Evaluation of drug prescribing pattern among pregnant women attending antenatal clinic at the 34 military hospital, Freetown, Sierra Leone
Article Sidebar
Main Article Content
Abstract
Background: Management of medical conditions in pregnancy is a challenge to clinicians. As a result, clinicians are faced with a quagmire in making evidence-based therapeutic decisions regarding patient management. No study has been conducted in Sierra Leone to determine drug prescription patterns among pregnant women.
Objective: This study assessed the prescribing pattern of drugs among pregnant women who attended antenatal care clinic at the 34 Military hospital in Freetown from May 1st, 2019 to October 31st, 2019.
Methods: A hospital-based cross-sectional retrospective study was conducted by reviewing medical charts of 314 pregnant women who attended antenatal clinic at the study site. The cases selected by simple random sampling were women who encountered at least one drug prescribed during their visit. The World Health Organisation (WHO) prescribing indicators and the United States Food and Drug Administration (FDA) pregnancy risk classification of medicines were used to assess drug prescribing patterns and contraindication in pregnancy respectively.
Results: Excluding minerals and vitamins, 99 (31.5%) of pregnant women from the 314 sampled for this study received at least one drug. Multivitamins/minerals 216 (40.3%) were the most frequently prescribed medicines. The average number of drugs prescribed per encounter was 1.7 with an index of polypharmacy of 0.86. The percentage encounters with an antibiotic and injection prescribed and drugs prescribed by generic names were 27.4%, 11.1%, and 40.0% respectively. About 221 (41.2%) of the drugs prescribed were from the FDA category A. No drug was prescribed from category X.
Conclusions: The prescribing pattern among prescribers was relatively rational, as three of the indicators met the WHO standard, with room for more improvement. The occurrence of contraindicated medicines was low as a high proportion of drugs were prescribed from FDA category A
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
How to Cite
Share
References
Cheney BE (2002). Management of Common Primary Care Problems during pregnancy. Programme and Abstracts of the 5th Annual
Conference of the National Association of Nurses Practitioners in women's health, Scottsdale Arizona, September 27-29. https://www.npwh.org/ (Accessed 22nd May, 2019)
Daw JR, Hanley GE, Greyson DL and Morgan SG (2011). Prescription drug use during pregnancy in developed countries: a systematic review.
Pharmacoepidemiology and drug safety 20(9):895-902.
Mitchell AA, Gilboa SM, Werler MM, Kelley KE, Louik C, Hernández-Díaz S, et al (2011). Medication use during pregnancy, with particular focus on prescription drugs:1976-2008. American Journal of Obstetrics and Gynecology 205(1):51. e1-. e8.
Lupattelli A, Spigset O, Twigg MJ, Zagorodnikova K, Mårdby A-C, Moretti ME, et al (2014). Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open. 4(2):e004365.
Andrade SE, Gurwitz JH, Davis RL, Chan KA, Finkelstein JA, Fortman K, et al (2004). Prescription drug use in pregnancy. American Journal of
Obstetrics and Gynecology 191(2):398-407.
Mazer-Amirshahi M, Samiee-Zafarghandy S, Gray G and Van den Anker JN (2014). Trends in pregnancy labeling and data quality for US-approved pharmaceuticals. American Journal of Obstetrics and Gynecology 211(6):690. e1-. e11.
Schonfeld T, Schmid KK, Brown JS, Amoura NJ and Gordon B (2013). A pregnancy testing policy for women enrolled in clinical trials. Ethics and Human Research 35(6):9-15.
Ayad M and Costantine MM (2015). Epidemiology of medications use in pregnancy. Seminars in Perinatology 39(7):508-511).
Lee E, Maneno MK, Smith L, Weiss SR, Zuckerman IH, Wutoh AK, et al (2006). National patterns of medication use during pregnancy. Pharmacoepidemiology and drug safety 15(8):537-45.
US Food And Drug Administration (FDA) (1980). Categories for Drug Use in Pregnancy. Federal Register 44: 37434-37467.
