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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 8  |  Issue : 1  |  Page : 39-42  

Evaluation of anti-malarial drugs' use in Fitche Hospital, North Shoa, Oromia Region, Ethiopia


Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia

Date of Submission31-Mar-2015
Date of Decision04-May-2015
Date of Acceptance16-Jun-2015
Date of Web Publication13-Jan-2016

Correspondence Address:
Eshetu Mulisa Bobasa
Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma
Ethiopia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.164294

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   Abstract 


Objective: Retrospective evaluation of anti-malarial drugs' use in Fitche Hospital, North Shoa, Oromia Region, Ethiopia. Methods: Retrospective cross-sectional study design was conducted using selected patients cards of 1-year (January 2012–January 2013 G.C) with anti-malarial agents from January 18 to 30, 2013. The sample size was calculated by using Joint Commission on the Accreditation of Health care Organization criteria and sampling was done by using a systematic random sampling technique. Results: One hundred and twenty-five patient cards with anti-malarial drugs were reviewed of which 32.8%, 21.6%, 15.2% belongs to age range of 20–29, 10–19, and 30–39, respectively. Chloroquine prescription accounts for 50.4% from total anti-malarial drugs. 71.2% and 78.4% of patients received antibiotics and analgesics, respectively, with anti-malarial drugs. 77.6% of drugs were prescribed by generic name while the brand name was 22.39%. Conclusions: The study done in Fitche Hospital revealed that the use of anti-malarial agent was not in complete agreement with the current guideline of Ethiopia despite good practice.

Keywords: Anti-malarial drugs, drug use, malaria, resistance


How to cite this article:
Getachew R, Amelo W, Bobasa EM. Evaluation of anti-malarial drugs' use in Fitche Hospital, North Shoa, Oromia Region, Ethiopia. J Pharm Bioall Sci 2016;8:39-42

How to cite this URL:
Getachew R, Amelo W, Bobasa EM. Evaluation of anti-malarial drugs' use in Fitche Hospital, North Shoa, Oromia Region, Ethiopia. J Pharm Bioall Sci [serial online] 2016 [cited 2019 Sep 15];8:39-42. Available from: http://www.jpbsonline.org/text.asp?2016/8/1/39/164294



Globally, there are 3000 death reports due to malaria, majority (90%) of them being in Sub-Saharan Africa. Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi are known to cause infections in human of which P. falciparum is the most infective and resistant to a number of drugs currently available for Malaria management.[1] Even though malaria can be easily controlled, the major obstacle facing the world is drug resistance development.[2],[3],[4]

Drug resistance was defined by WHO as “the ability of a parasite strain to survive or multiply despite the administration and absorption of a drug given in doses equal to or higher than those usually recommended but within the tolerance of the subject. The form of the drug active against the parasite must be able to gain access to the parasite or the infected erythrocyte for the duration of the time necessary for its normal action.” The processes of drug use such as correct diagnosis, correct drug and dose, effective drug, and adherence have a great input for the development of resistance.[4],[5] Therefore, the core solution for tackling malaria is developing rational policies on the drug use pattern.[6] Misuses of drugs are most common in developing countries accompanied by scarce drugs, poor infrastructures and shortage of manpower.[7],[8]

Drug resistance was documented in many countries of the world.[9] Currently, apart from resistance, cross-resistance is common among drugs having similar class or structure.[5] In general, the problem of malaria treatment revolves around rational drug use. As a result, the aim of this study was to assess anti-malarial drugs' use in Fitche Hospital, which gives the way to tackle the problem of irrational use of anti-malarial drugs.


   Methods Top


Fitche Hospital is located in Fitche Town, North Shoa, Oromia Region, Ethiopia. The town is at a distance of 112 km from the capital city, Addis Ababa, with 36,768 (19,472 males and 17,296 females) population according to the 1999 census. Fitche Hospital is the only zonal hospital in the town and provides antenatal and delivery care, antiretroviral follow-up, pediatrics, internal medicine and surgery services. The hospital was selected because of diversified health care deliveries and high patient loads, which can easily help us to evaluate anti-malarial drug use.

A facility based retrospective cross-sectional study design was conducted. The study populations were systematically selected out-patients' cards of anti-malarial drugs in the hospital visited in the last 1-year while patient cards of anti-malarial drugs in the hospital in the last 1-year (from January 2012 to 2013 G.C) were taken as source of study. During the study, the inclusion criteria were all complete patient cards of anti-malarial drugs in the hospital within the specified 1-year (from January 2012 to 2013 G.C). Incomplete patient cards of anti-malarial drugs, cards with anti-malarial out of the specified 1-year, patient cards with no malaria, and cards of antibiotic not related to malaria were excluded from the study. Data collection forms were designed by collecting and reviewing different literature done in the same area and the instruments were further strengthened by pretest to make the language more clear and concise. Then, information such as sociodemographic characteristics, drug-related information (name, route of administration, and drug naming), prescription pattern information (dose, durations and frequency), and commonly prescribed antibiotics/analgesics with anti-malarial drugs were extracted from the records onto the data collection forms.

