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Drug utilization pattern during pregnancy in Nekemte referral hospital: a

cross sectional study

Article  in  International Journal of Scientific Reports · August 2016

DOI: 10.18203/issn.2454-2156.IntJSciRep20162809

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International Journal of Scientific Reports
Asfaw F et al. Int J Sci Rep. 2016 Aug;2(8):201-206
http://www.sci-rep.com pISSN 2454-2156 | eISSN 2454-2164

DOI: http://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20162809
Research Article

Drug utilization pattern during pregnancy in Nekemte referral hospital:

a cross sectional study
Fanaye Asfaw1, Mekdes Bekele2, Shemsiya Temam3, Musin Kelel1*
1
Department of Biotechnology Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
2
Shool of pharmacy, Wollega University, Nekemte, Ethiopia
3
Department of Biomedical sciences, school of medicine and health sciences, Arsi University, Ethiopia

Received: 23 June 2016

Accepted: 11 July 2016

*Correspondence:
Mr. Musin Kelel
E-mail: [email protected]

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Pregnancy is a period of great physiological changes to the mother and fetus in which every
malfunction of the body as the result of drug use may lead to serious consequences in both. It is a period that demands
special care to the health care service providers. Therefore, the objective of this project is to conduct across sectional
study on drug utilization pattern during pregnancy in Nekemte referral hospital, Ethiopia from 2012-2013 that could
lay base for the maternal care programs.
Methods: A purposive sampling was used to draw 100 pregnant women from the source population. Data were
collected from the documented drug administration record of Nekemte referral hospital for all stages of pregnancy,
types of drugs, roots of administration and dosage forms for all the pregnant female who were admitted to the
hospital.
Results: Among the pregnant women, who visited Nekemte referral hospital during the study period, the majority
(96%) had a record for drug (s) and almost similar pattern of records were found in all wards for drug use. Of all the
pregnant women, there was a high record for drug utilization of the women in the first trimester. Unemployed and
uneducated pregnant females make the highest proportion. There was also a prescription of potentially dangerous
drugs during pregnancy in Nekemte referral hospital.
Conclusions: Many pregnant women were found using drugs during pregnancy in Nekemte referral hospital,
including potentially harmful drugs. Therefore, there should be intensive assessment of pregnant women treatment in
line with the US food and drug administration agency (FDA) risk category and locally operating regulations by
considering risks and benefits to both mothers and the foetus in drug prescription and administration.

Keywords: Drug, Pregnancy, Prescription, Hospital, Female

INTRODUCTION protocols may affect the life of the mother and her baby
too.1 Pregnancy management using medications has a
Medication use during pregnancy has been an issue of teratogen effects and the potential for foetal harm. This
concern since the discovery of birth defects resulting has increased the burden of risk assessment for health
from thalidomide use in early pregnancy during the care providers.2,3
1960s. Diseases occurring during pregnancy are more
dangerous because of the difficulties in their treatment Administration of a drug to the pregnant women presents
strategy. These days, pregnancy care is one of the great unique problem for the physician. Not only must
challenges in health care systems since drug therapy maternal pharmacologic mechanisms be taken in to

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 Asfaw F et al. Int J Sci Rep. 2016 Aug;2(8):201-206

