The number of drugs per prescription, found in the study, far exceeds the expected 1.6 considering the epidemiological profile of Nigeria5. This may be due to a number of factors notably overuse of antibiotics, injections, analgesics, NSAIDs and multivitamins etc. Absence of, and non-compliance, to standard treatment guidelines, appears to allow an unlimited choice of drugs for treatment of diseases.
5 Isah AO, Laing R, Quick J, Mabadeje AFB, Santoso B, Hogerzeil H, Ross Degnan D, The development of reference values for the WHO health facility core prescribing indicators West African Journal of Pharmacology and Drug Research 2002;18:6 - 11
The percentage of patients prescribed antibiotics far exceeds the suggested reference value of 20 - 26%5. Furthermore, numerous factors are at play influencing the injudicious prescribing. Notable factors include the lack of efficient laboratory services and the erroneous belief in a “give all - treat all” philosophy or a blanket treatment policy to cover “possible infections” in patients presenting with febrile states.
5 Isah AO, Laing R, Quick J, Mabadeje AFB, Santoso B, Hogerzeil H, Ross Degnan D, The development of reference values for the WHO health facility core prescribing indicators West African Journal of Pharmacology and Drug Research 2002;18:6 - 11
Transmission of diseases such as HIV/AIDS, Hepatitis B through reutilisation of needles and accidental needle pricks amongst health workers should have led to a decline in the popularity of injections. However, this is not the case as injection use is still the preferred route of drug administration. Ideally, with the morbidity profile of Nigeria, injection use should not be more than 13%5.
5 Isah AO, Laing R, Quick J, Mabadeje AFB, Santoso B, Hogerzeil H, Ross Degnan D, The development of reference values for the WHO health facility core prescribing indicators West African Journal of Pharmacology and Drug Research 2002;18:6 - 11
The high compliance with the EDL may be partly due to the large number of drugs listed. During the second revision of the EDL, the list was enlarged to accommodate most registered drugs for use in public and private health institutions since the maiden list was perceived to be restrictive. The enabling decree (No 43 of 1989) stipulated penalties for importation and use of drugs outside the list.
Only a few prescriptions were found appropriate due to the inclusion of drugs other than ORS/ORT in diarrhoea treatments. While it is desirable to treat diarrhoea with only ORS/ORT, malaria, which is a major cause of morbidity and mortality in under-fives, has been found to also present with diarrhoea as a symptom. Therefore, health workers have been trained to suspect malaria when a child has diarrhoea. It was however, difficult to judge whether the inclusion of other drugs such as antimalarials was irrational or presumptive treatment for malaria.
Only a few prescriptions for uncomplicated pneumonia were found to be appropriate This may be attributed the treatment guideline in the Standing Orders used at the PHC level which specifies administering crystalline penicillin at the health facility and continuing with oral cotrimoxazole at home. In addition prescriptions were obtained from case notes; therefore it may be difficult to differentiate between prescriptions that were meant for patients admitted into the wards from those belonging to outpatients.