Cleary KL, Roney K and Costantine M (2014). Challenges of studying drugs in pregnancy for offlabel indications: pravastatin for preeclampsia prevention. Seminars in perinatology 38(8):523-527
Eze UI, Eferakeya AE, Oparah AC and Enato EF (2007). Assessment of prescription profile of pregnant women visiting antenatal clinics. Pharmacy Practice 5(3):135-9.
Dillon P, O'Brien KK, McDonnell R, Donnelly-Swift E, Galvin R, Roche A, et al (2015). Prevalence of prescribing in pregnancy using the Irish primary care research network: a pilot study. BMC pregnancy and childbirth. 15(1):1-9.
Chaudhari A, Aasani D and Trivedi H (2016). Drug utilization study in antenatal clinic of Obstetrics Gynaecology Department of a Tertiary Care Hospital attached with Medical College. Indian Journal of Pharmacy and Pharmacology 3(4):186-91.
Bedewi N, Sisay M and Edessa D (2018). Drug utilization pattern among pregnant women attending maternal and child health clinic of a
tertiary hospital in eastern Ethiopia: Consideration of toxicological perspectives. BMC research notes. 11(1):1-7.
Kebede B, Gedif T and Getachew A (2009). Assessment of drug use among pregnant women in Addis Ababa, Ethiopia. Pharmacoepidemiology and drug safety 18(6):462-8.
Jimoh AO, Abubakar K, Abdulkadir R, Abubakar SB, Ugwah-Oguejiofor JC and Danzaki AM (2014). Drug Utilisation Pattern in Pregnancy in a Tertiary Hospital in Sokoto, North West. Journal of Health Science 4(4):99-104.
Geoffrey CU, and Scott P (1997). Research randomizer. https://www.randomizer.org/. (Accessed 12 June 2019)
World Health Organisation (1993). How to investigate drug use in health facilities: selected drug use indicators. Geneva: World Health Organization.
Yuxin Z and Mingguang Z (1995). Index System and Appraising Method for Comprehensive Appraisal [J]. Journal of Northern Jiaotong University. 19(3):393-400.
Umar LW, Isah A, Shuaibu and Musa BU (2018). Prescribing pattern and antibiotic use for hospitalized children in a Northern Nigerian
Teaching Hospital. Annals of African medicine 17(1):26-32.
Irunde H, Minzi O and Moshiro C (2017). Assessment of rational medicines prescribing in healthcare facilities in four regions of Tanzania. J Pharm Pract Community Med 3(4):225-31.
Cole CP, James PB, and Kargbo AT (2015). An evaluation of the prescribing patterns for under-five patients at a Tertiary Paediatric Hospital in Sierra Leone. Journal of basic and clinical pharmacy 6(4): 109-114.
World Health Organisation (WHO) Collaborating Centre For Drug Statistics Methodology (2018). Guidelines for ATC classification and DDD
assignment 2019. Oslo, Norway. https://www.whocc.no/ (Accessed 1st June, 2019)
Physicians' Desk Reference (PDR). Physicians' Desk Reference, 66th Edition 2012th Edition.
Varghese BM, Vanaja K and Banu R (2016). Assessment of drug usage pattern during pregnancy at a tertiary care teaching Hospital. International Journal of Medicine and Public Health 6(3):130-135
Garriguet D (2006). Medication use among pregnant women. Health Rep 17(2):9-18.
Fontoura A, Ayres LR, Martins-Nagai M, Dewulf NL, dos Santos V, Martinez EZ, et al (2014). Prevalence of medication use among low-risk pregnant women: a drug utilization study. African Journal of Pharmacy and Pharmacology 8(36):883-92.
Refuerzo JS, Blackwell SC, Sokol RJ, Lajeunesse L, Firchau K, Kruger M, et al (2005). Use of over-thecounter medications and herbal remedies in pregnancy. American journal of perinatology 22(06):321-4.
Etefa K and Kahissay M (2015). Assessment of drug prescribing pattern among pregnant women attending antenatal Care in Health Centers found in Arada Subcity, Addis Ababa, Ethiopia. J Pharm Sci Bioscientific Res. 5(4):347-62.
