern was not optimal in
accordance with the standard values of WHO prescribing indicators. There was
over prescription of antibiotics and a higher tendency of poly pharmacy.