{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:15:54Z","timestamp":1785406554841,"version":"3.56.0"},"reference-count":39,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T00:00:00Z","timestamp":1709078400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: Irrational medicine use is a global problem that may potentiate antimicrobial resistance.\n\nAim: 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.\n\nSetting: The study was conducted in public-sector healthcare facilities in Eswatini.\n\nMethods: 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.\n\nResults: 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.\n\nConclusion: 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.\n\nContribution: Multifaceted strategies, strengthening of pharmacy and therapeutics committees, and holistic monitoring of medicine use are recommended to promote rational medicine use.<\/jats:p>","DOI":"10.4102\/phcfm.v16i1.3943","type":"journal-article","created":{"date-parts":[[2024,1,6]],"date-time":"2024-01-06T09:22:59Z","timestamp":1704532979000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial"],"prefix":"10.4102","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0478-9523","authenticated-orcid":false,"given":"Nondumiso B.Q.","family":"Ncube","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6621-6144","authenticated-orcid":false,"given":"Tawanda","family":"Chivese","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00yhnba62","id-type":"ROR","asserted-by":"publisher"}],"name":"Qatar University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1441-2172","authenticated-orcid":false,"given":"Ferdinand C.","family":"Mukumbang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6384-9912","authenticated-orcid":false,"given":"Hazel A.","family":"Bradley","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0418-1828","authenticated-orcid":false,"given":"Helen","family":"Schneider","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3825-217X","authenticated-orcid":false,"given":"Richard","family":"Laing","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2024,2,28]]},"reference":[{"key":"ref0","unstructured":"Agnew E, Dolecek C, Hasan R, et al. Global antimicrobial resistance and use surveillance system (GLASS) report [homepage on the Internet]. 2021 [cited n.d.]. Available from: http:\/\/www.who.int\/glass\/resources\/publications\/early-implementation-report-2020\/en\/"},{"key":"ref1","unstructured":"Holloway K, Van Dijk L. The World Medicines Situation 2011, rational use of medicines. 3rd ed. Geneva: World Health Organization; 2011."},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Sisay M, Mengistu G, Molla B, et al. Evaluation of rational drug use based on World Health Organization core drug use indicators in selected public hospitals of eastern Ethiopia: A cross sectional study. BMC Health Serv Res. 2017;17(1):161. https:\/\/doi.org\/10.1186\/s12913-017-2097-3","DOI":"10.1186\/s12913-017-2097-3"},{"key":"ref3","unstructured":"WHO. Promoting rational use of medicines: Core components. WHO Policy Perspectives on Medicines [homepage on the Internet]. 2002 [cited n.d]. Available from: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/60519\/WHO_DAP_93.1.pdf?sequence=1&isAllowed=y"},{"key":"ref4","unstructured":"World Health Organization. How to investigate drug use in health facilities [homepage on the Internet]. 1993 [cited n.d.]. Available from: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/60519\/WHO_DAP_93.1.pdf?sequence=1&isAllowed=y"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Ofori-Asenso R, Brhlikova P, Pollock AM. Prescribing indicators at primary health care centers within the WHO African region: A systematic analysis (1995\u20132015). BMC Public Health. 2016;16:724. https:\/\/doi.org\/10.1186\/s12889-016-3428-8","DOI":"10.1186\/s12889-016-3428-8"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Ofori-Asenso R, Agyeman A. Irrational use of medicines \u2013 A summary of key concepts. 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