Investigating the availability of antimicrobials at Kamuzu Central Hospital in Malawi.

Masters Degree. University of KwaZulu-Natal, Durban.Stock-outs of medicines in Malawian public hospitals affect the majority of the population, and may have serious public health consequences. Aim The aim of this study was to identify stock-outs of selected antimicrobials in the years 2014 and 2015 at Kamuzu Central Hospital (KCH), and investigate whether there were alternative treatments available. Methods This was a retrospective, cross-sectional observational study. The sample list of 70 medicines represented antimicrobial agents on the Malawi Essential List of Medicines. Data was collected from Pharmacy stockkeeping records and analysed in Microsoft Excel. The following calculations were made; total number of days out of stock per year, total number of episodes out of stock and stock-out duration. Results The most available group were antituberculosis at stock-out median number of days of 10 and 62, in 2014 and 2015 respectively. Most stocked-out was the antiretroviral medicines group with a median stock-out days of 175 and 170 in 2014 and 2015 respectively. Antibiotic agents had median number of days of 65 and 96. Specifically penicillins had median stock-out days of 86 in 2014 and 119 in 2015 whereas cephalosporins had 67 in 2014 and 80 in 2015. Macrolides had 36 and 87 median stock-out days in 2014 and 2015. Antimalarial medicines had median number of stock-out days of 55 in 2014 and 32 in 2015. Alternative first line treatments for malaria and TB were available; however, HIV, STD and pneumonia alternatives were not always available. Recommendations Stock-outs of antimicrobials occurred at KCH in both 2014 and 2015. In some cases, alternative therapy was unavailable, and patients probably received inadequate treatment. This negatively affects patient outcome in addition to the possible negative public health effects due to development of antimicrobial resistance