Systematic review and meta-analysis of medicine use studies in Ethiopia using the WHO patient care indicators with an emphasis on the availability of prescribed medicines

Abstract

Objective: To collate the findings of studies on patient care indicators in Ethiopia using the WHO/International Network for Rational Use of Drugs indicators with a focus on the availability of medicines to patients.

Design: Systematic review and meta-analysis.

Data sources: Embase, Global Index Medicus, Google Scholar, Medline (via PubMed) and Web of Science.

Eligibility criteria: Medicine use studies employing the WHO patient care indicators across health facilities in Ethiopia.

Data extraction and synthesis: Descriptive summary of the indicators and a random-effects meta-analysis were performed for quantitative synthesis of findings on the percentage of medicines actually dispensed. Meta-regression was performed to assess the moderator effects of different attributes of the studies.

Results: A total of 25 studies conducted in 155 health facilities with 11 703 patient exit interviews were included. The median value of average consultation time was 5.1 min (25th-75th: 4.2-6.6) and that of average dispensing time was 78 s (25th-75th: 54.9-120.0). The median percentage of medicines with adequate labelling was 22.4% (25th-75th: 5.6%-50.0%). A concerning trend of decreasing dispensing times and adequacy of labelling were observed in more recent studies. The median percentage of patients with adequate knowledge of dosage schedules of medicines was 70.0% (25th-75th: 52.5%-81.0%). In the meta-analysis, the pooled estimate of medicine availability was 85.9% (95% CI: 82.1% to 89.0%). The multivariable meta-regression showed that geographical area and quality of study were statistically significant predictors of medicine availability.

Conclusion: Short consultation and dispensing times, inadequate labelling, inadequate knowledge of patients on medicines and suboptimal availability of medicines were identified in health facilities of Ethiopia. Studies aimed at further exploration of the individual indicators like problems of inadequate labelling and patients' knowledge of dispensed medicines are crucial to determine the specific reasons and improve medicine use.

Prospero registration number: CRD42020157274.

Keywords: clinical governance; health policy; health services administration & management; infection control; protocols & guidelines; quality in healthcare.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of the study selection procedure.

Figure 2

Forest plot of percentage of actually dispensed medicines across the studies. FMHACA, Food Medicine and Healthcare Administration and Control Authority; PFSA, Pharmaceuticals Funding and Supply Agency.

Figure 3

Funnel plot (using SE).

Figure 4

Funnel plot (using sample size).

Figure 5

Forest plot of percentage of actually dispensed medicines by health facility type. FMHACA, Food Medicine and Healthcare Administration and Control Authority; PFSA, Pharmaceuticals Funding and Supply Agency.

Figure 6

Forest plot of percentage of actually dispensed medicines by administration. FMHACA, Food Medicine and Healthcare Administration and Control Authority; PFSA, Pharmaceuticals Funding and Supply Agency.

Figure 7

Forest plot of percentage of actually dispensed medicines by year of study. FMHACA, Food Medicine and Healthcare Administration and Control Authority; PFSA, Pharmaceuticals Funding and Supply Agency.

Figure 8

Bubble plot of percentage of actually dispensed medicines by year of study.

Figure 9

Forest plot of percentage of actually dispensed medicines by geographical area. FMHACA, Food Medicine and Healthcare Administration and Control Authority; PFSA, Pharmaceuticals Funding and Supply Agency.