Assessment of rational drug use and prescribing in primary health care facilities in north west Ethiopia.

A study on rational drug use was undertaken in nine health centres (HCs) and nine health stations (HSs) in Ethiopia. Prescribing, patient care and facility specific factors were measured using drug use indicators. Prescribing patterns of drugs were also assessed. With only few exceptions, the drug use indicators in HCs and HSs and between retrospective and prospective studies were similar despite differences in manpower and facilities. The average consultation time (in minutes) in HSs and HCs was 5.1 +/- 0.8 and 5.8 +/- 1.06, respectively. The dispensing time (in minutes) was 1.5 +/- 0.7 in HSs and 1.9 +/- 0.6 in HCs. Both patient care indicators seem to be adequate to influence patient satisfaction to the overall health service and patient knowledge of important dosage instructions. Most drugs (more than 89% in HCs and 71% in HSs) were actually dispensed from the health facilities and labelling was satisfactory. Prescribing by generic names (average: 75% in HCs and 83% in HSs) was encouraging. While the availability of key drugs was ensured, essential documents were missing in most facilities or they were unpopular for use, and those available required revision and updating. Polypharmacy in which the number of drugs/encounter was < 2.5 was minimal, but that a large proportion of the prescriptions contained two or more drugs could result in adverse drug-drug interactions. The most frequently prescribed drugs were anti-infectives and analgesics accounting for over 76% in HCs and 82% in HSs and in most cases they are probably prescribed with little justification. The exposure of patients to antibiotics (average: 60% in HCs and 65% in HSs) was unacceptably high to justify epidemiological trends. The high exposure of patients to injections, especially in the HSs (over 37%), should be seen from the health and economic points of view. The results revealed priority areas for intervention. They also provide standard references to compare drug use situations and their change over time in different settings, area and time in Ethiopia.

PIP: In a study on rational drug use in 9 health centers (HC) and 9 health stations (HS) in Ethiopia, prescribing, patient care, and facility-specific factors were observed and measured through drug use indicators during February-June 1995. With only few exceptions, the drug use indicators in HCs and HSs were similar despite differences in manpower and facilities. The average consultation times in minutes in HSs and HCs were 5.1 and 5.8, respectively, while the dispensing times were 1.5 and 1.9 minutes, respectively. More than 89% of drugs in HCs and 71% in HSs were dispensed from the health facilities, and labeling was satisfactory. On average, generic brands were prescribed 75% of the time in HCs and 83% of the time in HSs. Key drugs were available, but important documents were missing in most facilities or were unpopular for use. When documents were available, they needed to be revised and updated. The level of polypharmacy was low. The most often prescribed drugs were anti-infectives and analgesics, accounting for more than 76% in HCs and 82% in HSs, and probably often prescribed with little justification. 60% of patients in HCs and 65% in HSs were exposed to antibiotics, levels too high for the prevailing disease conditions. More than 37% of HS patients received injections.

Child morbidity patterns in Ethiopia.

This study is based on the 1983 Rural Health Survey of Ethiopia. Patterns and levels of child morbidity by age, sex, geographic region, and sanitary facilities are examined. Morbidity levels peak in the second year of life. Diarrhoeal diseases are of major importance, especially among infants and toddlers. Parasitic diseases, and respiratory diseases other than pneumonia, become increasingly important with age. There are no significant sex differentials in morbidity except for higher rates of diarrhoeal diseases among female children. Geographic differentials are quite marked with particularly high morbidity levels from all disease types in the western mountainous regions of Ethiopia. Access to high quality drinking water, a latrine, and garbage disposal, are strongly related to reduced overall morbidity levels, though not necessarily to reduced diarrhoeal disease levels.

PIP: 1983 data on 11,962 6-year old children were analyzed to examine patterns of child illness in rural Ethiopia. Overall child morbidity was high, especially among children who were at the most 1 year old. No significant difference existed between boys and girls, except diarrhea occurred more often in girls. Diarrhea accounted for most illnesses, especially among infants and 1-year old children. As children aged, parasitic and other respiratory diseases increased. Children who lived in a house with a latrine and who defecated in the latrine had the lowest morbidity rate (p.001). Only 12.7% of children who lived in a home with piped water were sick in the 2 weeks prior to the survey compared with or=20% for all other sources of water (p.001). The water supply with the highest morbidity rate was a river (30%). In addition, children who had a garbage bin in their house experienced fewer illnesses than did those who did not have a bin (17.1% vs. 29.2%; p,.001). Even though these 3 sanitation indicators were associated with reduced morbidity, they were not always associated with reduced diarrhea levels. The 3 western mountainous regions (Gonder, Ilubabor, and Wellega) had the highest morbidity rates (59.3%, 41.9%, and 45.7%, respectively). Their rates were much higher than the country morbidity rate of 28.8%. Moreover, children in these mountains regions were 2.6-4.9 times more likely to become sick than those in the other regions. Gonder region had the highest malnutrition rate and the 2nd highest diarrhea prevalence rate. Wellega had the highest diarrhea rate and the 2nd highest malnutrition rate. Ilubabor ranked 3rd for both diarrhea and malnutrition. Yet Ilubabor ranked highest in parasitic and other respiratory diseases. Lack of health services and malnutrition most likely accounted for the higher child morbidity in these 3 regions. It is concluded that the Primary Health Care Program should focus on improvements in sanitation and health education.