Pattern Of Rational Use Of Drugs In The Treatment Of Malaria In Out Patients At The Princess Marie Louis Hospital In The Greater Accra Region Of Ghana.

ABSTRACT Many disease conditions have either lingered or resulted in death largely because drugs have been irrationally used in their management or treatment in developing countries. Malaria is one of such diseases which have featured in numerous mortality reviews especially in Ghana in the most vulnerable population, children. This study sought to assess how drugs are rationally used in the treatment of Malaria. It also sought to identify the types of anti-malarials used in the management of Malaria, the appropriateness of the prescription for the children (dose, frequency of dosing and the duration of therapy) and the adherence of the prescriptions to the WHO rational prescribing indicators. The study was conducted at the Princess Marie Louis Children’s Hospital in Accra a referral centre for children located in the heart of Accra. This study employed the WHO prescribing indicators to assess the trend of rational use of drugs in the management of malaria by reviewing records on children treated for malaria at the hospital between January 2017 and December 2017 as well as interviewing of prescribers and care givers who visited the facility during the study period. Data was entered, cleaned, coded and analyzed using STATA version 15 statistical software package. A total of 150 patient records were reviewed. The average number of drugs per prescription was 3.19 (95% CI 3.02-3.37). The percentage of drugs written in generics and from the essential drug list were 78.3% (CI 74.43-82.08) and 89.8% (CI 86.60-92.96) respectively. The percentage of encounters with antibiotics and injections were 48% (CI 40.66-56.67) and 4% (CI 0.86-7.13) respectively. The mean patient consulting time with prescriber was 13 minutes (CI 11.92-14.19) and dispensing time was 1.20 minutes (0.94-1.34). More than half of the patients’ parents and guardians (83% (CI 77.30-89.37) could accurately recall the dosage regimen of drugs dispensed to them. The proportion of the drugs dispensed that were accurately labeled was 91.4% (88.77- 94.07). Training and profession of prescriber (whether the prescriber is a medical doctor or a physician assistant) had significant association with knowledge and practice of Rational Use of Drugs. The antimalarials prescribed in the facility were Artemether Lumefantrine 73% (CI 65-79), Artesunate Amodiaquine 24% (CI 18-32) and Dihydroartemisinin Piperaquine 3% (1.4-7.8). Eighty nine percent of the prescriptions were appropriate treatment (right dose per weight, for out-patients at the facility). Polypharmacy, indiscriminate prescribing of antibiotics and brand prescribing may be the practice in this facility. The other prescribing indicators were of tolerable levels compared to the WHO stipulated limits. Consulting time was appreciable, dispensing time was, however, inadequate which might have influenced the proportion of parents or guardians who could correctly recall the dosage regimen of the dispensed drugs. Continuous training on Rational Use of Drugs and the profession of the prescriber (whether the prescriber is a doctor or physician assistant) of the prescribers have significant impact on knowledge and practice of Rational Use of Drugs.