University of Khartoum

Assessment of the drug therapy for sexually transmitted diseases in the White Nile State

Assessment of the drug therapy for sexually transmitted diseases in the White Nile State

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Title: Assessment of the drug therapy for sexually transmitted diseases in the White Nile State
Author: Siddig, Mutasim
Abstract: The present study was carried out to assess the drug therapy for sexually transmitted diseases (STDs) in the white Nile state Sudan particularly Kosti, Rabak, Kenana and Asslaya cities and to determine their prevalence among total patients, sex and age groups. A descriptive cross-sectional health facility based study was conducted at the pre intervention period, then a comparative study was conducted 1 month after intervention. 20 out of 23 urban health centers where selected by simple probability method. 60 prescriptions written for STDs were collected from each center ( 3 0 prescriptions during the pre intervention collection period and 30 prescriptions during the 1 month post intervention collection period ). The reference chart prepared by federal ministry of health HIV/AIDS / STD national program is inappropriate , illogical and it should be reevaluated .Therefore, a recommended standard therapy program was established according to the global recommendations . The collected prescriptions were assessed against the established recommended therapy . The result of the preintervention study identified the following irrational prescribing practices : poor ability to select the appropriate drug therapy (10.7%), only ( 4.5 %) of them showedan appropriate doses and duration of therapy, low generic prescribing ( 32.5 %), high percentage of the collected prescription showed a polypharmacy ( 28.8 %), and a high possibility of drug - drug interaction (17.3 % ).When the result were compared to previous studies done in South Africa, India, Kampodia and Ghana the situation in the state seemed to be worse. A comparison of the generic prescribing of the present study and other studies done Pakistan and India itself showed that the generic prescribing at the study area was higher. The main reasons of the irrational prescribing practices was due to lack of pharmacotherapeutic knowledge particularly medical assistants, which is similar to the conclusion of a study done in Lithuania. Selection of the appropriate drug therapy was significantly increased in both audits plus feedback + face to face discussion group (3.3 % VS 45.3 % ) and seminar group (6.7 % VS 46.7 %), but it was insignificantly increased in the control group (8 % VS 9.3 %) and audits plus feedback group (24.7 % VS 28 %), appropriate doses and duration of therapy was significantly increased in the three interventions method audits plus feedback group (13.3% VS 23.3%), face to face discussion group (2 % VS 36.7 %) and seminar group (2 % VS 33.3%), while it was insignificantly decreased in the control group (0.7 % VS 0 %). Polypharmacy was significantly decreased in face to face discussion group (14 % VS 2.7 %), significantly increased in the seminar group (25.3 % VS 46.6 %), insignificantly increased in audits plus feedback group (40 % VS 41 %) and it was insignificantly decreased in the control group (35.3 % VS 28 %). The result showed a significant increased in the generic prescribing of the two combined intervention method (43.3 % VS 61.3 %) in the seminar group and (29 % VS 44.7 %) in face to face discussion group, while it was significantly decreased in both audits plus feedback group ( 2 4 %VS 8 .7 %) and the control group (36.7 % VS 22 % ). Drug - drug interactions was significantly decreased in the two combined intervention method (20 7 % VS 15.3%) in the seminar group and (23.3 % VS 4.7 %) in face to face discussion group, while it was significantly increased in both audits plus feedback group (9.3 % VS 23.3 %) in the control group (17.3%VS 26.7%). The results revealed a significant improvement of selecting appropriate drug therapy by both medical officers (26.3 % VS 48.5 %) and medical assistants (6.3 % VS 63.3 % ), also the results of medical officers showed a significant worsening of polypharmacy (6.8 % VS 19.9 %), generic prescribing (44.1 % VS 25.7 % ), while a significant improvement of polypharmacy (33.7 % VS 15.9 %) and generic prescribing (24.4 % VS 41.7 %) was revealed by the results ofmedical assistants. Appropriate doses and duration of therapy was significantly improved in the results of medical assistants (0% VS 33.4 %), while an insignificant improvement was detected in the results of medical officers (22% VS25.7 %). Also the results of medical officers showed an insignificant increase of drug - drug interactions (20.3 % VS 25.4% ), while it was insignificantly decreased in the results of medical assistants (14.5% VS 11.8%). A significant worse prescribing practices except generic prescribing were detected in the results of the prescibers who attended a pervious workshop about STDs when they are compared to the prescribing practices of those who did not attended such workshop, appropriate drug therapy (1.6 % VS 13 %), appropriate doses ( 0 % VS 5.6 %), generic prescribing (55 % VS 26.8 % ), polypharmacy (42.6 % VS 25.3 % ) and drug - drug interaction (36.9 % VS 12.3 %) this is due to the inappropriate reference chart prepared by ministry of health .An audits plus feedback intervention was less effective than the combined intervention methods, both seminar and face to face discussion were equally effective in improving prescribing practices . The prevalence of STDs among total patients attending the health centers during the two collection periods was (2.2 % ), STDs were significantly high among females (78.8 % ), vaginal discharge was significantly the most prevalent STD syndrome (62.3%) the age group 15-29 years was significantly the most affected group and Kenana health centers showed the highest prevalence of STDs (3.6%) than the others cities Kosti(2 %), Rabak (1.9 %) and Asslaya (1.3%).
Description: 149 Pages
URI: http://hdl.handle.net/123456789/8052
Date: 2015-04-01


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