Pharmaceutical Management and Prescribing Pattern of Antimalarial Drugs in the Public Health Facilities in Dar-es-salaam, Tanzania

摘要

Despite the efforts of minimizing utilization of limited financial resources in Tanzania, there are still some factors that affect the whole system of supply chain of antimalarial medicines. The goals of Integrated Logistic System (ILS) have not been realized since still there is drug shortage and poor stock recording system in the health facilities. Inadequate knowledge of the pharmaceutical management and inappropriate use of antimalarial drugs always contribute to the poor quality and availability of the drugs in the health facilities and irrational use of the antimalarial drugs. The main objective of the study was to assess the knowledge in practice of pharmaceutical management and prescribing pattern of antimalarial drugs in the public health facilities in Dar-es-salaam. Descriptive retrospective cross-sectional study design was used to survey nine (9) public health facilities in Dar-es-salaam region. The health facilities included 4 hospitals and 5 Health Centers. A total of 32 pharmaceutical health workers (drug store managers and drug dispensers) were interviewed using structured questionnaires. Two different structured questionnaires were used to interview drug store managers and drug dispensers separately. Average stock-out time of antimalarial drugs from January to December 2010 was assessed using a designed form. A total of 4320 prescriptions were examined and recorded from all the selected public health facilities. Adequate storage conditions and handling of medicines procedures were also assessed. Since Medical Stores Department (MSD) is the main supplying source of the antimalarial drugs to these facilities, it was also included in this study as the special site for assessing availability of antimalarial medicines from the source. Among all nine (9) drug store managers, six (6) had poor knowledge on quantification concept, and seven (7) did not apply Integrated Logistic System indicating 2 that it is still confusing to be applied. All of drug store managers had inadequate knowledge on the concept of procurement, and there were no effective and efficient procurement systems in all the health facilities. In most of the facilities, BIN Cards and Stock ledger books were the most commonly used stock recording systems. . There are no Electronic Drug Recording systems in these facilities. A tedious and bureaurocratic process of expired drug disposal was cited as a reason for pilling up of expired drugs in the health facilities. Percentage time out of stock for the antimalarial drugs were 25% for Artemether-Lumefantrine (ALU) and 25.7% for Quinine tablets and 6.4% for injections All drug stores in the health facilities scored satisfactory marks in adequacy storage conditions and handling of antimalarial medicines. However, all facilities had no cold storage facilities with temperature charts; and medicines were kept directly on the floor in seven (7) out of 9 main drug stores and six (6) out of 15 dispensing rooms. Regarding rational dispensing of medicines, only 22 and 12 of all (32) interviewed drug dispensers had good knowledge on recommended doses and dosage regimen of ALU respectively. Regarding dispensing of ALU in pregnancy as special group, 19 drug dispensers were not able to provide correct information for use of ALU during pregnancy. The average number of drugs prescribed per prescriptions was 2.4±0.014, and 98 % of prescriptions contained only one antimalarial drug, among them 88.9 % was ALU. About 96.9 % of the prescriptions showed wrong prescribing pattern for ALU in terms of its dosage. Despite the government efforts in increasing public awareness of ALU and ensuring constant availability of such drugs at MSD, there is a significant stock-out period due to poor pharmaceutical management of antimalarial medicines in the public health facilities. Although adherence to the national malaria treatment guidelines is satisfactory, there is significant irrational prescribing of antimalarials among the prescribers. Based on these findings, it is proposed that regular on-job training and continuing education should be provided to drug dispensers and prescribers in the public health facilities.