The Joint Commission on the Accreditation of Health care Organization (JCAHO) criteria was employed to determine sample size. This criteria recommend to take 5%, 30% and 100% of cases for study if quarterly patient, respectively loads are more than 600, lower than 600 and fewer than 30.[10] The annual numbers of cases at Fitche Hospital was 417 (104.25 average numbers of cases per quarter). Following JCAHO criteria finally we got a total of 125 cases for evaluation.

Patient cards were selected by systematic random sampling by taking the first unit randomly among the total sample size. The data were collected by the principal investigator and analyzed after being checked for completeness and consistency. The result was presented using tables and graphs based on the type of data. The following variables were used for the study: Age, sex, weight, dosage form, route of administration, and irrational prescriptions.

Operational/standard definitions

Brand name - is a name assigned to the drugs by the company owning the patent.

Generic name - Is a name given to pharmaceutical substance as designated by the world health organization.

Incorrect use of anti-malarial drugs - the use of antimalarials not in line with standard guideline of the country.

Correct prescribing - Prescription of anti-malarial drugs as per the standard treatment guideline of Ethiopia.

Ethical consideration

Ethical clearance obtained from Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University. Then, officials at different levels in Fitche Hospital were communicated, and letters of permission were presented. After the purpose of the study had been explained, informed consent was obtained from responsible bodies prior to the reviews. Confidentiality of the information was assured, and privacy was maintained.


   Results Top


A total of 125 patient cards with malaria were reviewed of which 41 (32.8%), 27 (21.6%), 19 (15.2%) belongs to age range of 20–29, 10–19, and 30–39, respectively, as shown in [Table 1]. The lowest percentage was documented with the ages of <10, 40–49, 50–59, and above 60. Overall, the majority of the patients were males (54%) while that of females' accounts for 46%. Regarding the parasite, P. vivax (60, 48%) was the cause of the majority of the infection followed by P. falciparum (45, 36%) while 16% had mixed infection [Table 2].
Table 1: Age distribution of malaria patients collected from 1-year patient cards in Fitche Hospital, Oromia Region, 2013

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Table 2: Parasites identified from 1-year patient cards in Fitche Hospital, Oromia Region, 2013

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When the result was analyzed from the perspective of anti-malarial drugs information from 125 patient cards it was identified that treatment with chloroquine was the leading one (50.4%) as depicted in [Figure 1]. However, quinine was prescribed correctly of eight patient cards. As shown in [Figure 2] below, of the prescribed drugs the most common dosage form was tablet (61.6%). Even though syrup was prescribed less (8%), injection prescribing was high (30.4%).
Figure 1: Specific antimalarial drug prescribed of total antimalarials in Fitche Hospital, Oromia Region, 2013

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Figure 2: Dosage form of anti-malarial drugs in Fitche Hospital, Oromia Region, 2013

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Of total 125 study subjects, 89 (71.2%) and 98 (78.4%) received antibiotics and analgesics, respectively, with anti-malarial drugs. Of antibiotics amoxicillin accounts for 28% while paracetamol was the leading (51%) of analgesic prescribed.

A total of 312 drugs (anti-malarial, analgesics, and antibiotics) were prescribed. Most (242, 77.6%) were prescribed by generic name, despite significant brand prescription (22.39%). All anti-malarial drugs were prescribed by generic name. However, 67.4% of antibiotics and 58.2% of analgesics were prescribed by generic name. Regarding routes of drug administration, two hundred fifty (80.1%) were taken through oral route (PO) while only 19.9% were via intravenous routes [Table 4].


