Assessment of prescribing patterns and access to medicines for the management of sickle cell disease at Mulago National Referral Hospital, Kampala District

Abstract

Background Sickle cell disease is a public health concern and about 5% of the World's population carries genes responsible for haemoglobinopathies. Uganda is ranked fifth with sickle burden in Africa, with over 25000 babies born every year, up to 90% of them die before reaching five years, Globally, drugs account for about 60% of non-personnel cost of healthcare and about 59% of medications are presumed to be inappropriately prescribed, dispensed, or sold. This leads in partial increased coat of healthcare and emergence of drug resistance. Appropriate diseases management and chemotherapy reduces morbidity and prevents mortality. However, several factors affect the effectiveness of the treatment such as prescribing quality and patients' difficulty to access medicines therefore prescribing patterns and access to medicines has direct influence on the effectiveness of disease management.

Aim: The aim of the study was to determine the prescribing patterns and access to medicines in the management of sickle cell disease at Mulago National Referral Hospital.

Materials and Methods This was a cross-sectional study involving quantitative methods of data collection which include both observations and interviews. A total of 378 respondents were involved in the study. A semi-structured questionnaire was used to get information from patients while checklist was used to obtain data from prescriptions. Data was analyzed using Excel (STATA Copyright 1985-2015).

Result The mean age of SCD patients was 8.5 6.7 years and 51.3% of the patients were male. A total of 1878 drugs were prescribed with an average of 4.97 drugs per prescription. Analgesics , antimalarial, antibacterial, disease modifying agents and other drugs prescribed accounted for 571(30.4%), 233(11.9%). 339 (18.1%), 174(9.3%), and 570(30.4%) of the total prescriptions, respectively, Of the analgesics prescribed, paracetamol accounted for 278(73.5%), ibuprofen 188(49.7%) and morphine 28(7.4%). Artemisinin-based combination therapy was used in the management of malaria, and 376(91.8%) of SCF patients had prophylactic antimalarial. The availability of medicines at the facility was 75% and the average number of days out of stock was approximately 14 days. The average number of days out of stock of individual classes of drugs was 12, 43, 29,30,38 days for analgesics, penicillins, caphalosporins, hydroxyurea and antimalarials respectively in the past three months. Conclusion Drug prescription in SCD patients was in the accordance with the standard guidelines for the management of sickle cell disease and disease and patients fairly access medicines at the sickle cell clinic.