Prescribing pattern of medications prescribed to outpatients based on WHO prescribing indicators in Ethiopia: A systematic review and meta-analysis of observational studies

Abstract

Poor prescribing pattern is observed and become a serious problem in the world including developing countries. In Ethiopia, several studies showed that health care institutions did not meet WHO prescribing indicators and the prescribing pattern is not satisfactory in the health care institutions. This study aimsto review the prescribing pattern of medications prescribed to outpatients based on WHO prescribing indicators in Ethiopia. Literature search was performed through PubMed/MEDLINE, Google Scholar, and Research Gate from July 5-30, 2019. A standard data extraction format was used to collect important data from the included studies. Open meta analyst advanced software was used for analyses of the pooled estimate of outcome measures and subgroup analysis. Der Simonian and Laird's random-effect models were applied for the analyses at 95% confidence level. I 2 statistics were used to assess heterogeneity of studies. The presence of publication bias was assessed with comprehensive meta-analysis version 3 software and presented with a funnel plot. P-value of less than 0.05 was considered as statistically significant. The results revealed that a total of 13 studies with 33,567 drugs from 15,305 prescriptions were included for systematic review and meta-analysis. The results of prescribing indicators were 1.96, 93.0, 36.2, 18.3 and 94.8% for average number of drugs per prescription, percentage of drugs prescribed by generic name, percentage of drugs encounter with antibiotics, percentage of drugs encounter with injection and for the percentage of medicines prescribed from essential drug list respectively. Therefore, the prescribing pattern of Ethiopia is below WHO standard level.

Rational Medicine Prescription and Adherence to Prescription Format: A Description of Practices in the Private Sector in Addis Ababa, Ethiopia

“…This is slightly higher than the standard comparison (1.6-1.8). 6 This result is consistent with two prior studies that conducted systematic reviews at the country level in Ethiopia and found that the pooled number of drugs per prescription exceeded WHO standards, accounting for 1.96 and 2.14, respectively, Ayenew et al 20 and Bahiru et al 21 respectively. Poly-pharmacy was also recorded in the city as well as different parts of the country, according to study setting specialized studies.…”

“…34 In the current study, the proportion of encounters in which injections were issued was 11.5%, which is signi cantly lower than the WHO criterion (13-24.1%). 6 Ethiopian injection use is likewise below the standard, according to the combined results 18.3%, 13.2% of Ayenew et al 20 and Bahiru et al 21 respectively. There has also been a global drop in injection usage.…”

“…6 Similarly, Ethiopian public health institutions also show a high prevalence of antibiotic prescription, despite the fact that it is lower than the ndings of this study. 8,20,21,25,30 Antibiotics may be prescribed excessively for a variety of reasons. Various studies have found that Ethiopia has a high frequency of infectious illnesses 31 , as well as a lack of adherence to treatment protocols 21 and a disparity in health professional understanding.…”

“…6 however, The current study was lower similar studies done in public health sectors in Ethiopia. 8,20,21,25 . The highly adherence to EDL of prescribing from both public and private could be due to the imported drugs are being well controlled by the Ethiopian Food and Drug Administration (EFDA) to assure their registration on the EDL.…”

The Pattern of Medicine Use in Ethiopia Using the WHO Core Drug Use Indicators

“…Another systematic review and meta-analysis also reported that all of the prescribing indicators were not consistent with the standard values [ 20 ]. The practice of rational medicine use varied across the region of the country and deviation was also reported from the standard recommended by WHO [ 21 , 22 ].…”