RESUMEN
Good drug prescription and distribution practices are pre-requisites for rational use of essential generic medications. However few studies have been conducted on this topic in sub-Saharan Africa especially in rural areas. The purpose of this study in the Mambéré-Kadei health district of the Central African Republic was to evaluate drug use patterns with special attention to prescribing and dispensing, as a basis for assisting policy makers in planning and identifying intervention strategies. The transverse descriptive survey was undertaken in 14 public health facilities in the Mambéré-Kadéï health district. Data were collected by interviewing care providers and patients immediately after consultation and at the exit of the dispensary. The indicators recommended by the World Health Organization (WHO) for investigating drug use patterns in Communities were used for data collection. A total of 512 prescriptions were analysed. The average number of drugs prescribed per consultation was 3.5. Most drugs (68.6%) were prescribed by generic name. Antibiotic use (31.4% of consultations) was frequent and 29% of patients received injections. 82.1% of the drugs were compliant with the national essential drug list. The distribution survey showed that 79.46% of prescriptions were completely filled. No serious distribution errors occurred but 21.5% of the dispensed drugs were inadequately labelled. Patients understood the modalities of use for 69.6% of prescribed drugs. The average consultation and distribution times were 8.3 and 5 minutes respectively. Excessive use of antibiotics and injections and blunderbuss therapy is still observed in Mambéré-Kadei. Many drugs not included on the essential drug list and non-generics are prescribed. Other prescription and distribution problems identified in this survey include poor information on drug use, inadequate labelling of dispensed drugs, and lack of access to standard drug use tools such as a locally adapted essential drug list, formularies and standard treatment guidelines. To improve the system, caregivers must receive more training on the rational use of essential generic drugs and the population must be better informed.
Asunto(s)
Prescripciones de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Medicamentos Genéricos/administración & dosificación , República Centroafricana , Estudios Transversales , Humanos , Estudios ProspectivosRESUMEN
Les bonnes pratiques de prescription et de dispensation sont des prerequis a l'usage rationnel des medicaments essentiels generiques. Cependant; il y a peu d'etudes sur le sujet en Afrique subsaharienne; en particulier en zone rurale. Cette etude descriptive transversale a ete realisee a partir d'un echantillon representatif de 14 formations sanitaires de la prefecture de Mambere- Kadei. Les donnees ont ete collectees par interview des soignants et des patients juste apres la consultation et a la sortie du point de dispensation. Les indicateurs OMS de l'utilisation des medicaments ont ete employes pour la collecte de donnees. 512 prescriptions ont ete analysees. Le nombre moyen de medicaments par consultation etait 3;5; 68;6de medicaments ont ete prescrits par la Denomination Commune Internationale. Les prescriptions des antibiotiques (31;4) etaient frequentes; et 29des patients ont recu des injections. 82;1de medicaments prescrits sont conformes a la liste nationale des medicaments essentiels. Concernant la dispensation; les medicaments prescrits ont ete dispenses pour 79;5de prescriptions. 21;5de medicaments delivres avaient un etiquetage inadequat. 69;6des patients connaissaient la posologie correcte des prescriptions. La duree moyenne de consultation et de dispensation etait respectivement de 8;3 et de 5 minutes. Dans la Mambere- Kadei; on observe la polypharmacie; un usage excessif des antibiotiques et des injections. Les medicaments ne figurant pas sur la liste des medicaments essentiels et les specialites restent eleves. En termes d'interventions; les programmes de formations sur l'usage rationnel des medicaments essentiels generiques pour les soignants et des campagnes de sensibilisations des populations semblent necessaires
Asunto(s)
Medicamentos Esenciales , Medicamentos GenéricosRESUMEN
STATEMENT OF THE PROBLEM: in most sub-Saharan countries, an extensive economic crisis coupled with a low level of existing resources has put most pharmaceuticals beyond the reach of the general public. This situation was worsened by the devaluation of the Franc CFA in 1994. The supply of lowprice drugs and the improvement of rational drug use is now a priority. Unfortunately, essential generic drugs are little known and used in Africa. OBJECTIVE: 1. To improve the knowledge of and confidence in essential and generic drugs among providers, prescribers and consumers, through the participation of the general public in an incentive-based, creative competition; 2. To collect locally-adapted promotional material, to be used in the future promotion of essential and generic drugs in Africa. Design, setting and method: a competition was announced in June 1995, via various networks, in French-speaking Africa: the population was invited to create one or several items promoting essential generic drugs. These items included slogans, posters, songs and short plays. Over 550 entries were received before the deadline (15 October 1995), from 22 countries (mostly Sub-Saharan and French-speaking). The entries included 387 slogans, 94 posters, 22 plays, and various (photos, comic strips, songs, poems). RESULTS: 1. Greater awareness of essential generic drugs in Western Africa, through the publicity given to the competition; 2. Selection of a pool of approximately 200 promotional items, produced by the target populations, to be published in a catalog and distributed in African countries; 3. Insights into popular practices and representations of Western medications, and local re-interpretation of the concept. CONCLUSION: this public competition was effective at achieving three important goals: 1. Dynamic promotion (the competition was the opportunity for school projects, radio talkshows, etc. on generic drugs); 2. Re appropriation of a policy, thanks to a participative approach; 3. Analysis of the population's general comprehension of pharmaceuticals, through analysis of competition entries.