Done by Ms Arti B. Shah B.Pharm IV 2002

Supervised by Dr. G. Rimoy and Dr. M.J Temu

ABSTRACT

Objective:
This study was conducted to evaluate the drug-prescribing pattern of antihypertensives at District Hospitals in Dar Es Salaam using WHO drug use indicators.

Materials and Methods:
Three District Hospitals namely Temeke, Mwananyamala and Ilala were included in the study. All the patients attending the hypertension clinic of the Medical Outpatient Department (MOPD) were assessed.

200 prescriptions from each hospital were recorded as the patient came out of the doctor's consultation room. The patients were observed in the consultation room and at the pharmacy or dispensing unit and the data collection forms and the WHO indicator forms were filled accordingly.

Data collection forms were used to record patient's characteristics including age, sex, diagnosis, drugs prescribed and their hypertensive status. The Patient Care indicators were measured by recording consultation time, dispensing time, percent of drugs actually dispensed and adequately labelled whereas patient's knowledge of correct drug dosage was obtained using exit interviews.
Facility indicator verification was done by direct observation.

Results:
The average number of drugs per prescription was 4.1, 3.3 and 2.9 for Temeke, Mwananyamala and Amana respectively, while average number of antihypertensive drug per prescription was 2.6 in Temeke, 2.1 in Mwananyamala and 1.9 in Amana. Out of 600 prescriptions, those encountered with both antidiabetics and antihypertensives in Temeke, Mwananyamala and Amana were 141, 179 and 150 respectively. Out of these, 89.4%, 88.3% and 87.3% of the prescriptions in Temeke, Mwananyamala and Amana respectively were encountered with irrationally prescribed drugs containing antidiabetics, either with thiazide diuretic, propranolol or both.
Generic prescribing of antihypertensives prevailed with a mean of 50.0%. Oral antibiotic and injection appearing on each prescription prevailed with a mean of 4.8 and 9.8 percent respectively. Most drugs were prescribed according to the Tanzania National Formulary of 1998. Patients' average consultation time was 4.1 minutes in Temeke, 3.8 minutes in Mwananyamala and 3.2minutes in Amana whereas dispensing time was 55.0 seconds in Temeke, 41.5 seconds in Mwananyamala and 38.7 seconds in Amana. On overall 91% of all drugs dispensed were adequately labelled and patients knowledge of correct dose was adequate.
All facilities possessed almost all important antihypertensives and antidiabetics. They also had reference educational materials.

Conclusion:
The drug prescribing pattern in all three district hospitals was irrational, because the prescribers were not considering the two conditions (that is: hypertension and diabetes mellitus) separately. This kind of practice enhanced drug interactions resulting into worsening the patient's condition. Therefore, Ministry of health should continuously organise educational programmes like seminars to educate the prescribers on rational prescribing of the drugs especially in sensitive cases like hypertension and diabetes mellitus.