Prescribing for Patients Seeking Maternal and Child Healthcare in Sierra Leone: A Multiregional Retrospective Cross-Sectional Assessments of Prescribing Pattern Using WHO Drug Use Indicators

John Alimamy Kabba; Peter Bai James; Zongjie Li; Christian Hanson; Jie Chang; Chenai Kitchen; Minghuan Jiang; Mingyue Zhao; Caijun Yang; Yu Fang

doi:10.2147/RMHP.S256648

Prescribing for Patients Seeking Maternal and Child Healthcare in Sierra Leone: A Multiregional Retrospective Cross-Sectional Assessments of Prescribing Pattern Using WHO Drug Use Indicators

Risk Manag Healthc Policy. 2020 Nov 10:13:2525-2534. doi: 10.2147/RMHP.S256648. eCollection 2020.

Authors

John Alimamy Kabba^{1

2

3}, Peter Bai James^{4

5}, Zongjie Li^{1

2

3}, Christian Hanson^{6

7}, Jie Chang^{1

2

3}, Chenai Kitchen^{1

2

3}, Minghuan Jiang^{1

2

3}, Mingyue Zhao^{1

2

3}, Caijun Yang^{1

2

3}, Yu Fang^{1

2

3}

Affiliations

¹ Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, People's Republic of China.
² Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, People's Republic of China.
³ Shaanxi Center for Health Reform and Development Research, Xi'an, People's Republic of China.
⁴ Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
⁵ Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia.
⁶ Pharmacy Board, Ministry of Health and Sanitation New England, Freetown, Sierra Leone.
⁷ Pharmacy Department, Well Star Atlanta Medical Centre South, East Point, GA, USA.

Abstract

Purpose: Rational use of medicines is a necessary constrict towards increasing access for those that desperately need them in society. In this study, we assess medicines prescribing patterns in healthcare facilities implementing free healthcare policy for pregnant women, lactating mothers and children under the age of five in Sierra Leone.

Materials and methods: Using WHO drug use indicators, we evaluated prescription records from the pharmacies of four hospitals; one from each of the four regions in Sierra Leone. To study prescribing indicators, we systematically sampled 1200 prescriptions overall (300/hospital) retrospectively spanning a year, from June 2017 to July 2018. In evaluating patients care indicators, we randomly sampled 120 (30/hospital) patients encounter prospectively. We used MS Excel 2016 and IMB SPSS in data analysis, and p< 0.05 was considered significant for associational analysis.

Results: The average drug per prescription was 3.6 (SD=1.3) overall, 3.5 (1.3) for children under five and 3.4 (1.4) for pregnant women/lactating mothers. Eighty-seven percent of prescriptions for under-five children contains antibiotics as opposed to 68.4% of prescriptions for pregnant women/lactating mothers. More injections were prescribed per encounter for pregnant women/lactating mothers 23.2% than for children under five 18.1%. Overall, generic prescribing and prescribing from the National Essential Medicines List were 74.9% and 73.8%, respectively. None of the studied health facilities dispensed all of the prescribed medicines. The most prescribed pharmacological class of drugs were antibiotics, and paracetamol was the most commonly prescribed drug.

Conclusion: Following WHO drug use indicators used in this study, drugs were irrationally prescribed within government hospitals providing free healthcare in Sierra Leone. Sustainability of the free healthcare scheme will require efficient medicine supply and management strategies. Therefore, the formulation of stewardship programs and/or an active Drug and Therapeutics Committee may be necessary to optimise drug use in these hospitals.

Keywords: Sierra Leone; drug utilisation; free healthcare; prescribing pattern; rational drug use.

Grants and funding

This work was funded by the “Young Talent Support Plan,” “High Achiever Plan” of Health Science Center, Xi’an Jiaotong University, and the Central University Basic Research Fund (2015qngz05).