consideration while using drugs but also the foetus must majority of these prescribed drugs during pregnancy,
always be kept in mind that drugs administered during belonged to over the counter (OTC) medications
pregnancy can affect the foetus. Nevertheless studies (Ibuprofen) that are contraindicated in pregnancy. This is
conducted in the past few years indicate that drug used at unexpectedly at high rates during pregnancy.
consumption during pregnancy is increasing due to These uses of common OTC drugs during pregnancy can
several reasons.4 Most people in the developing world are lead to risks that ranges from a small to extremely high
unaware of their drug and chemical exposure. Many are risk to both mother and the fetus.23
uninformed about the potential harmful effect of drug on
the foetus even if there are some concerned groups. In the Only a few studies have instigated the pattern of drug use
modern society, many individuals are overly concerned particularly focusing on the drug safety of the pregnant
with their own comfort and seek pharmacological females in the study area in Ethiopia.24 There is no
solution to the many systems that may affect pregnant enough information on drug use pattern, which has
women. Absence of enough information about safety of importance in determining drug utilization during
many medications when they are taken by pregnant pregnancy and sensitize policy makers to know the
women is the first factor for hazardous effects which has magnitude of teratogenicity in the study area so far.
been evidenced by the thalidomide crisis that has Hence, this study underscores on the need to understand
occurred so far.2 drug utilization patterns for pregnant women and
investigate safety of drugs taken by the target population
Being a pregnant is a special physiological condition through the identification of the type of drugs prescribed
where there must be a precaution in administration of and the pattern of drug prescription to pregnant females
drugs to avoid teratogenic effect and undesired effect on in Nekemte referral hospital.
the mother.5 Rational drug use in pregnancy requires the
balancing of benefits and potential risks associated with METHODS
the use of the drug. The benefits of rational drug use
during pregnancy are not only restricted to the recovery Study design and population
of maternal health, but are also helpful in the
development of the foetus appropriate treatment of A cross-sectional study was conducted by using health
conditions like diabetes mellitus and infectious disease of records book of inpatient and outpatient departments in
genital organs, embryopathies and preterm births. 5,6 Per- Nekemte referral hospital in West Oromia, Ethiopia from
conception folic-acid supplements can prevent most March 2013 to April 2013 to assess drug utilization
neural tube defects and other congenital abnormalities of pattern among pregnant women. Pregnant women who
the cardiovascular system, urinary tract and limb visited Nekemte referral hospital in past one year (2012-
deficiencies.7-10 Moreover, folic- acid supplementations 2013 G.C) were the target population. The number of
in pregnancy complications like placental abruption and study population was 100 individuals who were
preeclampsia.4 purposely (pregnant woman only) selected to represent
the study population. Data were collected from their
Iron and vitamin supplementation are the most records of drug administered for pregnant women study
frequently used drugs followed by analgesics, colytic population using a designed data collection sheet that
agents and drugs for chronic conditions and common included the class of pregnancy, types of drugs, roots of
pregnancy symptoms.11 Of all the medications, about administration, dosage forms and sociodemographic
(70%) folate, (38%) iron and (27%) multivitamins are the information.
drugs taken by pregnant women along with herbal drugs
like, ginger (20%) and raspberry leaf (9%). 12 A similar Data analysis
trend for use of herbal drugs like cannabis ginger and
raspberry leaf during pregnancy is also reported. 12,13 Data The collected data were checked manually for
on herbal drug use by pregnant women and factor like completeness, recorded in excel and analyzed using table
prior use of herbs, high knowledge about herbal drugs and graphs for nonparametric analysis. SPSS version 16
and age between 26 and 35 years, showed associations. 16 was used for one way ANOVA and p<0.05 was
Usually, herbal preparations are classified as dietary considered significant.
supplements and are not regulated like conventional
drugs.17 RESULTS

There are reports of use of potentially harm full drugs A total of 100 pregnant women who were admitted to
1.5% to 4.8% during pregnancy from developed and Nekemte referral hospital were considered for this study.
under developed countries of the world.3,18-20 In a The registration book in each ward and outpatient
retrospective register-based cohort study, it was found department was used to sample the number of pregnant
that 20.4% women purchase at least one drug classified women who visited the hospital. Gynecology (GYN)
as clearly harmful.21 Many women can be exposed to (32), antenatal care (ANC) (45) and Obstetric surgery
drugs (mainly non steroidal anti inflammatory drugs) that (OBS) (23) women were identified. The highest number
can leads to some risk during pregnancy. 22 A vast of women visited the ANC ward. Of 100 gravid who

