PRESCRIBING HABITS IN CHURCH-OWNED PRIMARY HEALTH CARE FACILITIES IN DAR ES SALAAM AND OTHER TANZANIAN COAST REGIONS

Objective: To assess prescribing practice of Primary Health Care (PHC) workers in churchowned health care facilities using WHO drug use indicators.Design: Across-!iectional study in which twenty primary health care facilities were randomlyselected. Prescribing indicators were obtained by analysing outpatient records retrospectivelyfor the past 14 months between January 1997 and February 1998. This period was chosenbecause of compete records of outpatient attendances. Patient care and facility indicatorswere recorded prospectively during the study period.Setting: The study was conducted in the Coast and Dar es Salaam regions of Tanzania. Sixdistricts were randomly selected from both regions. The selected districts included llala,Temeke and Kinondoni in Dar es Salaam, Kibiti, Bagamoyo and Kisarawe in Coast region.Subjects/materiaCs: Twenty primary health care facilities were randomly selected from thechosen districts. Patient registers were collected and patients' characteristics including age,sex, diagnosis, ;and drugs prescribed for the period January 1997 to February 1998 wererecorded on data collection forms. Patient care indicators were measured by recordingconsultation tirne, dispensing time, per cent of drugs actually dispensed and adequatelylabelled whereas patients' knowledge of correct drug dosage was obtained using exitinterviews. Verification of facility indicators was done by direct observation.Results: The average number of drugs per prescription was 2.3 (range 1.8 - 2.8). Genericprescribing prevailed with a mean of 75.W0 of all drugs. Antibiotic and injection encounters perprescription was 35.4 and 19%, respectively. Most drugs were prescribed according to theessential drug Ikt of Tanzania (NEDLIT). Patient's average consultation time was 3.6 minuteswhereas average dispensing time was 39.9 seconds. On average, 87% of all drugs dispensed wereadequately labelled and patients' knowledge of correct dose was adequate. All facilities possesseddrugs for treating important illnesses, all had reference educational materials.Conclusion: The study shows that there is an overuse of injections 19% + 1.7 (range 0-73% )compared to the recommended figure of 15%. The use of antibiotics appears appropriatewhen compared with the morbidity patterns in the study areas. A focus group discussion withprescribers in these facilities to address the question of overuse of injections is needed in orderto plan an appropriate intervention