Rational Drug Use Evaluation Based on World Health Organization Core Drug Use Indicators in Ethiopia: A Systematic Review

Abstract

Background: Rational use of medicines plays a vital role in avoiding preventable adverse drug effects, maximizing therapeutic outcomes with promoting patient adherence, and minimizing the cost of drug therapy. Irrational use of drugs is often observed in countries with weak health care systems. No review has been done that systematically expresses rational drug use practice based on the three WHO core drug use indicators in Ethiopia. Thus, this study was aimed to review systematically the prescribing, health-facility, and patient-care indicators based on WHO core drug use indicators in Ethiopia. Methods: A systematic article search was conducted in different electronic databases including PubMed/ MEDLINE, the Cochrane Library, EMBASE, Web of Science, POPLINE, the Global Health, and Google scholar. Quality assessment was conducted using Newcastle-Ottawa quality assessment scale. Studies were synthesized and grouped in to prescribing, patient care and health facility indicators. Results: From a total of 6239 articles, 21 studies were found suitable for the review. The highest average number of drugs per encounter was 2.5 while the lowest was 0.98. The percentage of generic drug use was ranged from 70.5% to 100%. The highest percentage of encounters with an antibiotic was 85%. The lowest percentage of drugs prescribed from essential drugs list was 81.4%. The highest percentage of drugs actually dispensed and adequately labeled was 96.16% and 96.25%, respectively. Conclusion: This study showed that the practice of rational drug use varied across region of the country. The average number of drugs per prescription, percentage of drugs encounter with antibiotics, drugs prescribed by their generic name, average consultation time, average dispensing time, percentage of drugs adequately labeled, and availability of essential drugs showed deviation from the standard recommended by WHO. Thus, provision of regular training for prescribers and pharmacists, and ensuring the availability of essential drugs should be encouraged.

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

“…Percentage of medicines dispensed and percentage of medicines adequately labeled did not meet the WHO rational drug use recommendation. The result was in line with other systematic reviews [ 21 ]. This might result medication error, medicine-related adverse event, and therapeutic failure.…”

“…This review revealed that only two of the reviewed studies showed complete medicines prescription by generic name. The percentage of generic drug use was ranged from 70.5% to 100% [ 21 ]. The lower level of prescription by generic name was also reported by other systematic reviews and meta-analyses [ 22 , 31 ].…”

“…In Ethiopia, twelve studies evaluated rational medicine use patterns based on WHO patient care indicators, and only one study [ 34 ] reported that the pharmacist consulted appropriately in comparison with WHO recommendation (ten minutes) [ 35 ]. An average dispensing time between 6.74 minutes and 0.7 minutes was reported by a systematic review [ 21 ]. This might be due to patient load and lack of knowledge.…”

“…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 ].…”

Theoretical model and measurement of shared decision making in web-based pharmaceutical care consultation

“…Irrational drug use practices, such as polypharmacy, overuse of antibiotics, and inadequacy of drug labeling, exist all over the globe, predominantly in developing countries. 1 – 4 Severe irrational drug use has been abundantly evidenced in China. For example, overuse of injections was common, and studies indicated the percentage of injections prescribed per 100 encounters was between 21% and 60%.…”