Prevalence and factors associated with medicine dosage form modification among paediatric patients in paediatric wards of Mulago National Referral Hospital

Abstract

Background: Medicine dosage form modification in this context refers to the act of changing the physical form in which a medicine is presented by the manufacturer for final consumption without the manufacturer’s recommendation. Factors that were seen to be associated with medicine dosage form modification include; patient’s age, diagnosis and monthly income of the care takers. The reasons that lead to medicine dosage form modification were seen to include; unavailability of appropriate medicine dosage form, unaffordability of the appropriate dosage forms, swallowing difficulties, ignorance about the hazardous, instructions from health workers and perceived benefit. Medicine dosage form modification may be hazardous because it poses both public health concerns and personal health hazards. Aim of the study: Little was known about the prevalence and factors associated with medicine dosage form modification in Uganda. The aim of this study was to determine the prevalence and factors associated with medicine dosage form modification among paediatric patients in paediatric wards at Mulago NRH. This provided a basis to come up with solutions to avoid the consequences associated with medicine dosage form modification. It also advocated for inclusion of the appropriate dosage forms in the national essential medicines list and provided a motivation for the publication of national guidelines of how best medicine dosage form modification can be done. Methods: The research was conducted through a mixed method cross-sectional and qualitative study at Mulago National Referral Hospital (MNRH). The 385 respondents (patient caretakers) were randomly sampled from a total of about 780 caretakers over the period of five weeks. The key informants were purposively selected from the health workers on each ward. Quantitative data was obtained from caretakers using a questionnaire and qualitative data was obtained from key informants using an interview guide. The collected data obtained was organized and electronically stored. It was analysed using Statistical Package for Social Sciences (SPSS) version 23. Results: Medicine dosage form modification was found to have a high prevalence of 7 in 10 caretakers. The factors that were found to be significantly associated with dosage form modification were patient’s age, diagnosis and care taker’s monthly income. The major reasons for medicine dosage form modification included; patient’s difficulty in swallowing, unavailability of appropriate dosage form, instruction from health workers and ignorance. Conclusion: Medicine dosage form modification was found to have a high prevalence of 7 in 10 caretakers. Both patient factors and caretakers contributed towards medicine dosage form modification. Recommendations: Inclusion of appropriate paediatric dosage forms into the essential medicines list of Uganda by in-charge professionals, the government should revise the budget so that the procured medicines can satisfy most of the available patient population, employment of pharmacists by government at every ward to guide on the appropriate use of medicines, dosage form modification should be done by health workers in cases it is inevitable, purchase of equipment by government to aid in the modification if unavoidable and coming up with guidelines on how best medicine dosage form modification can be done.