Spectrum of skin diseases and drug prescribing pattern among out patients in public and faith based hospitals in three regions of Tanzania.

Abstract

Background: Skin diseases account for a higher proportion of outpatient attendances especially for children under five years in Tanzania. In some studies, skin diseases have shown to be among the top ten diseases of hospital admissions. Inappropriate prescription and use of medicines is an extremely serious global problem that waste resources, may be harmful to patients and lead to development of antimicrobial resistance. Prescribing patterns studies and data of spectrum of skin diseases are used in interventions to improve use of medicines, informed decision making and health planning. Objectives: The study aimed at investigating the spectrum of skin diseases and drug prescribing pattern among out patients in public and faith based hospitals in three regions of Tanzania. Methodology: This was both a cross sectional retrospective and prospective study conducted between January to December 2014. The Spectrum of Skin diseases and the data for prescribing indicators were collected retrospectively from medical records of 5 health facilities using WHO-Simple Prescribing Indicator Forms. The Prospective study involved use of structured questionnaires to collect data from 43 OPD prescribers on availability and utilization of Standard Treatment Guidelines (STG). Study sample of 1020 prescribing encounters were obtained through random sampling from 4520 medical records of skin diseases. Data was analyzed using the ‘Statistical Package for Social Sciences’ (SPSS) program version 20.0. Results: A total of 2151 drugs were prescribed for the 1020 prescriptions obtained from the health facilities, giving a range of 1.9 – 2.5 average number of drugs per encounter with a mean of 2.11 (SD 0.64). Medicines prescribed by generic name constituted 75% (SD 7.2%) of the total prescribed medicines. Antibiotics and injections were encountered by 38 % and 5.0% respectively. Eighty one to ninety percent (81%-90%) of the prescribed medicines with a mean of 85% (SD 3.7%) were from EML. About 72% (31/43) of prescribers reported to consult STGs, only 65% (28/43) of them had copies of STGs in their working rooms. The study established that 68.7 % of the patients were treated according to STGs in both public and faith based health facilities. The skin diseases observed included noninfectious dermatoses (63.8%) and infectious dermatoses (36.2%) of which included dermatitis variants 40%, pyoderma 19% and superficial mycosis 12%. Conclusions and Recommendations. Overall the prescribing practices were agreeable with WHO recommendations for 4 indicators which were average number of drugs per prescription, prescribing from EML, percent of encounter with injections and key drugs in stocks. However, 3 indicators were not in accordance with the WHO guidelines and they included percent encounter with antibiotics, generic prescribing and percent availability of STGs among prescribers. From this study it is recommended that rational prescribing of antibiotics and generics should be provided to both public and faith based prescribers. Also an intervention is necessary to enhance accessibility of STG by improving their distribution to various health facilities. All this will in turn improve management of the prevailing skin diseases.