MIND LINES AGAINST GUIDELINES IN TREATMENT OF MALARIA …
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and dispensaries), secondary level health care facilities (tehsil headquarter
hospitals and district head quarter hospitals) and tertiary level health care
facilities (tertiary hospitals, post graduate medical institutes, teaching hospitals).
All the tertiary healthcare facilities have a primary section for treating common
disease including malaria.
Cases are referred from lower to higher level depending on severity of
problem and available infrastructure (8). The study population included all the
public and private tertiary health care facilities treating malaria in Islamabad and
Rawalpindi. A list of all the public and private tertiary healthcare facilities was
obtained from respective District Health Offices. All the 20 public and private
tertiary healthcare facilities were selected for the study and the sample size was
Islamabad (n =10, 5 each public and private healthcare facilities) and Rawalpindi
(n =10, 5 each public and private healthcare facilities).
For assessing the prescribing practices in each facility, thirty patients
treated for malaria by the prescribers over the last one year were reviewed (7).
A total of 600 patient encounters i.e. 300 from each sector (public and
private) healthcare facilities situated in both cities were collected randomly from
daily registers, medical records, prescriptions, patient-‐held records. At least two
patients encounter per month during the low season (October till April) and four
patients encounter per month during the high season (May till September) for
malaria were selected.
As there is no trend of laboratory confirmation of malaria in Pakistan all the
prescriptions with diagnosis of malaria, anti-‐malarial drugs and tests of malaria
parasite results were included in the sample.
Plasmodium vivax
is common in
Rawalpindi and Islamabad so the adherence of prescribers with standard
treatment regimen for
P.vivax
was assessed.
Interview of the head of the outpatient department on recommended
current prescribing practices in the healthcare facilities were recorded and applied
to all encounters where records were missing (9). Prescriptions without the name
of the prescriber and folder without patient’s information were excluded. The
prescribers were identified from patient’s prescriptions and information regarding
their designation and experience was recorded.
Data collection and analysis
Data was collected by the principal investigator along with two teams
comprised of five trained data collectors in each team trained by the group of
experts including principal investigator (9).
The data collectors were trained students of the final year Doctor of
Pharmacy program who tallied data with standard treatment regimen. Data were
