Objectives:To assess the quality of dispensing and patient knowledge of drugs dispensed in primary care in Botswana. Setting: Thirty randomly assigned primary healthcare facilities in three districts of Botswana. Participants: Patients visiting clinics and health posts. Design: Analysis of data from prospective participative observations of the drug dispensing process and interview of patients about their knowledge of drugs received immediately after dispensing. The quality of drug labelling was assessed by calculating mean labelling scores composed of five dispensing attributes: name of patient, and name, strength, dosage, and volume of the drug (incorrect or no labelling=0, 1 point for each correct labelling attribute; maximum score=5). Mean knowledge scores were obtained immediately after dispensing from patient recall of name and dosage of drug, duration of treatment, and reason for prescription (incorrect recall=0, 1 point for each correct recall attribute; maximum score=4). Results: 2994 consecutive patient consultations were analysed. The mean labelling score was 2.75. Family welfare educators and pharmacy technicians scored highest (3.15 and 2.98, respectively) and untrained staff lowest (2.60). Factors independently associated with the labelling score were analgesics v other drugs, district, health posts v clinics, education of prescriber (nurse best), and years of experience of prescriber (4-11 years best). The mean patient knowledge score was 2.50. The reason for prescription of the drug(s), dosage, duration of treatment, and name of the drug(s) was recalled by 92%, 83%, 44%, and 31% of patients, respectively. The qualification level of the dispenser was the strongest factor independently associated with the knowledge score. Antibiotics had the second lowest score, both for labelling (2.39) and patient knowledge (2.39). Conclusion: Only trained dispensing staff provided satisfactory quality of labelling. Patients had a fair knowledge of the drugs dispensed. The knowledge of drugs dispensed by family welfare educators was less than satisfactory. The labelling score is a useful indicator of the quality of dispensing, and the knowledge score of both the quality of prescribing and of dispensing. These indicators should be added to the WHO list of patient care indicators. R ational prescription and use of drugs has been a concern in both developed and developing countries during the last two decades and has been promoted by WHO and others.

BackgroundEfforts aimed at reducing maternal mortality as per the Millennium Development Goal 5 (MDG 5) include reducing early childbearing through increased adolescent contraceptive use. Despite a substantial attempt to study factors influencing adolescent contraceptive use in Sub-Saharan Africa (SSA), few studies have explored the role of community level characteristics on adolescent modern contraceptive use. This study examines the influence of both individual, household and community variables in influencing adolescent contraceptive use in Zimbabwe. This study posits that community characteristics are more critical predictors of adolescent contraceptive use in Zimbabwe than other individual and household characteristics.MethodsData from the 2010/11 Zimbabwe Demographic Health Survey (ZDHS), supplemented by additional data from the Measure DHS consultants were used. A total weighted sample of 457 non-pregnant adolescent women aged 15 to 19 years who had their last sex within 12 months preceding the 2010/11 ZDHS was analysed. Univariate, bivariate and multilevel binary logistic regression analysis were performed using generalized linear mixed models (GLMM).ResultsThe odds of contraceptive use were higher for adolescent women with one or more children ever born (Odds Ratio (OR), 13.6) and for those ever married (OR, 2.5). Having medium and high access to media also increased the odds of using contraceptives (OR, 1.8; 2.1 respectively). At community level, the odds of modern contraceptive use decreased with an increase in the mean number of children ever borne per woman (OR, 0.071), an increase in the mean number of school years per women (OR, 0.4) and an increase in the proportion of women with at least secondary education (OR, 0.5). It however increased with an increase in the proportion of women experiencing at least one problem accessing health care (OR, 2.0). Individual and community level variables considered successfully explained the variation of adolescent contraceptive use across provinces.ConclusionsBoth individual and community characteristics were important predictors of adolescent contraceptive use in Zimbabwe. Reproductive program interventions aimed at increasing adolescent contraceptive use should take into account both individual and community factors. There is need for further research that examines other community characteristics influences that include political and cultural factors.

Summary OBJECTIVES OBJECTIVESTo assess the quality of nurses' prescribing through an assessment of their prescription in relation to diagnosis, and to investigate trends in drug use in Botswana primary health care. METHODS METHODSKey data regarding nurses' adherence to national prescription and treatment guidelines were obtained through participatory observation using a questionnaire, related to each consultation. Adherence was categorized into (i) Full adherence, (ii) acceptable adherence, (iii) acceptable adherence, but one or more useless, but not dangerous, drugs and (iv) insuf®cient or dangerous treatment. The study comprises data on nurses' prescriptions, diagnoses and quality of dispensing in 2994 consecutive consultations in 30 primary health care facilities in three districts of Botswana: Ngami East, Gaborone and Kgalagadi North. RESULTS RESULTSThe average number of drugs prescribed per patient was 2.3. Antibiotics were prescribed in 27% of all encounters. Full adherence was found in 44%, acceptable compliance in 20%,`acceptable, but one or more useless, but not dangerous, drugs' in 33% and`insuf®cient or dangerous treatment' in 3% of the consultations. Four factors were found to be independently associated with full adherence: patient age 16±31 years, speci®ed diagnosis, type of health facility and nurses' years of practice (4±11 years best). CONCLUSIO N CONCLUSIONAlthough Botswana's health workers perform relatively well in terms of drug use indicators, there is a clear potential for improving health workers' adherence to national treatment guidelines.keywords drug use study, primary health care, prescription adherence, drug use indicators, quality of care, treatment guidelines correspondence Eelco Boonstra,

Health care providers' adherence to guidelines on history taking was suboptimal in acute respiratory infection and diarrhoea but poor on examination in both conditions. A high level of inappropriate antibiotic prescription was found in acute respiratory infection and diarrhoea. Overall, there is considerable scope for improving diagnostic and therapeutic management of these major childhood diseases in Botswana primary health care.