Impact of Medicine Management and Rational Use Workshop on Antimicrobial Drug Use in five Hospitals

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Impact of Medicine Management and Rational Use
Workshop on Antimicrobial Drug Use in five
Hospitals Eastern Province, Zambia Kandeke C,
Chibuta C, Banda D Churches Health Association
of Zambia, www.chaz.org.zm , P.O. Box 34511,
Lusaka, Zambia


2. Background and setting The Churches Health
Association of Zambia (CHAZ) is an
interdenominational non-governmental
umbrella organisation of the 116 church health
administered health institutions in Zambia. It is
responsible for 30 of national and 50 of rural
health care in Zambia. CHAZ has been involved in
supporting member institutions in drug supply
management and promoting appropriate use for over
ten years. In all these CHAZ has been involved
in training activities, concerns have always been
raised on the use of antimicrobial agents for in
patients. Out patient drug use indicator studies
by various groups estimate that 80 of
outpatient prescriptions have at least one
antimicrobial agent prescribed (Chileshe et al
1998, O.Hazemba 1999). However, no studies have
been conducted in Zambia to look at antimicrobial
use for in patients. The Churches Health
Association of Zambia (CHAZ) decided to conduct a
study on in patient antimicrobial use in five
hospitals in the Eastern Province of Zambia. This
was done following reports of high
drug consumptions and increased drug expenditures
in mission hospitals due to inappropriate use .
To compare how mission hospitals were using AMDs
one government district hospital was included in
the study. The hospitals are located in rural
and semi-urban areas of the province.
1. Abstract ID 192 Author Name Kandeke C Email
kandeke_at_zamnet.zm Presenter Name Kandeke
C Authors Kandeke C, Chibuta C, Banda
D Institution Churches Health Association of
Zambia Title Impact of Medicine Management and
Rational Use Workshop on Use of Antimicrobial
Drugs in Five Hospitals in the Eastern Province,
Zambia Abstract Problem Statement
Antimicrobial drugs (AMDs) are the most
frequently prescribed therapeutic agents in
Zambia. Antimicrobial agents account for 50 to
80 of drug prescriptions. Stock outs may
jeopardize lives as they are necessary for the
treatment of most bacterial infections
inappropriate use can lead to the development of
resistance, adverse drug reactions, and waste of
scarce resources. Objectives To describe
antimicrobial drug prescribing practices in five
hospitals (four church affiliated and one
government in the eastern provine of Zambia to
compare antimicrobial use among the five
hospitals and to assess changes resulting from a
training workshop on the use of antimicrobial
drugs in the five hospitals. Design Before and
after study with no control group was carried out
in a sample of four mission and one government
hospitals using some of the MSH in-patient drug
use indicators. Setting and Population Four
church and one government hospital in the Eastern
Province using in-patient drug charts and case
notes. One hundred in-patient records were
randomly (simple random sampling) selected from
each hospital during baseline and post training
phases. Intervention A baseline study on
antimicrobial use was conducted using selected
Management Sciences for Health (MSH) indicators
in February 2003, followed by a training workshop
on antimicrobial therapy (with experiential
practical exercises at a hospital and a health
center) in March 2003. Participants included
medical doctors, clinical officers, pharmacy
technologists and nurses. A post training study
was then conducted six months after the
workshop. Outcome Measures Availability of a
key set of antimicrobial drugs average number of
days out of stock of hospitalizations with one
or more AMDs prescribed average number of AMDs
prescribed per hospitalization AMDs prescribed
consistent with the hospital formulary list
average duration of prescribed antimicrobial
treatment antimicrobials prescribed by generic
name of doses of prescribed AMDs actually
administered average duration of hospital stay
of patients on antimicrobial drugs number of AMD
sensitivity tests reported per hospital admission
including AMD treatment. Results Availability
of key AMDs on day of study decreased from 95 to
88.6. Average number of days out of stock
increased from 88 to 139 hospitalisations with
or more AMDs decreased from 65.7 to 62.5
average number of AMDs prescribed per
hospitalisation decreased from 1.6 to 1.5
prescribed consistent with formulary list
remained same (100) percentage of generic AMDs
prescribed increased from 55.7 to 65 percentage
of doses of AMDs actually administered increased
from 54 to 56 average duration of hospital
stay was reduced only one hospital admission
sensitivity test was conducted. Conclusions
Training workshop with experiential practical
exercises improved use of AMDs in most hospitals.
However, there were some outcomes that improved
only slightly ( of doses of prescribed AMD
actually administered) some were worse than the
baseline in some hospitals. Study Funding
Catholic Organization for Relief and Development
(CORDAID) in conjunction with Churches Health
Association of Zambia (CHAZ)

• 3. Study Objectives
• To describe antimicrobial drug prescribing
• practices in five hospitals (four church
  affiliated
• and one government in the eastern province of
• Zambia
• To compare antimicrobial use among the five
• hospitals
• To assess changes resulting from a training

• 5. Intervention
• The training was designed to address problems
  identified in
• the pre-training indicator study.
• The target group was health providers involved in
  prescribing,
• dispensing and administering antimicrobial drugs.
  These
• included medical doctors, clinical officers,
  pharmacy
• technologists and nurses.
• The training workshop lasted five days. Training
  methodology
• included lectures, group discussions, case
  studies and
• experiential field visits to nearby health
  facilities.
• Facilitators were from CHAZ secretariat and
  member
• institutions and was comprised of a pharmacist,
  medical
• doctor, nurse and a pharmacy technologist.
• A post training study was then conducted six
  months after
• the workshop.

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• 8. Results

• 6. Data collection
• Data was collected retrospectively. In both
  baseline and post
• training studies 100 in patient drug charts for
  2002 were
• randomly selected and examined for outcome
  measures of the
• study.
• 7. Outcome measures
• 1. Availability of a key set of antimicrobial
  drugs
• 2. Average number of days out of stock
• 3. Percentage of hospitalizations with one or
  more AMDs

  .
9. Summary Generally results show some
improvement in the use of Antimicrobial drugs
in most hospitals after training workshop.
However, there were instances where some
indicators actually deteriorated. For example
availability of key antimicrobials decreased
from baseline (there were logistical problems
at the Medical Stores) and others where there
was a very small improvement. The use of
laboratory for sensitivity testing was only done
in two cases at one hospital. Prescriptions for
Antimicrobial drugs were therefore written
empirically. Generally use of AMDs was better in
smaller hospitals than bigger ones.
10. Discussion Although results show some
improvement in the use of antimicrobials after
training, there could have been other external
factors other than the training that could have
affected the results. For example reduced
availability of key antimicrobials could have
influenced prescribing habits. However, other
indicators such as administration of doses
prescribed and generic prescribing could not
have been influenced by availability. It is
recommended that future studies be designed in
such a way that there are control groups.


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Acknowledgements The authors acknowledge the
Catholic Organisation for Relief and
Development (CORDAID) and the Churches Health
Association of Zambia (CHAZ) for funding this
study. Special thanks to Mr. Oliver Hazemba for
help with this work.