Factors Associated with Irrational Drug use at a District Hospital in Zambia: Patient Record-based Observations

Background: The irrational use of drugs remains a key health problem in many developing countries. The prevalence of irrational drug use and factors associated with it were investigated at Kapiri Mposhi District Hospital in Zambia.Methods: The outpatient records (n = 680) of clinical encounters from the hospital registry department for the year 2010 were analysed. The selection process adapted a random sampling method using the patient logbook in order to get a representative sample. Standardised World Health Organization (WHO) prescribing and facility indicators were used to describe irrational drug use. The composite measure of irrational drug use was used to determine the prevalence of irrational drug use at the hospital. Logistic regression was used to assess factors associated with irrational drug use. In addition, a selfadministered questionnaire was administered to assess the availability of key medical personnel at the hospital.Findings: Overall prevalence of irrational drug use was 51.4% (n = 680) at Kapiri Mposhi District Hospital Outpatient Department. Disaggregating the composite indicators revealed that antibiotics (65.4%) and polypharmacy (52.2%) were the highest contributors to irrational drug use. A mean of 2.5 (SD 1.07) drugs were prescribed, with a low rate of prescribing by generic name 56.9% (95%CI 52.4-58.8). The proportion of prescriptions for antibiotics was 65.4% (95%CI 61.7- 68.9) and for injections, it was 9.7% (95%CI 7.48-11.9). A high percentage of drugs were from the essential drugs list (95.9%) while drug availability was 92%. The essential drug list was not available at the hospital. The availability of prescribers was 55% whereas that of dispensers was 67%. In multivariate logistic regression, polypharmacy was the main determinant of irrational drug use. A oneunit increase in drug use increased the odds of using antibiotics by 2.7 times (P < 0.001; OR=2.68, 95%CI 2.20-3.25) and injections by 2.3 times (P < 0.001; OR=2.28, 95%CI 1.75-2.97).Conclusion: The prevalence of irrational drug use at Kapiri Mposhi District Hospital was high suggesting the need for rationalisation. Overuse of antibiotics, polypharmacy and the use of non-generic names were the identified drug-use problems. These findings suggested that there is a need for continuous monitoring of rational prescribing of drugs and strengthening of factors that support the rational use of drugs