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 Asfaw F et al. Int J Sci Rep. 2016 Aug;2(8):201-206

attended the hospital 96 of them had records that showed prescribed in the three wards of the hospital when
prescription for medication of which 44, 22 and 30 were compared to other forms of drugs as shown in Table 2A.
from ANC, OBS and GYN respectively as given in Table
1. Out of 96 pregnant women who received at least a The majority of prescription was made in first trimester.
prescription for medication during their visit, 32 (33.3%) About 64 drugs with an average of 2.2 drugs per pregnant
were in the first trimester, 30 (31.3%) were in the second woman were prescribed in the first trimester. These drugs
trimester and 34 (35.4%) were in the third trimester as were prescribed for upper respiratory tract infection in the
seen in Table 1. first, second and third trimester. An average of 1.9 drugs
per pregnant woman in second trimester; and 58 drugs
Table 1: Pregnant women attended Nekemte referral with an average of 1.7 drugs per pregnant woman in third
hospital. trimester were prescribed. Mainly, the drugs were
administered in PO rout and the least being virginal route
Without With as shown in Table 2B.
Ward prescribed prescribed Total
drugs drugs The data presented in Table 3 reveal that antibiotics for
ANC 1 44(97.8%) 45 treating infections were the most frequently prescribed
drug followed by iron folates iron supplement. Anti-
OBS 1 22(95.6%) 23
acids, Chlorpromazine and IV fluids were still the third,
GYN 2 30(93.75%) 32
fourth and fifth respectively. Potentially harmful drugs,
Total 4 96(96%) 100 oxytocin and paracetamol (FDA category X and B
Trimester 1st 2nd 3rd respectively) were prescribed 12 times each. The
Frequency 32 30 34 frequency of antibiotics prescription was significantly
high (p<0.05) when compared to other prescriptions.
Majority of the drug prescription 70 (40%) was in the 1st
A total of 183 drugs with an average of 1.83 drugs per and 54 (30%) for each of 2nd and 3rd trimester.
individual woman were prescribed to pregnant women in
the hospital. In ANC alone, on average 0.8 drugs Table 2A: Dosage form of drugs prescribed to
/woman was prescribed. Among 81 drugs prescribed pregnant women in Nekemte referral hospital.
during ANC follow up, the majority 54 (62.8%) were
prescribed in capsule form. Tablets 14 (16.4%), injection Dosage
12(13.9%) Ccx 1 (0.1%) and no prescription were made ANC GYN OBS Total
form
for syrup and pessary. About 58 drugs with an average of 12 18 24
1.8 drugs per pregnant woman were prescribed to women Injection 54
(13.9%) (31%) (54.5%)
who attended GYN ward. About 18, 16, 18, 4 and 2 drugs
14 16 6
in the form of injection, tablet, capsule, syrup and pessary Tablet 36
(16.4%) (27.6% (13.6%)
were prescribed respectively and no prescription was
54 18 12
made for Ccx form in this ward. On average in OBS Capsule 84
(62.8%) (31%) (27.4%)
ward, a woman received 1.9 prescription for the drug
forms with the highest (54.5%) being injection form Syrup 0 4(6.9%) 0 4
(parenteral). The majority of the prescription in GYN and Pessary 0 2(3.44%) 2(4.5%) 4
ANC were capsule forms and injection forms are used Ccx 1 0 0 1
mostly in OBS ward and majority of the prescription TOTAL 81 58 44 183
were from ANC ward with no significant difference. But
significantly (p<0.05) high amount of capsule forms were

Table 2B: Route of administration of prescribed drugs for pregnant women in Nekemte referral hospital.

