Browsing by Author "Ncube, Nondumiso B.Q."

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    A combined strategies intervention on the world health organization prescribing indicators: a quasi-randomised trial
    (AOSIS (pty) Ltd, 2024) Ncube, Nondumiso B.Q.; Mukumbang, Ferdinand C; Laing, Richard; Schneider, Helen; Laing, Richard
    Background: Irrational medicine use is a global problem that may potentiate antimicrobial resistance. Aim: This study aims to assess prescribing practices and the effect of a prescription audit and feedback coupled with small-group education intervention on prescribing indicators. Setting: The study was conducted in public-sector healthcare facilities in Eswatini. Methods: A cluster quasi-randomised controlled study was conducted from 2016 to 2019 using the World Health Organization/International Network for Rational Use of Drugs (WHO/INRUD) prescribing indicators at baseline, post-intervention and post-follow-up. A 6-month unblinded intervention was tested in 32 healthcare facilities, randomly allocated to intervention (16) and control (16) arms. Prescribing practices were assessed post-intervention, and 6 months after the intervention, through an audit of 100 randomly selected prescriptions from each facility. Comparisons of WHO or INRUD prescribing indicators were conducted using the intention-to-treat analysis at the two times. Results: At baseline, in both arms, rational prescribing standards were met by the number of medicines per prescription and the use of injections. Antibiotic use was above 50% in both arms. After adjustment for baseline antibiotics use, region and level of care, there were no significant differences in all prescribing indicators between the two arms, post-intervention and at 6 months follow-up. Conclusion: In a lower middle-income setting with a high prevalence of irrational prescribing practices, a prescription audit, feedback and small-group education intervention had no benefits in improving rational prescribing. Contribution: Multifaceted strategies, strengthening of pharmacy and therapeutics committees, and holistic monitoring of medicine use are recommended to promote rational medicine use.
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    Health system actors' perspectives of prescribing practices in public health facilities in Eswatini: A Qualitative Study
    (Public Library of Science, 2020) Ncube, Nondumiso B.Q.; Knight, Lucia C.; Bradley, Hazel Anne
    Rational medicines use (RMU) is the prescribing/dispensing of good quality medicines to meet individual patient's clinical needs. Policy-makers, managers and frontline providers play critical roles in safeguarding medicine usage thus ensuring their rational use. This study investigated perspectives of key health system actors on prescribing practices and factors influencing these in Eswatini. Public sector healthcare service delivery is through health facilities (public sector, not-for-profit faith-based, industrial) and community-based care. Methods A qualitative, exploratory study using semi-structured in-depth interviews with seven policymakers and managers, and 32 facility-based actors was conducted. Drawing on Social Practice Theory, material (health system context), competence (provider) and cultural (patient and provider) factors influencing prescribing practices were explored. Results Participants were aged between 21-57years, had been practicing for 1-30 years, and were a mix of doctors, nurses, pharmacists and pharmacy-technicians. Factors contributing to irrational medicines use included: Poor use of treatment guidelines, lack of RMU policies, poorly-functioning pharmaceutical and therapeutics committees, stock-outs of medicines, lack of pharmacy personnel in primary healthcare facilities, and restrictions of medicines by level of care. Provider-related factors included: Knowledge, experience and practice ethic, symptomatic prescribing, high patient numbers.