   Discussions Top


Drug use evaluations are one of the most important tools in standardizing use of medicines. In the use of anti-malarial drugs, the big problem is resistance development. Microorganisms may become resistant to drugs through different mechanisms such as: Enzyme elaboration, target modification, decreased influx, increased efflux, and change in cellular structure.[11] Of several factors to be mentioned for the spread of resistance, patterns of drug use is the major one.[5]

According to the present study, the sociodemographic characteristics showed that males (54%) were more susceptible to plasmodium infection than a female (46%) which was almost comparable to study done in Gezira state, Sudan.[12] And also the study revealed age range of 20–39 was the most affected group. This is an indicator of the effect of malaria on country's economy through affecting the productivity of young generation.[13]

Of all anti-malarial drugs, chloroquine and coartem (artemether and lumefantrine) were prescribed more frequently. These finding are somewhat in agreement with the study done in rural Ugandan Hospital [14] and Mukalla (Yemen)[15] where the most frequently prescribed anti-malarials were artemether-lumefantrine (88.5%) and chloroquine (42.9%), respectively. The high prescription rate for the two drugs might be explained in terms of high prevalence of P. Vivax in the study area [Table 2]. Literature revealed that P. vivax grows easily in the tropical area as compared with the P. faciparum.[6] Thus, the climate at our study site could be one factor for the prevalence of P. vivax. Previously, chloroquine was the first-line treatment for malaria according to the Standard Treatment Guideline of Ethiopia. But to date, drug resistance has been documented in P. falciparum and P. vivax. Findings proved P. falciparum resistance to nearly all anti-malarials in current use.[16] Nowadays it is recommended to use artemisinin-based combination therapy because of their efficacy and safety. However, minor error in prescribing and adherence to drugs can facilitate resistance.[17]

Of the patients diagnosed with malaria, majority used anti-malarial with antibiotics and analgesics as described in [Table 3]. Antibiotics like tetracycline, doxycycline, clindamycin, azithromycin, fluoroquinolones, and erythromycin were sometimes may be combined with anti-malarial agents to shorten the duration of therapy and minimize toxicity. They also used as an adjunct to treat malaria caused by chloroquine-resistant P. falciparum or P. vivax[18]. However, the 2010 standard treatment guideline stated the use of doxycycline for the prophylaxis of P. falciparum.[19] Thus, the rest of the prescribed antibiotics were maybe for other diseases or prescribers' use of current WHO or other research findings. The analgesic of wide use in our study area was paracetamol. However, there is a controversial report on whether to use analgesic or not. Paracetamol was reported to have a negative effect on parasite clearance as it reduces the amount of tumor necrosis factor and oxygen radicals.[8]
Table 3: Antibiotics and analgesics used with anti-malarial drugs as collected from 1-year patient cards in Fitche Hospital, Oromia Region, 2013

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Table 4: Routes of administration of drugs and percentage of drugs prescribed in generic and brand name in Fitche Hospital, Oromia Region, 2013

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Regarding the dosage form, the tablet was the most common formulation followed by an injection. Patients' belief, health professionals' lack of knowledge, and patient load may be one of the factors for the high injection prescription than oral anti-malarial drugs. If used inappropriately, injections are toxic, dangerous, and life-threatening. This problem can be improved by training health staffs and public educations. This study also revealed that all anti-malarials, 67% of antibiotics, and 58% of analgesics were prescribed by generic name. Generic prescription facilitates communication and promotes safe and effective drug use. Brand prescription can cause doubling of medications, creates confusion, and makes communication difficult which may contributes a lot to decreased adherence to drugs.[11]

The strength of the study is its input for study, which is going to be conducted on rational use of anti-malarial drugs and the study was conducted focusing on whether the health facilities were aware of current drug resistance to chloroquine. And also this study reveals the use of chloroquine over coartem despite the guideline recommendation of coartem use for uncomplicated malaria. This study is a great input for health policy makers to control the use of anti-malarial agents in the care of patients to prevent resistance. The cross-sectional nature of the study, incomplete patient cards, timing of data collections, poor records at health facilities, and the sample size were the limitations of the study.


   Conclusions Top


According to study in Fitche Hospital, anti-malarial agents were not used in complete agreement with the guideline of Ethiopia even though the practice is judged as good. The majority of patients identified were in the age range of 20–29 years. The most common parasite at the study site was P. vivax. We found high prescription of chloroquine than coartem. Prescriptions with injections were high. 71.2% and 78.4% received antibiotics and analgesics, respectively, with anti-malarial drugs. Though all anti-malarial drugs were prescribed by generic name, drugs combined with anti-malarials were prescribed by both generic and brand name. Therefore, rational use of anti-malarial drugs should be promoted by the governing body particularly during prescribing and dispensing of drugs through a continuous in service trainings, seminars, and workshops. There should also be future research direction on the rational use of anti-malarial agents to identify the root cause of irrational anti-malarial drugs use.

Acknowledgment

The authors would like to acknowledge Jimma University for facilitating our research.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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Ucakacon PS, Achan J, Kutyabami P, Odoi AR, Kalyango NJ. Prescribing practices for malaria in a rural Ugandan Hospital: Evaluation of a new malaria treatment policy. Afr Health Sci 2011;11 Suppl 1:S53-9.  Back to cited text no. 14
    
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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