Variation in service-providers’ prescribing behaviour and policy

implications for women with genitourinary tract infections in Ramallah, occupied Palestinian

territory (oPt)

Rula Ghandour BPharm MPHRana Khatib Bpharm, MSc, PhD

Institute of Community and Public Health Birzeit University -oPt

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Background(1)

Globally:Genitourinary tract infections including both reproductive (RTI) and urinary (UTI) tract infections are among the most common reasons for women seeking health care worldwide.

Both Infections are associated with adverse pregnancy outcomes and negatively affect women’s quality of life.

Emerging resistance to agents active against uropathogenes is noted worldwide

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In the oPt

• Limited data available on RTIs and UTIs.

• Limited data available on microbial resistance patterns to such infections.

• Although some guidelines were available, yet, with inadequate awareness and minimal adherence at the clinic level.

Background(2)

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Objectives of the study

To assess prescribing patterns related to RTIs and UTIs in selected women's health clinics in the Ramallah district in the occupied Palestinian territory;

To provide the evidence required to set policy and improve prescribing patterns.

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Methodology (1)• Type of study: Observational (Descriptive

analytical)

• Target population: all women attending women’s health clinics in the Ramallah district of Palestine

• Sample: Convenient sample (12 clinics, 100-120 cases per clinic).

• Time frame: 4 months (February – May 2010)• Tools used:

• Women’s questionnaire • Physicians’ questionnaire

• Consent: Verbal

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Methodology (2)

Appropriateness of treatment was based on: • Evidence based medicine and available

guidelines under the assumption of correct diagnosis.

An appropriate treatment included:• Indication• Dosage regimen (strength, frequency)• Duration of treatment

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Results and Discussion(1)

Sample:• Sample size: 1052 women• Response rate: 98%

• 15% (162) of the total sample were diagnosed as having an RTI, UTI or both infections by their women’s health physicians.

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Socio-demographic characteristics for women with genitourinary tract infections (162):

• Young : 69.1% < 35 years old

• Mostly married : 96.3% ever married

• Low level of education: 61% below secondary

• Living within nuclear families : 65.8% nuclear families

• Living within the low or middle socio-economic status: 43.2% and 48.4% respectively

Results and Discussion(2)

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Results and Discussion(3)

RTI 55%

UTI 36%

Both in-fec-

tions 9%

Distribution of women diagnosed with geni-tourinary tract infections by type of infection

N=162

Diagnosis

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Appropriateness of Treatment per diagnosis The medications prescribed to 132 (81%) of 162

women at the time of diagnosis were not in accord with treatment guidelines or the evidence based

medicine

RTI UTI Both Infections

70%

95% 100%

Percent of women treated not in accord with treatment guidelines by general infection

category (N=132)

Results and Discussion(4)

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Appropriateness of treatment (inappropriate practice)

Indication Dosage regimen Duration

40%

14%

50%

Distribution of women with inappropriate treatment prescribed by aspect of inap-

propriateness (N=132)

81 % (132) of the total women with infection were treated inappropriately

Results and Discussion(5)

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Conclusion

Results of this study showed:• High rate of variation in prescribing

practices and managing women with such infections

• Indication and duration of treatment were the major contributors to this variation.

• Inadequate awareness and implementation to treatment guidelines and protocols leading to inappropriate treatment

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Policy Recommendations

• Management guidelines (diagnosis and treatment) should be implemented and supervised at the clinic level

• Continuing professional development for women’s health physicians supported by proper supervision and follow-up is needed

• Microbial resistance patterns should be identified in the local context to guide appropriate prescribing patterns.