It is estimated by the World Health Organisation (WHO, 2004) that globally, over 50%
medicines are prescribed inappropriately. In Namibia, suboptimal prescribing practices
have been reported in previous medicine use surveys. Prescribing patterns in the outpatient
settings have however not been evaluated in the Khomas Region.
The aim of this study was to evaluate the medicine prescribing patterns in out-patient
departments of public health facilities in the Khomas Region, Namibia.
The study adopted the WHO descriptive cross-sectional observational design for a
medicine use survey using both quantitative and qualitative methods of data collection.
The study was conducted at three levels of health care: Hospital, Health Centre and Clinic.
Data on prescribing indicators were collected from patient prescriptions and data on
prescribers’ use of treatment guidelines was also collected. The main outcome variables
were the use of STGs in prescribing of medicines at OPD units and five prescribing
indicators recommended by WHO.
A total of 1,243 prescription records were reviewed and 37 prescribers participated in the
study. Four out of the five prescribing indicators were below acceptable prescribing
thresholds clearly showing that rational prescribing in Khomas Regions is suboptimal.
The very high level of antibiotic prescribing (69%) is very worrying and will directly lead
to increase in Anti-microbial resistance. The average of over three medicines per
prescription shows that there is a degree of polypharmacy and the low level of generic
prescribing only (64%) is also worrying. Adherence to STGs was found to be 73%, which
is better than found in some other studies but still below the acceptable level. The main
factors driving the use of STGs were access to STGs and/or training; access to STG
recommended medicines at the health facility and the simplicity in indexing of the STG.
The study recommends implementation of a prescribing performance management system
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to standardize, continuously monitor and improve on the prescribing of medicines at OPD
units in Khomas Region.