Assessment of quality of essential medicines in public health care facilities of Nepal: Findings of nationwide study.

Essential medicines are those medicines that satisfy the primary health care needs of the citizens. Poor quality of essential medicines can have serious impact on public health. Thus, this study is aimed to assess the quality of essential medicines available in public health care facilities of Nepal. A cross sectional descriptive study was carried out in 62 health facilities across 21 districts, representing all seven provinces of Nepal and selected proportionately from all three ecological regions i.e. Terai, Hill and Mountain using lottery method. Health facilities in selected districts were chosen using random number generator. Face to face interview was taken with health facility in charge using structured questionnaire. All storage conditions information was recorded through observation checklists. Temperature and humidity were measured using a digital instrument. Similarly, 20 different generic medicines were collected for quality testing. The obtained data were entered in Epidata version 3.1, cleaned in Microsoft Excel 2007 and analyzed in SPSS version 16.0. Among 62 health facilities, only 13% of health facilities were found to follow the medicine storage guidelines, with temperature and humidity levels exceeding recommended limits. Out of 244 batches of 20 different generics of essential medicines, 37 batches were found to be substandard. These substandard medicines were- Ciprofloxacin hydrochloride eye/ear drop, Iron supplement tablets, Metformin Hydrochloric tablet, Metronidazole Tablets, Paracetamol Oral suspension, Paracetamol tablet and Povidone Iodine solution. The study recommends the urgent need for the Government of Nepal to prioritize ensuring the quality of essential medicines in the country.

Quality of Drug in Health Facilities: A Cross-sectional Study.

BACKGROUND: Poor quality drugs result minor to detrimental effect on human health. The drug should be of standard quality and should be used appropriately in order to meet its therapeutic efficacy. This study aims to assess the quality of drug in Nepal. METHODS: A cross sectional study was conducted in randomly selected 88 health facilities in Nepal from 10th April to 30th June 2016. Selective medicines were collected from both private licensed pharmacies and selected public health facilities. Face to face interview with health facility in-charge of selected health facilities was carried out along with the direct observation of the medicine storage room. The collected medicine samples were dispatched to two laboratories for in-vitro analysis. The labels of the collected medicine were analyzed. The obtained data were entered in Epidata version 3.1, cleaned in Microsoft excel 2007 and analyzed in SPSS version 20. RESULTS: Out of 172 brands, nine brands of medicines were found substandard. Information regarding storage conditions, direction for use and category of the drug were lacking in the label of some brands of medicines. Some selected health facilities were found not meeting major requirements for drug storage: protection from sunlight, moisture, heat, well ventilation and proper sanitation. CONCLUSIONS: Few drugs were found to be substandard in Nepalese market from both public and private sectors. Adequate labeling and proper storage condition of medicines in health facilities were lacking.

Medicine Prescribing Pattern and Knowledge on Medicine Use at Different Level of Health Care Settings in Nepal.

BACKGROUND: It is imperative to have adequate knowledge about medicines being used for their proper administration so as to obtain desirable therapeutics effects. This study aims to assess the medicine prescribing pattern and patients' knowledge about medicine use at different level of health care settings in Nepal. METHODS: A cross sectional study was conducted in randomly selected 88 health facilities in Nepal. Altogether 2200 patients, taken randomly after the doctor visit, were interviewed and assessed for the prescription. RESULTS: Out of total drugs prescribed from 88 health facilities (6,175), 68.91% were essential drugs, 23.74 % were antibiotics and 61 % of medicines were prescribed in generic names. And among patients receiving medicines, adequate response on medicine use was received on 49% of medicines out of 3,806 medicines dispensed. CONCLUSIONS: Greater percentages of medicines were prescribed from essential drug list in health facilities. Knowledge on medicine use was poor among people.

Establishing and strengthening a medicine and therapeutics committee in a medical college in Nepal: initial experiences.

Drug and Therapeutics Committees (DTCs) serve as a forum to bring together various stakeholders to improve drug use. DTCs are a key intervention to promote rational use of medicines. DTCs are however, functioning in only a limited number of hospitals in Nepal. A Medicine and Therapeutics Committee (MTC) was started at KIST Medical College, a new medical school in Lalitpur district, Nepal to promote the rational use of medicines in February 2008. The MTC has members from various departments and the full support of the administration. The MTC has been involved in preparing the hospital medicine list and limiting the number of brands available in the pharmacy. Measures to regulate pharmaceutical promotion have been undertaken. Pharmacovigilance and medication counseling activities have been started. Educational programs for various levels of staff are regularly carried out and drug use in the hospital is periodically monitored. Initial experiences regarding MTC functioning is positive.