Rational drug use in rural health units of Uganda: effect of national standard treatment guidelines on rational drug use

PROBLEM STATEMENT: In Uganda, there is no reliable baseline data on rational use of drugs. Reasons for the current drug use situation in the country are unknown. OBJECTIVES: 1. Assess the degree of rational drug use in the country. 2. Identify the reasons for drug use situation in the country. 3. Assess the suitability of the developed NSTGs booklet. 4. Determine the effect of the different interventions on drug use in the country. DESIGN: Randomised controlled study with pre-post observations of outcomes using qualitative and quantitative research methods. SETTING: 6 districts in 4 regions of Uganda, 21 health units randomly selected in each district. The health units were divided into 3 groups and assigned interventions A1, A2, B or none to a control group. Data were collected retrospectively for 30 patient encounters and 6 additional cases of diarrhoea in children under 5 years from out patient registers covering a period of 6 months. Data was also collected prospectively on the day of the survey. STUDY POPULATION: 127 health units out of 987 were covered, 13631 general patient encounters and 1463 diarrhoea cases in children under 5 were studied. Interventions: B, dissemination of NSTGs alone to health units. A2, dissemination of NSTGs + timely feedback and targeted training of health workers. A1, dissemination of NSTGs + timely feedback and targeted training of health workers + support supervision for six months. OUTCOME MEASURES: Average number of drugs prescribed, average diagnosis, % of cases given antibiotics / injection, % generic use, % drugs on EDLU, % of general cases, malaria cases, and diarrhoea cases in < 5 years treated according to NSTGs, % diarrhoea cases given ORS. Results: There was significant reduction in the number of drugs prescribed for the general cases for intervention A1 and A2. RESULTS: similar for A1 and A2. Intervention B increased the number of drugs prescribed and the control group had no change. The average drugs prescribed for diarrhoea decreased significantly for both intervention A1 and A2, no change in B and minimal increase in control groups. No change in antibiotic prescribed for intervention A1 and minimal reduction for A2. However, there was a significant increase in antibiotic use in B and control groups. There was a significant reduction in injectable prescribing for A1 and A2, increased in B and to a smaller extent for control groups. There was significant improvement in the treatment of general cases, malaria and diarrhoea for A1 and A2, and none for B and control groups. CONCLUSION: Provision of NSTGs does not result into behaviour change in rational drug use. Support supervision does not necessarily increase the effects of training.