The drug use pattern and the quality of care were assessed in 80 public sector facilities throughout rural Bangladesh. A total of 40 thana health complexes and 40 union subcentres, the lowest level in primary health care facilities, were selected at random. A total of 2880 prescriptions, consultations, and drug-dispensing practices were studied, and the availability and use of essential drugs and of the essential drugs list were recorded. The average consulting time (54 seconds), the proportion of adequate examinations (37%), and prescription of drugs according to standard treatment guidelines (41%) were unsatisfactory. The mean number of drugs prescribed per patient was 1.44; 25% were treated with antibiotics, and 17% with metronidazole, irrespective of the diagnoses. The availability of drugs (54%) and the presence of an essential drugs list (16%) in the health facilities were low. However, 78% of the drugs were prescribed by their generic names, 85% complied with the essential drugs list, and 81% were dispensed according to prescription. The average dispensing time (23 seconds) and the proportion of patients who correctly understood the dosage (55%) were poor.
PIP: A nationwide survey was undertaken in Bangladesh to determine current treatment practices for the 6 most common diseases seen in outpatient clinics. Assessment was made of patient care in terms of history-taking, physical examination, and time devoted to each patient; of the drug dispensing process in terms of time taken and whether drugs were properly dispensed; of patient's knowledge of how to take the drugs; of the availability of 12 essential drugs on the survey date; and of the availability of an essential drugs list. The 6 diseases were watery diarrhea, dysentery with blood, helminthiasis, pneumonia, acute respiratory tract infections, and scabies. The health units analyzed were 10 Thana Health complexes (THCs) and 10 union subcenters (USCs) from each of the 4 administrative divisions in the country. Retrospective data were examined for September 1991 to August 1992. Prospective data were collected through observations and exit interviews with patients. It was found that the average consultation time in the THCs (60 seconds) was significantly greater than that in the USCs (48 seconds). Significantly more patients were sufficiently examined in the THCs than in the USCs, but the quality of care was found to be inadequate in each type of facility. Standard treatment guidelines were followed for only 41% of the patients, with no statistically difference between type of facility. The mean number of drugs prescribed per patient was 1.44. 25% of the patients were treated with antibiotics, and 17% with metronidazole, regardless of the diagnoses. The availability of drugs (54%) was low, and only 16% of the facilities had an essential drugs list. However, 78% of the drugs were prescribed by generic name, 85% complied with the essential drugs list, and 81% were dispensed according to prescription. The average dispensing time (23 seconds) and the proportion of patients who understood the dosage (55%) were poor. This survey was the largest to examine compliance with the World Health Organization/International Network for the Rational Use of Drugs guidelines on drug use. These findings are likely representative of the use of drugs in the public health system in rural Bangladesh. Similar surveys should be undertaken to cover the private health sector, to monitor inpatient prescribing and care, and to investigate the drug use pattern in the medical colleges and teaching hospitals.