M. MALIK & col
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2. MATERIALS AND METHODS
Study design
A comparative, cross-‐sectional study was designed to evaluate the case
records of patients from October 2010-‐ 2011 including (daily registers, medical
records, prescriptions, patient-‐held records) treated for malaria in public and
private tertiary healthcare facilities in the twin cities, namely Islamabad (federal
capital) and Rawalpindi.
Study tool
The case records were collected from the male and female medicine wards
and out-‐patient departments (OPD) of the healthcare facilities. A pre-‐validated tool
i.e. WHO prescribing indicator form was used to collect data regarding current
prescribing practices for the treatment of malaria(7).
The prescribing form included five core indicators such as % of encounters
having diagnosis, average number of drugs per encounter, % average number of
antibiotics and injections prescribed per encounter and % of drugs prescribed by
generic names. Beside this few additional indices such as demographics of patient,
type of drug combinations prescribed and availability of standard treatment
guidelines in the healthcare facilities were also assessed.
Prescriptions were also assessed for the prescribed anti-‐malarial drugs,
their doses, strengths, frequencies and durations of use to check whether if they
followed national standard treatment regimen or not. The minimum requirement
for the adherence of prescriptions with standard treatment regimen was
elaborated and transformed into measurable adherence indicators scale. The scale
included five indicators including correct prescribing of right anti-‐malarial drug,
its dose, strength, frequency and duration of use. The composite score for the scale
was 5-‐10 and lower score referred to better adherence with the standard
treatment regimen.
Data collection was planned and permission for survey was obtained from
relevant district health officers (DHO) and Medical superintendents (MS) of
respective healthcare facilities. The study was also approved by Malaria Control
Program, Ministry of Health, Government of Pakistan.
Sampling of facilities and patient encounters
Keeping in view the federal administrative and regulatory structure of the
country and due to location and operation of Malaria Control Program in the
capital city, two main cities of Pakistan namely Islamabad and Rawalpindi were
selected for the study. The public healthcare facilities providing services at
provincial and district levels are categorized as: primary level health care facilities
(basic health units, rural health centers, mother & child health centers, TB clinics
