Preference for routes of drug administration among adult patients attending Makerere University Hospital Outpatient Services - Kampala, Uganda

Abstract

Introduction Routes of drug administration significantly influence therapeutic outcomes, patient comfort, and adherence to treatment. While WHO guidelines advocate for rational use of routes like intravenous (IV) and intramuscular (IM), irrational use particularly of parenteral routes remains a challenge in many low- and middle-income countries. In Uganda, frequent use of injections, even in non-critical conditions, suggests a misalignment between clinical practice and recommended protocols. Prior studies in Africa and elsewhere show that patient perceptions such as beliefs about speed of relief and effectiveness influence their preferences for drug administration routes. However, little is known about how Ugandan patients perceive or prefer these routes, particularly in outpatient settings. This study aimed to assess the Preferences for routes of drug administration among adult patients attending outpatient services at Makerere University Hospital in Kampala, Uganda. Objective To assess Preferences for routes of drug administration among adult patients attending Makerere University Hospital outpatient services - Kampala, Uganda. Methods A descriptive cross-sectional study design was employed, involving a sample of 384 participants selected through systematic random sampling. Ethical approval was obtained, and informed consent was collected from all participants. Data were collected using a structured questionnaire adapted from a validated multi-country study by (Murdan et al., 2023), which had been implemented across 21 countries. The tool assessed patients' perceptions including pain, efficacy, speed of action, acceptability, and altered taste and their preferences for six routes of medicine administration: oral, rectal, intramuscular (IM), inhalational, intravenous (IV), and topical. Descriptive statistics and the Friedman test were used to analyze preferences and mean ranks using SPSS software. Results Participants demonstrated varied willingness to accept different routes of drug administration. Among the routes assessed, the intravenous (IV) route was the most accepted, with 19.12% of respondents expressing willingness to use it. This was followed by the oral route (18.62%), subcutaneous (SC) route (17.15%), intramuscular (IM) route (16.18%), topical route (15.76%), and finally, the rectal route (13.16%). When preferences were assessed for managing simple illnesses, the IV route had the highest mean ranking at 3.87, suggesting it was most preferred. This was followed closely by the inhalational and rectal routes, both with mean ranks of 3.70, then the IM route (3.60), topical route (3.23), and the oral route (2.91), which ranked lowest. In the context of complicated illnesses, the topical route emerged as the most preferred with a mean rank of 3.74, followed by the rectal route (3.73), IV (3.56), IM (3.44), inhalational (3.28), and again, the oral route was least preferred with a mean rank of 3.25.

Conclusion This study reveals a critical gap between clinical best practices and patient preferences. The widespread preference for IV and IM routes, even in non-critical cases, may be driven by perceptions of potency and quick relief, leading to irrational use. Meanwhile, the relatively low preference for oral medication contradicts global trends that favor non-invasive routes for their safety and ease. Such findings underscore the importance of aligning healthcare delivery with both clinical guidelines and patient education. Rational drug use can only be promoted when patients are well-informed about the merits and risks of each route, and when healthcare providers communicate effectively.