The Economic costs associated with
Irrational Prescribing in children:
Implications for reducing Childhood
Mortality in South east Nigeria
BSC UZOCHUKWU, OE ONWUJEKWE, NWOBI EA,
EZEOKE U, CHUKWUOGO OI
HEALTH POLICY RESEARCH GROUP, COLLEGE OF
MEDICINE, UNIVERSITY OF NIGERIA, ENUGU-CAMPUS
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
BACKGROUND
In Nigeria, Malaria, ARI and DD are responsible
for majority of childhood diseases
 These diseases are preventable or treatable
with low cost drugs bought mainly from Patent
Medicine Sellers (PMS) who are the primary
source of drugs in rural and urban Nigeria.
 A large proportion of a family’s OOPEs on
health care is on drugs in Nigeria

Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
BACKGROUND
PMS are preferred because of lower cost and
flexible pricing policies.
 Most PMS are unaware of the correct dosages
and duration of treatment leading to irrational
prescribing.
 Little has been reported on the economic costs
associated with inadequate drug prescribing for
childhood illnesses by these PMS in Nigeria.

Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
OBJECTIVES
To assess the economic costs of inadequate
drug prescribing by Patent Medicine Sellers for
malaria, ARI and DD in urban Nigeria
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
METHODOLOGY
Exit interviews with 395 caregivers who sought
care for their children from all the 45 PMS in
Abakpa district of Enugu east LGA, Enugu state,
south east Nigeria
 Information collected: Respondents’ & patients’
profile, umber and type of drugs
prescribed/bought and for which disease and
whether they had a prescription or not
 Fever for malaria; Cough & difficulty in breathing
for ARI and Watery stool for DD.

Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
METHODOLOGY

Each treatment episode was analyzed based on
the symptoms reported by the caregiver and the
prescription/treatment provided at each episode.

These episodes were assessed by the researchers
who are all medical doctors in the University of
Nigeria teaching hospital

The Nigerian standard treatment guideline for
Malaria, ARI and DD were used to determine the
adequacy of prescribing.
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
METHODOLOGY
For each of the prescriptions/treatment provided,
the variables collected were the
 average number of drugs prescribed per
encounter
 average percentage of prescriptions with injections
 average percentage of prescription with one or
more antibiotics
 percentage of prescription with essential drugs
 Average cost of drugs per prescription
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
METHODOLOGY
The difference between the average cost of the
standard treatment and the drugs purchased was
regarded as the additional cost
 50 patients who had irrational prescribing were
followed up after 2 weeks to determine further
costs incurred as a result of the illness
(consultation fees, drugs, transport and the cost
equivalent to the working days lost due to illness)
 Market price was used to cost the drugs
 Data analysis was with EPI-Info and Excel

Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
RESULTS
Variables
N (%) N= 395
Sexof
). respondent (Female)
365 (92.4)
Years of education of respondent: Mean (SD) 9.5 (3.6)
Age of respondent (years): Mean (SD)
34.1 (6.5)
Age of ill person (years): Mean (SD)
3.8 (1.7)
Sex of ill person (Female)
249 (63.0)
% Had a prescription
85 (21.5)
% received treatment for malaria
% received treatment for DD
316 (80.0)
47(12.0)
% received
treatment for ARI
32 (8.0)
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
RESULTS
Drug use indicators
The average number of drugs per prescription
Average percentage of prescription with
injections
Average percentage of prescription with one or
more antibiotics
Percentage of prescription with non essential
drugs
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
6.8
72.5
59.7
45.9
RESULTS
Variables
Additional costs to the standard
treatment (Naira): Mean (SD)
Malaria
ARI
DD
Losses attributable to irrational
prescribing/patient (Naira): Mean (SD)
255 (164.5)
350 (201.6)
175 (93.5)
4,500 (1,950)
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
CONCLUSION & RECOMMENDATIONS

An average of 6.8 drugs per prescription,
average percentage of prescription with
injections of 72.5% and 59.7% of prescription
with one or more antibiotics is clearly irrational
and wasteful
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
CONCLUSION & RECOMMENDATIONS
More than half of the drugs were on essential
drug list, implying some cost savings for the
consumers.
 But the high 6.8 drugs on average/prescription
is likely to increase the total cost of prescription
and therefore cancel out the cost savings to
consumers arising from prescribing essential
drugs

Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
CONCLUSION & RECOMMENDATIONS
Irrational prescribing imposes unnecessary
cost on health care users especially the poor
who are the ones more prone to these diseases
 Training the PMS in rational drug prescription is
advocated so as to improve the quality of drug
prescription and hence reduce the cost of
treatment to caregivers.
 Necessary to achieve the MDG goal of reducing
infant mortality in Nigeria by the year 2015.

Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009
Inaugural Conference of the African Health Economics and Policy Association (AfHEA)
Accra - Ghana, 10th - 12th March 2009