Route of ANC GYN/OBS

st st Total
administration 1 trimester 2nd trimester 3rd trimester 1 trimester 2nd trimester 3rd trimester
PO 42 16 16 0 36 16 126
IV 0 0 0 6 0 20 26
IMr54e3 12 0 0 4 4 4 24
Vaginal 0 0 0 0 2 2 4
Total 54 16 16 10 42 42 280

The socio-demographic status of the patients is depicted 35years and >35 years old respectively with 85% married
in Table 4. Among the 100 pregnant women visited and the rest 15% single, 39% primi gravid and 61%
Nekemte referral hospital during the study period, 15% multi gravid woman. Multigravida and married woman
were under age of 20 and 76% and 9% of them are 20- are the dominant group of the pregnant female attended

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 Asfaw F et al. Int J Sci Rep. 2016 Aug;2(8):201-206

the hospital. Most 76% of the woman were in the regular The highest group are protestant and followed by ortho-
periods of high fertility rate ages. Most of them were and dox and muslims respectively.
unemployed house wives.
Table 3: Drugs prescription frequency for pregnant women in Nekemte referral hospital.

Drug prescribed 1st trimester 2nd trimester 3rd trimester Total FDA category
Vitamins 0 0 2 2 A
Iron sulfate 4 4 4 12 N
Folic acid 4 0 0 4 A
Iron folate 22 4 2 28 A/C
Antibiotics 6 20 22 48 B/C/D
Paracetamol 2 10 0 12 B
NSAID (diclofenac) 0 2 0 2 B/C/D
Oxytocin 0 0 12 12 X
Antacids 10 2 0 12 B
PPIs/H2blocker 4 2 4 10 C
Methyl DOPA 0 4 2 6 B
IV fulid 2 0 6 8 C
Cotrimoxazole 0 2 0 2 N
Anti protozoal 2 4 0 6 N
Chlorpromazine 14 0 0 14 N
Total 70 54 54 178 -

Table 4: Socio-demographic characteristics of pregnant women attending Nekemte referral hospital.

Socio- Demographic characteristics Number Percentage (%)

<20 15 15%
Age 20-35 76 76%
>35 9 9%
Married 85 85%
Marital status
Single 15 15%
1-8 25 25%
Educational Status 9-12 48 48%
>12 27 27%
Employed 24 24%
Occupation
Unemployed 76 76%
Primi gravid 39 39%
Gravida
Multi gravid 61 61%
Protestant 41 41%
Orthodox 37 37%
Religion
Muslim 22 22%
Other 0 0

DISCUSSION hyper emesis gravid arum in which the patient can’t take
drugs orally.25
Women received prescription for many drugs in ANC
ward in the study subjects. This probably to treat From the results of this study, diclofenac FDA category
infection of upper respiratory tract infection in the first, X (pregnancy contraindicated) was used in third trimester
second and third trimester which is also common in other for pregnant women in labour; however, this can cause
parts of Ethiopia 21and those vising for health care also early closure and constriction of ductus arteriosus with
have increased the proportion. Most of the drugs in OBS subsequent neonatal pulmonary hypertension and
ward were given by parenteral administration. The transient right-sided hypertrophic cardiomyopathy.18
patients admitted to OBS ward for labour and they Therefore, it is very important to search for other
underwent cesarean section for delivery in which they alternatives that could alleviate pain during labour than
took different IV fluids and anesthetics parentrally. The using this drugs without prior risk assessment methods.
high value for the injectable prescribed in GYN ward Among the total drugs prescribed during ANC, on
may be due to the nature of the diagnosis observed i.e., average 2.2 drug per woman was antibiotics. This

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 Asfaw F et al. Int J Sci Rep. 2016 Aug;2(8):201-206

prescription is against FDA (US) as the drugs can cross Funding: No funding sources
the placenta and their use late in pregnancy causes Conflict of interest: None declared
permanent discoloration of teeth, enamel hyperplasia and Ethical approval: The study was approved by the
impaired fetal skeletal growth.9,26 Folate supplementation institutional ethics committee
stands second to antibiotics 44 (out of 178 drugs
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