Prescription practice and potential drug-to-drug interactions in the management of childhood malaria at Mbale regional referral hospital :

Abstract

Background: Malaria remains a leading cause of mortality among the under-fives in Uganda, and yet health professionals do not adhere to the treatment guidelines and standards. The poor prescription practices have led to irrational drug use; polypharmacy, inappropriate medications, high antibiotic and high injection rate. These contribute to drug interactions, overdose, under dose, poor health outcomes, antimicrobial resistance, drug shortage and increased cost of care. This study was done with an aim of describing prescription practices and potential drug-to-drug interactions in the management of malaria among patients admitted at the paediatric department at Mbale Regional Referral Hospital (Mbale RRH). Methods: This was a cross sectional retrospective study conducted at the Paediatric Acute Care Unit (PACU) of Mbale RRH from October 2017 to April 2018 on 633 Paediatric admission records of in- patients with malaria diagnosis using consecutively sampling. This data was analysed using the STATA statistical analysis software using univariate and bivariate analysis. Results: The prevalence of malaria was 45.6% with majority being under five (79.5%) but poor documentation of the anthropometric data. The percentage adherence to laboratory tests for malaria diagnosis was at 86.3% with 13.7% diagnosed for malaria without any documented laboratory test, Blood slide at (66.2) and mRDT was at (47.6%). Drug prescription trends were as follows; artesunate (60.3%), paracetamol (42.8%), ceftriaxone (37.9%), gentamicin (36.5%), and ampicillin (24%). It was noted that 70.1% of the patients without a malaria test performed had antimalarials prescribed which is worrysome. There was also a high antibiotic prescription (65.9%). The prevalence of potential drug-drug interactions was 10.7% with 5.5 % of the prescriptions having one potential drug-drug interaction, 4.3% prescriptions having two potential DDIs, 0.6% prescriptions having three potential DDIs, 0.2% prescriptions having four potential DDIs and 0.2% prescriptions having five potential DDIs. Conclusion: The percentage contribution of malaria to inpatient admissions is higher and there exist high levels of children with malaria co-infected with other illnesses. There is also non-adherence to the test and treat policy for malaria management with inappropriate prescription of antibiotics. Key words: Prescription practice, potential drug-drug interactions, malaria, irrational prescription.