Effects of an Intervention on the Use of Medicines in Herat Province of Afghanistan Bapna , Jawahar Singh (1); Aaen , Inge-Lise (2); Hamedi , Saeed (2) [email protected] 1. Jaipur College of Pharmacy, Jaipur, India; 2: Danish Afghan Committee, Herat Afghanistan .
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Abstract: Problem statement: No systematic study on quality of prescribing is available in Afghanistan
Objective: To study the effect of educational intervention on prescribing in selected health facilities in Herat
Province, Afghanistan. Design: It was a before-and-after, face-to-face intervention with no control group.
Baseline data on use of medicines, quality of prescribing, dispensing, and stock-outs were collected using
WHO/INRUD indicators and the change that occurred after 1 year assessed. Setting: The study was conducted
at Herat Province of Afghanistan at public sector health facilities supported by a nongovernmental
organization, the Danish Afghan Committee. Study population: All the prescribers, a total of 60 working at 1
district, 2 community health centers, and 5 basic health centers of Herat Province were included in the study.
Intervention(s): Participants were trained at two 4-day participatory workshops at the beginning and after 3
months. In the first, the concept of essential drugs and rational drug use was presented to them. In the
second, training was given on problem-based learning using Guide to Good Prescribing. Outcome measure(s):
The changes in prescribing practices, quality of medical and dispensing services, and stock-outs was measured
after 1 year. Results: The pooled data of 30 prescriptions or observations each at 8 facilities were analyzed
before and after intervention. Drug use indicators showed a trend towards improvement; however, it was not
statistically significant. The average number of drugs per prescription changed from 2.43±0.051 to 2.59±0.052,
generic drugs 91.17±0.284 to 95±0.218, combinations 37.9±0.20 to 30.8±0.19, Injections 4.8±0.009 to
6.4±0.10, antibiotics 19.6±0.017 to 22.2±0.017, drugs from essential medicines list 87.5±0.014 to 84.9±0.014,
and drugs dispensed 81.5±0.016 to 82±0.015. Prescribing indicator showed that consultation time per patient
increased significantly from 150.97±2.23 to 174.35±3.54 seconds (p<0.05). Dispensing time reduced from
41.90±0.092 to 37.33± seconds. The Average number of stock out days for key dugs decreased from 28.65 to
23.22 % days of the year. Conclusions: The study shows that the educational intervention can improve the
prescribing practices. The drug use Indicator showed a trend Toward improvement. Consultation time
increased significantly, which is helpful In rational use of drugs. The decrease in stock-outs also helps in
promotion of rational prescribing. Training and motivation of prescribers is needed on regular basis to achieve
these objectives. This study supports the view that a flash effect of education programs for rational
prescription and use exists: immediately after training prescription patterns improve, but prescribers tend to
return to old habits. After a while, so long-term effects need more sophisticated interventions than just
education. Educating patients along with the prescribers may be useful since the patients can be 50% of the
problem and their requests are often driving the prescription patterns. Funding source(s): Danish Afghan
Committee, Herat, Afghanistan