Patterns of Prescribing Practices in Makueni County Referral Hospital, Kenya

Background: Prescribing is said to be irrational if it does not conform to good standards of treatment. Irrational prescribing leads to increased cost of drug therapy, increased risk for adverse drug reactions and emergence of drug resistance. Objective: The study objective was to determine the quality and patterns of prescribing in Makueni County Referral Hospital, Kenya, using World Health Organization prescribing indicators. Methodology: The design was a descriptive retrospective cross-sectional study. Data was abstracted from 824 patient encounters selected through quasi-random sampling. Data was collected from the sampled prescriptions using a pre-tested data collection form, entered into and analyzed using Stata version 10.0 software. Results: The mean number of drugs per patient encounter was 2.7. Only 45.5% of the total drugs were prescribed using generic names. Antibiotics and injections were prescribed in 74% and 13.2% of the prescriptions surveyed respectively. Discussion: On average, inpatients received a higher number of drugs per encounter compared to outpatients, probably because they usually have more severe disease than outpatients which may require management with more drugs. Conclusion: The results showed a trend towards irrational prescribing, particularly polypharmacy, underuse of generic names and over-prescription of antibiotics. Relevant educational, managerial and regulatory interventions are recommended to remedy the problems. Keywords: Irrational prescribing, prescribing indicators, polypharmac

Herbal remedies and other risk factors for preterm birth in rural Kenya

Background: Premature infants contribute substantially to infant morbidity and mortality especially in low resource settings.  Information on herbal remedy use, previous preterm birth and low social-economic status and their association with incidence of preterm birth in Kenya is scanty. Objectives: To determine the use of herbal remedy use in pregnancy, previous preterm birth and low socio-economic status as risk factors for Preterm Birth in Kitui County among the immediate post-partum mothers. Methods: Unmatched case control study with a 1:4 ratio of cases to controls. The study was done in Kitui and Mwingi District Hospitals.  A total of 107 mothers with preterm birth (cases) and 453 mothers with term births (controls) were eligible and administered structured interviews. Results: Of the sample, 98% of cases resided in rural areas compared to 90% of controls.  The cases had a higher parity and were more likely to belong to the lowest three and four levels of socio-economic status. On multivariate logistic regression analysis, predictors of preterm birth were: preeclampsia (OR=9.06 [2.60-31.63], p=0.001), previous preterm, (OR=9.31 [2.82-30.68], p<0.001), low socioeconomic status (OR=1.51 [1.05-2.16], p=0.03), herbal use in first trimester for 2-5 days (OR=11.10 [4.34-28.41], p<0.001), herbal use in first trimester for 6-10 days (OR=44.87,[4.99-403.87] p=0.001), and herbal use in second trimester for 6-10 days (OR=16.43 [4.53-59.57], p<0.001). Use of prescribed folic acid in second trimester for more than 31 days was associated with lower risk of preterm birth (OR=0.20 [0.12-0.34], p<0.001). Conclusion: Herbal use in pregnancy regardless of gestation, previous preterm birth and low socio-economic status and are risk factors for preterm birth in Kitui County Kenya.  Interventions targeted to reduction of these risk factors will be an important additional prong in the reduction of preterm birth. Key words: Preterm birth, herbal remedy, risk factor