Adverse Drug Events and Medication Errors in African Hospitals: A Systematic Review

Abstract

Background: Medication errors and adverse drug events are universal problems contributing to patient harm but the magnitude of these problems in Africa remains unclear.

Objective: The objective of this study was to systematically investigate the literature on the extent of medication errors and adverse drug events, and the factors contributing to medication errors in African hospitals.

Methods: We searched PubMed, MEDLINE, EMBASE, Web of Science and Global Health databases from inception to 31 August, 2017 and hand searched the reference lists of included studies. Original research studies of any design published in English that investigated adverse drug events and/or medication errors in any patient population in the hospital setting in Africa were included. Descriptive statistics including median and interquartile range were presented.

Results: Fifty-one studies were included; of these, 33 focused on medication errors, 15 on adverse drug events, and three studies focused on medication errors and adverse drug events. These studies were conducted in nine (of the 54) African countries. In any patient population, the median (interquartile range) percentage of patients reported to have experienced any suspected adverse drug event at hospital admission was 8.4% (4.5-20.1%), while adverse drug events causing admission were reported in 2.8% (0.7-6.4%) of patients but it was reported that a median of 43.5% (20.0-47.0%) of the adverse drug events were deemed preventable. Similarly, the median mortality rate attributed to adverse drug events was reported to be 0.1% (interquartile range 0.0-0.3%). The most commonly reported types of medication errors were prescribing errors, occurring in a median of 57.4% (interquartile range 22.8-72.8%) of all prescriptions and a median of 15.5% (interquartile range 7.5-50.6%) of the prescriptions evaluated had dosing problems. Major contributing factors for medication errors reported in these studies were individual practitioner factors (e.g. fatigue and inadequate knowledge/training) and environmental factors, such as workplace distraction and high workload.

Conclusion: Medication errors in the African healthcare setting are relatively common, and the impact of adverse drug events is substantial but many are preventable. This review supports the design and implementation of preventative strategies targeting the most likely contributing factors.

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses flow diagram of the selection of eligible studies. ADR adverse drug reaction

Fig. 2

Graph showing origin of included studies. * one study from Ethiopia and two studies from Morocco gave data for both adverse drug events (ADEs) and medication errors (MEs), and counted as independent studies in this figure

Fig. 3

Graph showing the extent of the prescribing error rate in African hospitals. Light bars indicate total medication orders used as denominators for error calculation. Solid bars indicate total prescriptions used as denominators for error calculation

Fig. 4

Graph illustrating the percentage of prescriptions or medication orders or medication administrations with dosing errors in African hospitals. Light bars indicate the study used the total number of medication orders as a denominator to calculate dosing errors. Solid bars indicate the total number of prescriptions and white bars indicate the total number of medication administrations as denominators for dosing errors