Drug utilisation in the geriatric population in the nursing homes and central hospitals of urban Harare.

This paper outlines the pattern of drug utilisation in the elderly inpatient population in the nursing homes, Bumhudzo and BS Leon Trust and the two central hospitals, Harare and Parirenyatwa, in urban Harare, during the period, February to September 1990. The total population of elderly patients in the four institutions was calculated at 324 (52 pc) 170 of which were males and 48 pc were females. Of these patients 273 (84 pc) were Black, 44 (14 pc) were White and seven (2 pc) were Asians. Drug use pattern was estimated using the defined daily dose (DDD) system. The pattern of drug use was matched with the disease pattern to detect any discrepancies in drug utilisation. Of the 324 patients interviewed 114 (35 pc) were not on medication. The total number of drug formulations taken by the studied population was 1,117 with a mean of 3.45 drugs per individual at any one moment. Polypharmacology seems rife. The study indicated irrational and over utilisation of centrally acting drugs and vitamins and minerals. The most utilised group of drugs are the cardiovasculars (22 pc of the total) The most common disease conditions encountered in the elderly were hypertension, 7 pc, congestive heart failure, 7 pc, epigastric pain, 6 pc, senile dementia, 5 pc and pneumonia, 5 pc. The responses on sources of drug information available for the elderly revealed that pharmacists are totally unknown to the elderly in this respect. Measures that could be taken to improve elderly drug use are suggested.

Diagnoses and prescribing for pediatric patients at two hospitals in Harare, Zimbabwe.

PIP: During March-August 1990 in Zimbabwe, researchers reviewed the medical records of 500 consecutive patients, 0-12 years old, at Harare Hospital and Parirenyatwa Hospital to lean what the most frequent pediatric diagnoses were and to compare prescribing patterns. These hospitals were of comparable size but served different populations. Patients at Harare Hospital tended to have a lower income and be children than those at Parirenyatwa Hospital. Parirenyatwa Hospital specialized in cardiovascular, hematology, medicine, and oncology services. Clinicians identified 737 diagnoses. The most common diagnoses included respiratory infections (39.4% of patients), gastroenteritis (16.8%), malnutrition (10.4%), sepsis (9.6%), and AIDS (8.6%). 97.8% of the children received at least 1 medication (1725 prescriptions). The mean drugs prescribed per patient stood at 3.45 (range, 0-18). Patients with AIDS accounted for the high end of the range. The most frequently prescribed drug type was antibiotics (about 35%), especially penicillin. The recommended duration of antibiotic treatment is 7-14 days, but the mean duration among these children was only 5.1 days. Harare Hospital had more patients admitted for infections and neurologic conditions than did Parirenyatwa Hospital (47.1% vs. 35.% and 4.5% vs. 2%, respectively), which accounted for the higher prescription rate for anti-infective drugs and central nervous system drugs at Harare Hospital (55.4% vs. 47.3%, and 3.5% vs. 2.6%, respectively). Parirenyatwa Hospital had more surgical procedures and febrile convulsions than Harare Hospital, which explained why it had higher prescription rate for analgesics (12.5% vs. 8.7%). It also had more children diagnoses with respiratory infections. Harare Hospital had more malnutrition, sepsis, and AIDS pediatric cases. Since the two hospitals served different socioeconomic populations, it was not surprising to find differences in prescription patterns, which were appropriate and tended to abide by the Essential Drugs List recommendations.^ieng