Prescribing practices of doctors attending to under fives in a children's outpatient clinic in Owerri, Nigeria

Prescribing practices of doctors in different clinical settings have been documented but there is a dearth of information on prescribing practices with regards to children especially the under fives. This study set to describe the prescribing practices of doctors attending to under fives in a children's outpatient clinic. The information obtained is expected to aid in designing appropriate interventions. Between January and April 2004 the age, sex and drugs prescribed for under fives seen at the children's outpatient clinic of Federal medical centre, Owerri in South eastern Nigeria were extracted at the end of each day's consultations from their cards and entered into a spread sheet. Patients who had no prescriptions were excluded. A total of 2471 medications were prescribed for 790 patients who met the criteria for inclusion in the study. Antimalarials, Analgesics, Antibiotics, Vitamin C, Antihistamines and Multivitamin preparations were the commonest drugs prescribed. The prescription rate per patient was 3.13.While three different antimalarials were prescribed a total of twelve different antibiotics were. Prescription rate for injections was 1.9 per cent. Only 13.3 per cent of the patients had all their drugs prescribed in generic names. The others had at least two drugs prescribed in brand names. The difference in cost between same drugs prescribed in brand names as against in generic names were between 41.7 per cent and 60 per cent. All the antimalarials and analgesics prescribed were in the Nigerian National essential drug list while only 16.7 per cent of antibiotics prescribed were not. This study has documented significant flaws in the prescribing practices of these doctors, particularly the low rate of prescription in generic names, high rate of antibiotics prescription, inappropriate prescription of multivitamin preparations and Vitamin C and a relatively high rate of poly pharmacy. Suggested interventions include developing and circulating easy to use treatment guidelines for diseases commonly seen in our centre and a regular audit of the application of these guidelines. Continuing medical education of doctors on rational drug use and evidence based medicine should also be instituted.