Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995-2015)

Abstract Background Rational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015. Methods Systematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines. Results Forty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends. Conclusions Prescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences

Antimicrobial prescribing patterns in a group of private primary health care clinics in South Africa

The aim of this study was to investigate the prescribing of antimicrobials in private primary health care in South Africa. A retrospective drug utilisation study was conducted on data obtained from the database of nine private primary health care clinics for the year 2001. Antimicrobials were classified pharmacologically and their usage analysed according to number of patients and consultations, age groups, gender, diagnoses and cost. Of the 83 655 patients, 49 772 (59.50%) were female and 33 650 (40.22%) males. No gender was indicated in 233 (0.28%) of the cases. Medicine items (n = 515 976) were prescribed costing R1 716 319. Of these, 18.69% (n = 96 421) were antimicrobials costing R1 045 108 (60.89%). Antimicrobials were prescribed in 72% of the consultations. The antimicrobials that were the most often prescribed were penicillins (38.17%), sulphonamides (22.49%), antiprotozoals (9.88%) and tetracyclines (9.34%) for diagnoses such as viral-influenza, upper-respiratory infections, acute-bronchitis and acute-sinusitis. Antibiotics prescribed for viral diseases indicated inappropriate use because these infections are caused by non-bacterial agents, and thus are self-limiting. Therefore antibiotics were neither necessary nor appropriate. Further investigations should be done on standard antimicrobial treatment-guidelines in private primary health care settings in South Africa. Keywords: antimicrobials; South African private health sector; primary health care; rational drug therapy; drug utilisation Health SA Gesondheid Vol. 12 (1) 2007: pp. 21-2