Zhu X, Qi X, Hao J, Huang Z, Zhang Z, Xing X, et al (2010). Pattern of drug use during the first trimester among Chinese women: data from a populationbased cohort study. European journal of clinical pharmacology 66(5):511-8.
Maats F and Crowther C (2002). Patterns of vitamin, mineral, and herbal supplement use prior to and during pregnancy. Australian and New Zealand Journal of Obstetrics and Gynaecology 42(5):494-6.
Rohra DK, Das N, Azam SI, Solangi NA, Memon Z, Shaikh AM, et al (2008). Drug-prescribing patterns during pregnancy in the tertiary care hospitals of Pakistan: a cross-sectional study. BMC pregnancy and childbirth 8(24): 1-5.
Admasie C, Wasie B and Abeje G (2014). Determinants of prescribed drug use among pregnant women in Bahir Dar city administration,
Northwest Ethiopia: a cross-sectional study. BMC pregnancy and childbirth 14(1):325.
Reveiz L, Gyte GML, Cuervo LG and Casasbuenas A (2011). Treatments for iron?deficiency anaemia in pregnancy. Cochrane database of systematic reviews. Issue 10. Art. No.: CD003094. DOI: 10. 1002 / 14651858. CD003094. pub 3. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003094.pub3/abstract (Accessed 20th July, 2019)
Robbins MS, Farmakidis C, Dayal AK and Lipton RB (2015). Acute headache diagnosis in pregnant women: a hospital-based study. Neurology 85(12):1024-30.
Ministry of Health and Sanitation (2015). National Malaria Control Policy. Revised Edition
Pouchieu C, Lévy R, Faure C, Andreeva VA, Galan P, Hercberg S, et al (2013). Socioeconomic, lifestyle, and dietary factors associated with dietary supplement use during pregnancy. PLoS One 8(8):e70733.
De Oliveira ACP and Fonseca TMM (2007). Estudo Epidemiológico Sobre O Uso De Medicamentos Durante A Gravidez Na População Atendida Pelo Serviço De Obstetrícia Do Hospital Municipal De Confresa-Mt. Interseção-Revista da Faculdade São Camilo. 1(1):73-78.
Ladipo OA (2000). Nutrition in pregnancy: mineral and vitamin supplements. The American journal of clinical nutrition. 72(1):280S-90S.
Liew Z, Ritz B, Rebordosa C, Lee P-C and Olsen J (2014). Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA pediatrics 168(4):313-20.
Rebordosa C, Kogevinas M, Bech BH, Sørensen HT and Olsen J (2009). Use of acetaminophen during pregnancy and risk of adverse pregnancy outcomes. International Journal of Epidemiology. 38(3):706-14.
Rebordosa C, Kogevinas M, Horváth-Puhó E, Nørgård B, Morales M, Czeizel AE, et al (2008). Acetaminophen use during pregnancy: effects on risk for congenital abnormalities. American journal of obstetrics and gynecology 198(2):178. e1-. e7.
Eyers S, Weatherall M, Jefferies S, Beasley R (2011). Paracetamol in pregnancy and the risk of wheezing in offspring: a systematic review and meta?analysis. Clinical & Experimental Allergy. 41(4):482-9.
Shaheen S, Newson R, Sherriff A, Henderson A, Heron J, Burney P, et al (2002). Paracetamol use in pregnancy and wheezing in early childhood. Thorax 57(11):958-63.
De Jonge L, Bos HJ, van Langen IM, de Jong?van den Berg LT, and Bakker MK (2014). Antibiotics prescribed before, during, and after pregnancy in the Netherlands: a drug utilization study. Pharmacoepidemiology and drug safety 23(1):60-8.
Fonseca MRCCD, Fonseca ED and Bergsten-Mendes G (2002). Prevalence of drug use during pregnancy: a pharmacoepidemiological approach. Revista de saude publica. 36(2): 205-212.
Ministry of Health and Sanitation (MOHS) [2015]. National Malaria Strategic Plan 2016-2020, National Malaria Control Programme.
