Date of Award

1-1-2018

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Jeremy I. Schwartz

Abstract

Essential Medicines (EM) for non-communicable diseases (NCD) are often unavailable to patients in Uganda. We sought to determine the gap between prescribed and dispensed medicines for the treatment of NCD - specifically, diabetes mellitus (DM) and cardiovascular disease (CVD) - in Ugandan public healthcare facilities. We conducted a cross-sectional study in which systematic sampling was used to collect data from patients attending outpatient NCD clinics at 20 national, regional and general higher level public healthcare facilities throughout the country. Convenience sampling was used to obtain data from prescribers and dispensers of NCD medicines at the same facilities. Data were collected using structured questionnaires. The primary outcome was the percentage of prescribed doses that were not dispensed. We analyzed data from 637 patient participants, 24 prescribers and 28 dispensers. 454 (71.3%) patient participants were female, 107 (16.8%) had no formal education, 259 (40.7%) were unemployed and 391 (62.3%) earned below the poverty line. The mean number of prescribed medicines per encounter was 2.3 (SD 1.1), of which only 1.4 (SD 0.9) were dispensed. The most commonly prescribed medicines for DM were metformin 291 (48.6%) and glibenclamide 161 (26.9%) while for CVD they were nifedipine 188 (21.7%), bendroflumethiazide 134 (15.4%). Of the 1467 prescriptions analyzed, 1157 (78.9%) were generic names and 1412 (96.3%) were on the Essential Medicines List (EML), which is less than the World Health Organization (WHO) standard of 100% for prescription of generic names and medicines on the EML. 1151 (78.5%) prescriptions were adequately written by prescribers, and 802 (89.6%) dispensed medicines were adequately labelled. Overall, there were 82,591 total prescribed doses and 35,290.5 dispensed doses, meaning that 57.3% of prescribed doses were not dispensed. The percentage of non-dispensed doses varied significantly by participant travel time (p=0.04), facility (p

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