This study looked at 2,192 medicines that were prescribed on 1,200 prescriptions. As per the findings of this study, the average number of medications ordered per prescription from the private health sector in Addis Ababa was 1.83. This is slightly higher than the standard comparison (1.6–1.8).6 This result is consistent with two prior studies that conducted systematic reviews at the country level in Ethiopia and found that the pooled number of drugs per prescription exceeded WHO standards, accounting for 1.96 and 2.14, respectively, Ayenew et al20 and Bahiru et al.21 respectively. Poly-pharmacy was also recorded in the city as well as different parts of the country, according to study setting specialized studies. In Tikur Anbesa Specialized Hospital (TASH) in Addis Ababa, for example, the average number of medicines per prescription was found to be 1.89 (SD = 1.16).22 According to the investigations, per prescription amounts of (1.9)8,(2.34)23,(2.2)24,(2.13)25 were reported in Ethiopia's southern, eastern, northern, and south-west regions, respectively. The presence of polypharmacy in the country may indicate a constraint in prescribers having appropriate therapeutic training, variation in the health care delivery system, differences in socioeconomic profiles, as well as morbidity and mortality characteristics of the population, despite the fact that the factors have not yet been investigated.8 In this study, clinics are more likely to prescribe more medication per patient (P = 0.026) than hospitals.
The percentage of medications prescribed by generic name in the private health sectors evaluated was substantially below the standard average, at 65.3% (100%).6 However, according to various Ethiopian studies, generic drugs make up more than 90% of Ethiopian prescriptions. In Ethiopian public facilities, for example, the percentage of pharmaceuticals administered by generic name was found to be 93.5% (89.13–97.96%).21 Similarly, studies from public facilities in Addis Ababa (88.5%)26 and among regions such as 90.61% in eastern Ethiopia23, 98.7% in Hawassa8, 97 % in selected health facilities in eastern Ethiopia24, and 88%, 88.5%, and 77.3% in North-west27, South-west19, respectively also showed higher percentages than the current study. Similarly, according to studies conducted in Ethiopia's southwest region, participants stated that brand prescribing has certainly grown.8,19 The higher score of public sectors could indicate that the public health sector receives medication from the Ethiopian Pharmaceutical Supply Agency (EPSA), which purchases more generic pharmaceuticals.28 However, the lower rate of generic prescriptions from private health sectors in the current study could be due to a variety of factors. For example, there is no policy requiring private health care providers to purchase from public suppliers, which could lead to prescribers being influenced by factors such as the prescriber's personal characteristics, the cost of the medicine, and the marketing and promotion of importers and pharmaceutical companies.29
The percentage of prescriptions containing antibiotics was 63.8% in this study, approximately three times the WHO limit (20–26.8%).6 Similarly, Ethiopian public health institutions also show a high prevalence of antibiotic prescription, despite the fact that it is lower than the findings of this study.8,20,21,25,30 Antibiotics may be prescribed excessively for a variety of reasons. Various studies have found that Ethiopia has a high frequency of infectious illnesses31, as well as a lack of adherence to treatment protocols21 and a disparity in health professional understanding.32 Antimicrobial resistance is also on the rise, and there have been instances of hospitalization and mortality as a result of it.33 As a result, it is possible that Ethiopia's antimicrobial resistance danger is being exacerbated by over prescription of antibiotics. Antibiotic resistance has a considerable impact on medicine accessibility and healthcare financing in Ethiopia because of the high prevalence of poverty and limited resources.34
In the current study, the proportion of encounters in which injections were issued was 11.5%, which is significantly lower than the WHO criterion (13-24.1%).6 Ethiopian injection use is likewise below the standard, according to the combined results 18.3%, 13.2% of Ayenew et al20 and Bahiru et al.21 respectively. There has also been a global drop in injection usage. Professional and patient-related intervention efforts are amongst the most regularly mentioned factors.35 In Ethiopia, patients have a lower preference for injection dosage forms due to concerns about contamination and the belief that other dosage forms are equally effective. Injections, on the other hand, were preferred by health professionals for certain conditions including as pneumonia, tuberculosis, and urinary tract infections.36 In this study, there was a statistically significant correlation (P = 0.000) between private hospitals and clinics providing injections. This could indicate that the lower prevalence of injections in the private sector is linked to a commitment to their clients' demands. The lower incidence of therapeutic injection prescribing is recommended since it lowers the danger of infection via the parenteral route as well as the cost of treatment.37
