Assessment of Prescription Practices at the Kapenguria County Referral Hospital General Outpatient Clinics

Abstract

Introduction: Improving medical treatment standards is essential in low—and middle-income countries (LMICs), necessitating performance reviews to assess care quality. Drug utilization studies emphasize using medications following World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD) guidelines. This study aimed to assess prescription practices at Kapenguria County Referral Hospital (KCRH) using WHO drug use indicators. Methods: A retrospective cross-sectional design was adopted, analyzing 1,200 prescriptions dispensed at the KCRH outpatient pharmacy from January 1 to December 31, 2022. Data were collected using a WHO/INRUD-based tool to evaluate prescribing patterns and facility indicators. Core drug-use indicators were determined and summarized using frequencies, percentages, and means. Bivariate and multivariate logistic regression analyses identified factors associated with antibiotic prescriptions and polypharmacy. Results: Of the 920 prescriptions reviewed, 69.2% were for adults, and 57% were for females. The most prescribed drug classes were analgesics 819 (32.3%), antibiotics 736 (29.0%), and gastrointestinal drugs 459 (18.1%). Amoxicillin 238 (25.9%) and amoxicillin-clavulanate 205 (22.4%) were the most frequently prescribed antibiotics. Most prescribers were female, 474 (51.5%), and clinical officers comprised 93.3%. WHO prescribing indicators revealed deviations from optimal values: 84.1% of prescriptions contained antibiotics, 8.7% contained injectables, 97.6% of drugs were prescribed by generic name, and 95.6% were from the Kenya Essential Medicines List. The average number of drugs per prescription was 2.7 (SD 1.0). Males had a 46% reduced risk of antibiotic prescriptions compared to females (aOR: 0.556, 95% CI: 0.371, 0.833), and patients with more than five drugs or without injection encounters had reduced odds of antibiotic prescriptions. Polypharmacy was significantly higher among male prescribers. Conclusion: These findings highlight the need for interventions promoting rational antibiotic use and prescribing practices through education and adherence to WHO guidelines