Appropriateness of drug prescriptions among children on treatment for Tuberculosis at Kenyatta National Hospital, Nairobi-Kenya

Abstract

Background: Tuberculosis is an ancient disease. It contributes significantly to the burden of disease in today's world. Globally, tuberculosis (TB) accounts for an estimated 9.4 million cases and 2 million deaths per year. Of the cases, one million occur in children. The disease can be cured in 6 months if the proper chemotherapeutic agents are provided. The management of tuberculosis in Kenya is guided by the National guidelines developed after consideration of internationally recognized recommendations. A continuous audit of the practice of the healthcare personnel involved in the management of the disease is paramount to maintaining provision of quality health care to the patients. Objective: To determine the proportion of inappropriate prescriptions for the children on treatment for tuberculosis at Kenyatta National Hospital Methodology: This was a hospital based cross sectional audit of the treatment records of children admitted in the general paediatric wards of Kenyatta National Hospital. Consecutive sampling was done till the sample size of 96 was achieved. The sample size of 96 was estimated using the Fischer's formula, assuming a precision of 0.10 and expected prevalence of inappropriateness of 50%. All patients aged 13 years and below whose parents/ guardians gave consent for participation in the study were recruited. Results: Out of the 97 patients whose treatment records were analyzed, only 19 (19.6%) had the formulation of fixed dose anti-tuberculous drugs specified as either adult or paediatric. Similarly, when the dosage in mg/kg was calculated, only 19 (19.6 %) of the patients had correct dosage for all individual drugs in the fixed dose tablets prescribed. Thus 80.4% of the patients received inappropriate dosage. The inappropriateness of the dosing was not influenced by the age or the severity of the patient's disease. However, when the four general paediatric wards were compared, i.e., wards 3A, 3B, 3C and 3D; one ward, 3B was found to have performed significantly better than the others, p-value 0.038. Conclusions: Majority, 80.4%, of the prescriptions done for the paediatric patients on treatment for tuberculosis at Kenyatta National Hospital general paediatric wards are inappropriate. Recommendations: A study should be done to establish the factors that contribute to the large proportion of inappropriateness in the prescriptions for TB among the children at KNH. Once identified, efforts should be put in place to correct them, thus improving the care of children on treatment for TB at KNH.