In the present study majority of drugs 1,730 (78.9%) in the private health, sectors were from national EDL however, lower than the WHO standard (100%).6 however, The current study was lower similar studies done in public health sectors in Ethiopia.8,20,21,25. The highly adherence to EDL of prescribing from both public and private could be due to the imported drugs are being well controlled by the Ethiopian Food and Drug Administration (EFDA) to assure their registration on the EDL.38 These could result in the better availably of essential drugs in the Ethiopian market so prescribers most likely prescribed those medicines. In the contrary, the lower adherence in private sectors might be critical since, compliance with the list of essential medicines is one of the key tools for a stable health care delivery system, as it ensures the availability and affordability of quality medicines at all care providers thereby promotes the rational use of medicines.39,40
In this study, patients' full names, ages, and sexes were mentioned in 99%, 95.3%, and 96.3% of prescription papers, respectively. The card number (54.3%) and weight of the patient (2.3%) were similarly poorly adhered to in this investigation. Similarly, age and sex were well-presented in study conducted in governmental facilities of South-Eastern Ethiopia, which revealed that age, sex, and card number were not mentioned in 18.2%, 23.7%, and 60.2% of the encounters, respectively.25 This means that the majority of prescribers use the patient's name rather than a card number when prescribing a medicine, but TASH in Addis Ababa, Ethiopia, does the opposite.22 Therefore, the observed difference between private and government health facilities may be related to the burden flow of clients, which caused them to lean toward what was easiest to provide the service.
The treatment information, such as drug name, strength, dose, frequency, duration, and how to use, revealed that 85 to 99% of the prescriptions evaluated were adhered to. In this study, however, prescribers were less likely to complete out dosage forms (35.5%) and diagnoses (31.7%). Similarly, public healthcare facilities reported percentage variability that was lower than the standard (100%)8,16,41−43 Medication errors, drug-related adverse events, and therapeutic failure may occur when medications are dispensed with insufficient labels6. As a result, practitioners are required to be enforced to label each and every drug given to patients.
In terms of this prescriber’s information, only 36.6% and 25.8% of prescribers wrote their name and qualification, respectively. While a higher percentage of prescriptions 79.8%, 94% were filled with their day of prescriptions and signatures, respectively, to ensure they took responsibility for any responsibilities. Only 27 (2.3%) and 73 (6.1%) of prescribers (P = 0.127) met all of the characteristics in their information from the hospital and clinic, respectively. Prescriptions in the public sector, on the other hand, scored differently than those in the private sector. According to Admassie et al, 33.4%, 96.7%, 72.6% and 16.1% of prescriptions have the prescriber's name, signature, date, and qualification.44 Furthermore, in another investigation, the name of the prescriber was found in 82% of the prescriptions examined.45 The disparity across both sectors could imply a difference in perceptions of the value of prescribing information. Furthermore, because of this poor practice, identifying the accountable prescriber for any feedback or explanation is challenging. Moreover, this study revealed, obtaining prescription papers with the full name, qualification, date of dispensing, and signature of the dispenser is extremely difficult; only 9.1%, 1.3%, 0.7%, and 26.8% of dispensed prescriptions contained such information, respectively. Interestingly, no dispenser filled out all of this information in a single prescription. However, in the pediatric emergency unit of a tertiary hospital in Lagos, Nigeria, for example, the dispensers placed their signature following a refill in 92.1% of prescriptions.42 Because the type and contents of the prescriptions used by the practitioner differed, the preparation and execution of standard prescriptions in all departments and units of the hospital was critical. Due to the relevance of rational drug use and private sector practice in Ethiopia; health practitioners must be given with regulatory interventions and strategies, close monitoring from concerned bodies, and regular training on proper prescribing and dispensing practice to encourage rational drug use is required in our context.
Limitation of the study
There are some drawbacks to this study. These limitations, however, do not invalidate the study's findings because all of the WHO-recommended procedures were used. Despite the fact that this study attempted to cover all of the WHO core drug use and prescription indicators, the smaller sample size of completeness and prescription pattern indicators, as well as the study's limited scope, may limit the generalizability of these specific components to the general population. Because to financial constraints and the current pandemic (COVID-19), we have chosen to limit it to only eight drug outlets. Multi-institutionally and sampling approaches could help to overcome the limitation in generatability. This study, on the other hand, provided useful information on the private sector's practice of prescribing and dispensing patterns.