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

Enhancement of external forced convection by ionic wind

An ionic wind is formed when air ions are accelerated by an electric field and exchange momentum with neutral air molecules, causing air flow. Because ionic winds can generate flow with no moving parts and have low power consumption, they offer an attractive method for enhancing convection heat transfer from a surface. In the present work, corona discharges are generated between a steel wire and coppertape electrode pair on a flat plate, perpendicular to the bulk flow direction such that the ensuing ionic wind is in the direction of the bulk flow. The corona discharge current is characterized, and experimental measurements of heat transfer from a flat plate are reported. Infrared images demonstrate that the cooling occurs along the entire length of the wire, and local heat transfer coefficients are shown to increase by more than 200% above those obtained from bulk flow alone. The magnitude of the corona current and the heat flux on the flat plate are varied. The heat transfer coefficient is shown to be related to the fourth root of the corona current both analytically and experimentally, and heat transfer enhancement is seen to be solely a hydrodynamic effect. Variation of the spacing between electrodes demonstrates that while the local peak enhancement is largely unaffected, the area of heat transfer enhancement is dependent on this spacing