Enato EF, Okhamafe AO and Okpere EE. A survey of knowledge, attitude, and practice of malaria management among pregnant women from two health care facilities in Nigeria. Acta Obstetricia et Gynecologica Scandinavica 86(1):33-6.
World Health Organisation (WHO) [2004]. A strategic framework for malaria prevention and control during pregnancy in the African region. A strategic framework for malaria prevention and control during pregnancy in the African region.
Menendez C, Ordi J, Ismail M, Ventura P, Aponte J, Kahigwa E, et al (2000). The impact of placental malaria on gestational age and birth weight. The Journal of infectious diseases. 181(5):1740-5.
Greenwood B, Greenwood A, Snow RW, Byass P, Bennett S and Hatib-N'Jie A (1989). The effects of malaria chemoprophylaxis given by traditional birth attendants on the course and outcome of pregnancy. Transactions of the Royal Society of Tropical Medicine and Hygiene 83(5):589-94.
Morgan H (1994). Placental malaria and low birth weight neonates in urban Sierra Leone. Annals of Tropical Medicine & Parasitology 88(6):575-80.
Amorha KC and Okonkwo CA. Drug Utilization Pattern In Pregnancy In A Tertiary Hospital In Ebonyi State, Nigeria: A Five-Year Retrospective Analysis. African Journal of Pharmaceutical Research and Development 11(2); 125-136.
Fikadu M, Kebebe D, Amelo W and Gashe F (2015). Drug utilization pattern and potential teratogenicity risk among pregnant women visiting antenatal clinic: the case of a primary hospital. Indian J Pharm Pract 8(1):27.
Gawde S, Bhide S, Patel T, Chauhan A, Mayadeo N and Sawardekar S (2013). Drug prescription pattern in pregnant women attending antenatal outpatient department of a tertiary care hospital. British Journal of Pharmaceutical research 3(1):1-12.
Guerra GCB, Silva AQBD, França LB, Assunção PMC, Cabral RX and Ferreira ADA (2008). Drug use during pregnancy in Natal, Brazil. Revista Brasileira de Ginecologia e Obstetrícia. 30(1):12-8.
Belay M, Kahaliw W and Ergetie Z (2013). Assessment of drug utilization pattern during pregnancy in Adama Referral Hospital, Oromia Region, Ethiopia. Int J Pharm Sci Res 4(5):1905-11.
Maher RL, Hanlon J, Hajjar ER (2014). Clinical consequences of polypharmacy in the elderly. Expert opinion on drug safety. 13(1):57-65.
Hovstadius B, and Petersson G (2013). The impact of increasing polypharmacy on prescribed drug expenditure-a register-based study in Sweden 2005-2009. Health Policy. 109(2):166-74.
Bourgeois FT, Shannon MW, Valim C and Mandl KD (2010). Adverse drug events in the outpatient setting: an 11? year national analysis. Pharmacoepidemiology and drug safety. 19(9):901-10.
Joshi H, Patel S, Patel K and Patel V (2012). Drug use pattern during pregnancy: A prospective study at tertiary care teaching hospital. Journal of Medical Sciences 1(1):14-7.
Gadisa A and Guyo A (2014). Drug prescribing pattern and its potential fetal harm among pregnant women in Bishoftu General Hospital, Oromia regional state, Ethiopia. European Journal of Pharmaceutical and Medical Research 1(1):13-34.
Ministry of Health and Sanitation [MOHS] (2012). National Medicine Policy.
Cars O, Hedin A and Heddini A (2011). The global need for effective antibiotics-moving towards concerted action. Drug Resistance Updates
(2):68-9.
Molla F, Assen A, Abrha S, Masresha B, Gashaw A, Wondimu A, Belete Y et al. (2017). Prescription drug use during pregnancy in Southern Tigray region, North Ethiopia. BMC pregnancy and childbirth 17(1):170.
Patel K, Joshi H and Patel V (2013). A study of morbidity and drug utilization pattern in indoor patients of high-risk pregnancy at tertiary care hospital. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2(3):373.