Field tests for rational drug use in twelve developing countries

Lancet. 1993 Dec 4;342(8884):1408-10. doi: 10.1016/0140-6736(93)92760-q.


Increasing efforts are being made to improve drug-use practices and prescribing behaviour in developing countries. An essential tool for such work is an objective and standard method of assessment. We present here a set of drug-use indicators produced and tested in twelve developing countries. We describe practical applications, which include the use of indicators to increase awareness among prescribers in Malawi and Bangladesh, to identify priorities for action (eg, polypharmacy in Indonesia and Nigeria, overuse of injections in Uganda, Sudan, and Nigeria, and low percentage of patients who understood the dosage schedule in Malawi), and to quantify the impact of interventions in Yemen, Uganda, Sudan, and Zimbabwe.

PIP: A set of drug-use indicators produced and tested in 12 developing countries and the recommended method for data collection are presented to improve drug use and prescribing behavior. The International Network for the Rational Use of Drugs in collaboration with the WHO Action Program on Essential Drugs undertook a project to develop and field-test a set of basic drug-use indicators. The method for collecting the data was first tested in Indonesia, Bangladesh, and Nepal; other tests took place in Guatemala, Malawi, Nigeria, Tanzania, and well as in Ecuador, Sudan, and Zimbabwe. In results from 12 developing countries, drug-use patterns were ascertained. The average numbers of drugs per encounter were high in Indonesia and Nigeria (3.3 and 3.8); the prescriptions of 1 or more antibiotics were also high in Uganda and Sudan (56% and 63%), similar to injectable drugs in Uganda, Sudan, and Nigeria (36-48%); and the availability of essential drugs was low in Ecuador (38%). 94% of drugs were prescribed by generic name in Zimbabwe, whereas only 37% were in Ecuador. In Yemen the comparison of an essential drugs project area to a control area demonstrated 1.5 and 2.4 drugs per encounter, 46% and 67% of them antibiotics and 22% and 45% of them injections, respectively. In Uganda, a study on the effect of training showed decline in the use of injections (50% to 41%), improvement in the use of oral rehydration treatment for diarrhea (52% to 89%), and reduction in antidiarrheal drug use (60% to 39%). In rural health facilities in Sudan the drugs prescribed by generic name increased from 17% to 70% between 1989 and 1991. In 10 developing countries the average number of drugs per prescription for general outpatient encounters ranges from 1.3 to 2.2., but in Indonesia and Nigeria it is 3.3 and 3.8. The median of 41% of antibiotics prescribed in the 12 countries reflects actual prescribing, not optimum values.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Developing Countries*
  • Drug Prescriptions / statistics & numerical data*
  • Drug Therapy / standards
  • Drug Utilization / standards
  • Drug Utilization / statistics & numerical data*
  • Drug Utilization Review / methods*
  • Humans
  • Practice Patterns, Physicians' / statistics & numerical data*