2.1 Study Setting and Period
The study was carried out at the Medical Ward of the Bedele General Hospital, which is 480 kilometers from Finfinne (Addis Abeba), capital city of Ethiopia and is located in the Buno Bedele Zone of Bedele Town in South-West Oromia, Ethiopia. The town has one public hospital, one health center and few private medium clinics. Around 450,000 individuals are served by Bedele general Hospital and within Bedele general Hospital; there are numerous wards and clinics, including a medical ward, a surgery ward, a pediatric ward, a genecology and obstetrics ward, an Antenatal care (ANC) clinic, dental clinics, tuberculosis (TB) clinic, and an anti-retroviral therapy (ART) clinic. The study was carried out from July 1 to December 30, 2021.
2.2 Study Design
A retrospective cross-sectional study design was employed.
2.3 Population
2.3.1 Source Population
Every patient's medication history who took ceftriaxone while being treated in the medical ward at Bedele General Hospital
2.3.2 Study population
Medication histories of patients who were hospitalized at Bedele General Hospital between July 1 and December 30, 2021, and who took ceftriaxone
2.4 Sample size determination and Sampling technique
The sample size determined using the following formula:
Where: n= sample size
p=prevalence of Ceftriaxone prescribing
d=margin of sampling error tolerated.
z=the standard normal value at confidence interval of 95%
n= (1.96)2(1-0.5)0.5/(0.05)2
n= 3.84(0.5)0.5/0.0025, n= 0.96/0.0025, n= 384. The sample size has been changed because the population size for the aforementioned sample was less than10,000 which is 380.
nf = n/ (1+ (n/N)) nf = 384/ (1+ (384/380)), nf= 193
Where; nf =final sample size; N=source of population and we took 10% of 193 as a contingency number. Finally, 212 patient cards in total were determined to constitute the study's sample size.
To choose representative members of the population for this study, a systematic random sampling technique was used and sampling began by isolating medication chart that contained ceftriaxone for the time period of July 1, 2021, to December 31, 2021. As part of the sampling frame, 380 medication chart documents in total had been acquired. Then each tallied card was coded chronologically and by dividing the entire number of medication chart (380) by the total number of patient medication records needed for the study (212), a sampling interval of two was determined. Next, the first sample was initiated by randomly selecting and following that, the remaining samples were chosen using the interval of 2.
2.5 Inclusion Criteria and Exclusion Criteria
2.5.1 Inclusion Criteria:
➣ Patients admitted to medical ward and who were prescribed ceftriaxone.
➣ Patients above the age of 18 who have been admitted to the medical ward and took ceftriaxone.
2.5.2 Exclusion Criteria:
Patients who received ceftriaxone and were admitted to any other ward (including pediatrics, surgery, emergency, and gynecology), as well as patients with incomplete records
2.6 Study Variables
2.6.1 Independent variables.
Patient parameters (age, medication category, number of drugs taken, disease, co-morbidity), treatment dosage, frequency, length of hospital stay and diagnosis are independent variables.
2.6.2 Dependent variable
Ceftriaxone use
2.7 Data Collection Method and Data collectors
Data was collected by 2 trained pharmacists under supervision of the investigators and through patients’ medical chart review by using patient data abstraction tool. The content of the data collection tool was designed to record patient information, disease condition, working diagnosis, information regarding administration of ceftriaxone including its indication, dose, frequency of administration, duration of therapy, and information regarding co- administered medications. Five criteria, namely indication for use, dose, frequency of administration, duration of treatment, and drug interaction were used to evaluate appropriateness of ceftriaxone utilization based on the prepared protocol.
2.8 Data Quality Control
Every day, collected data was checked for accuracy and consistency before being processed and analyzed. Although the data collectors received training at the beginning, ongoing supervision and support were provided throughout the data gathering period to guarantee consistency and accuracy.
2.9 Data Processing and Analysis
The data was manually processed and evaluated using the predetermined criteria for evaluating drug use in comparison to Ethiopia's national standard treatment guidelines (STG) for general hospitals and the World health organization( WHO) guidelines for the management of common illnesses[20-22]. In this study, Ceftriaxone was assessed using a predetermined set of criteria, including dose, duration, frequency, and indication.
2.10 Ethical Consideration
The ethical clearance was obtained from department of pharmacy, College of Health sciences Mattu University and support letter was delivered to Bedelle General Hospital. Permission was secured from the hospital before conducting the data collection.