Assessment of medicines use pattern using World Health Organization’s Prescribing, Patient Care and Health facility indicators in selected health facilities in eastern Ethiopia

The average number of medicines per prescription in the present study was 2.2, which is higher than the ideal WHO standard (1.6–1.8) [12]. The values reported in this study are very much similar with some studies [13–16]. However, lower average numbers of medicines per encounter (1.2, 1.7, 1.8, and 1.9) were reported in different regions of Ethiopia [8, 17–20]. In addition, other studies outside Ethiopia, also reported a low number of medicines per encounter, for example, 1.4 (Sudan) [21] and 1.3 (Zimbabwe) [22]. Even though there are no adequate studies that identify the reasons for poly-pharmacy in the study area, it might be related to lack of adequate training of health professionals, variation in the health care delivery system, differences in socioeconomic profiles as well as morbidity and mortality characteristics of the population [8].

The percentage of medicines prescribed by generic name in this study was 97 %, which is close to the standard (100 %) [12]. The high level of generic prescription could probably attributed to the fact that the study was conducted in governmental health centers, where procurement of generic drugs is the prevailing practice. Similar findings have been reported in other studies conducted locally [8] as well as elsewhere [23]. Values which are significantly lower, ranging from 58–75 % than the present study have also been reported in different studies [16, 21, 22, 24].

The percentage of encounters in which antibiotics were prescribed in the study area was 82.5 %, which is high compared to the standard (20.0–26.8 %) [12]. A national baseline study on medicine use indicators in Ethiopia in 2003 also showed that, the percentage of encounters in which antibiotics were prescribed was 58.1 % [17]. Similarly, studies conducted in University Teaching and Referral Hospital and in four randomly selected health care facilities in southwest Ethiopia reported that, the percentage of encounters in which an antibiotics prescribed were 58 % and less than 30 % respectively [8, 24]. In the medicine use pattern study in 12 developing countries, the percentage of encounters with antibiotics prescribed were 63 % in Sudan, 56 % in Uganda, 48 % in Nigeria and 29 % in Zimbabwe [16, 21–23]. Besides, similar studies in Yemen, western China, and Nepal reported the percentage of encounters in which an antibiotic was prescribed as 66.2, 48.43, and 28.3 % respectively [3, 25, 26]. Over prescribing of antibiotic in this study might be due to mid level health professionals working in this area and small distribution of health professional to population ratio specially physician, health officers and pharmacist in the study area [27]. Over use of antibiotics, as it is the case in this study, may increase the chance of emergence of antimicrobial resistance [8].

In this study, the percentage of prescription with an injection encounter was 11.1 % which is lower than the standard (13.4–24.1 %) [12]. A higher percentage of encounter in which injections were prescribed at Hawassa University Teaching and Referral Hospital was 38.1 % [8]. In a prescription pattern study in 12 developing countries, the percentage of encounters in which injections were prescribed was high in Uganda (48 %) and Sudan (36 %) but very low in Zimbabwe (11 %) and in the acceptable range in Indonesia (17 %), Ecuador (17 %), and Mali (19 %) [16, 21–23]. Minimum use of injections is preferred as it reduces the risk of infection through parenteral route and cost incurred in therapy [3]. The lower prevalence of injection in this study might be the cultural barriers against injection based treatment in the study area.

The percentage of medicines prescribed from the essential medicine list for this study was 92 %, which is lower than the standard (100 %) [12]. This figure is lower than other studies in Ethiopia [8, 17]. In this study, the average consultation and dispensing time of facilities were 5.60 and 2.70 min respectively, which was similar with the study conducted in north west and south west Ethiopia where the average consultation times were 5.8 and 6.14 min respectively; and the average dispensing times were 1.9 and 1.28 min respectively [24, 28]. In fact, a shorter dispensing time (22.5 s) was reported on a study conducted in Jimma University Specialized Hospital [18]. Another study which was conducted in Niger reported a 5.75 min of consultation time which was similar to our finding but 3.25 min of average dispensing time [29]. However; another study in Jordan and Cambodia documented that 3.90 and 4.43 min of average consultation times and 28.80 s and 3.92 min of average dispensing times respectively [13, 30]. In this study, the average consultation time and dispensing time in some health centers were short. For instance in Kebrebeyah and Awberae Refugee Health Centers, the average consultation times were 1.79 and 3.0 min and the average dispensing times were 0.46 and 1.6 min respectively. Shorter consultation and dispensing time may lead to inadequate information about the medication being given to patients and patients had little chance to obtain information about their treatment. The potential reason for this variation can be due to differences in man power, patient overload, set up of dispensary area and ease of access for essential materials like medicines, medical equipment among health facilities.

The finding revealed that, on average 64 % of dispensed medicines were adequately labeled which is close to the study conducted in southwest Ethiopia, 70 % [24] and a study conducted in Islamic Republic of Iran, 60 % [31]. In other studies, all dispensed medicines were improperly labeled in Cambodia [31] and only1.4 % of prescriptions was adequately labeled in Nepal [3]. The study also showed that, 69.0 % of patients were able to repeat the correct dosage schedule of the medicine they had received which was relatively lower when compared to the other studies conducted in south west Ethiopia which were 79 and 72.80 % [19, 22], but higher than a study conducted in Cambodia [30].