| Summary: | Introduction
The study aimed at determining health workers’ prescription patterns using selected
WHO/INRUD core drug-use indicators and investigated determinants of appropriate antibiotic
prescribing in public Zambian primary health care facilities.
Methods
The study was a secondary data analysis of a cross sectional survey of health facility data
collected in four districts of Zambia. This study extracted patients’ diagnoses and treatments
and linked them to the health worker demographics and health facility characteristics in order
to determine prescription patterns and factors influencing appropriate antibiotic prescribing.
Results
A total of 2206 prescriptions were analysed. An average of 2.5 drugs per encounter was
prescribed. Injections were prescribed in 4% of the encounters. While over 95% of drugs were
from the essential drug list fewer drugs were prescribed by their generic names. Only 1.5% of
encounters did not result in a prescription.
Antimalarial drugs and antipyretics were prescribed in at least 70% of encounters while
antibiotics were prescribed in close to 40% of encounters. Of all encounters in which a
systemic antibiotic was prescribed, just above a quarter were of appropriate indication and
dosage.
Determinants of appropriate antibiotic prescribing included patient’s age, presence of clinical
wall charts and treatment guidelines; and the health worker cadre. Under-5s were more likely
to receive antibiotics when indicated, though at wrong dosages. Health workers with access to
guidelines were more likely to prescribe antibiotics only when indicated. Health worker cadre
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without pre-service clinical training were more likely to prescribe antibiotics when not
indicated and at wrong dosages.
Discussion
This study showed that health workers’ performance for most of the WHO drug-use core
indicators was similar to findings in other developing countries. The study also revealed
overuse of antibiotics for diseases that do not require antibiotics as treatment. Increasing
access to guidelines and other clinical job aids, continuous medical education for all health
workers and targeted training of health worker cadres without prior medical training will
contribute to better prescribing of antibiotics.
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