1. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 The Economic costs associated with Irrational Prescribing in children: Implications for reducing Childhood Mortality in South east Nigeria

2. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009  In Nigeria, Malaria, ARI and DD are responsible for majority of childhood diseases  These diseases are preventable or treatable with low cost drugs bought mainly from Patent Medicine Sellers (PMS) who are the primary source of drugs in rural and urban Nigeria.  A large proportion of a family’s OOPEs on health care is on drugs in Nigeria

3. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009  PMS are preferred because of lower cost and flexible pricing policies.  Most PMS are unaware of the correct dosages and duration of treatment leading to irrational prescribing.  Little has been reported on the economic costs associated with inadequate drug prescribing for childhood illnesses by these PMS in Nigeria.

4. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 To assess the economic costs of inadequate drug prescribing by Patent Medicine Sellers for malaria, ARI and DD in urban Nigeria

5. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009  Exit interviews with 395 caregivers who sought care for their children from all the 45 PMS in Abakpa district of Enugu east LGA, Enugu state, south east Nigeria  Information collected: Respondents’ & patients’ profile, umber and type of drugs prescribed/bought and for which disease and whether they had a prescription or not  Fever for malaria; Cough & difficulty in breathing for ARI and Watery stool for DD.

6. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009  Each treatment episode was analyzed based on the symptoms reported by the caregiver and the prescription/treatment provided at each episode.  These episodes were assessed by the researchers who are all medical doctors in the University of Nigeria teaching hospital  The Nigerian standard treatment guideline for Malaria, ARI and DD were used to determine the adequacy of prescribing.

7. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 For each of the prescriptions/treatment provided, the variables collected were the  average number of drugs prescribed per encounter  average percentage of prescriptions with injections  average percentage of prescription with one or more antibiotics  percentage of prescription with essential drugs  Average cost of drugs per prescription

8. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009  The difference between the average cost of the standard treatment and the drugs purchased was regarded as the additional cost  50 patients who had irrational prescribing were followed up after 2 weeks to determine further costs incurred as a result of the illness (consultation fees, drugs, transport and the cost equivalent to the working days lost due to illness)  Market price was used to cost the drugs  Data analysis was with EPI-Info and Excel

9. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009  ). Variables N (%) N= 395 Sex of respondent (Female) 365 (92.4) Years of education of respondent: Mean (SD) 9.5 (3.6) Age of respondent (years): Mean (SD) 34.1 (6.5) Age of ill person (years): Mean (SD) 3.8 (1.7) Sex of ill person (Female) 249 (63.0) % Had a prescription 85 (21.5) % received treatment for malaria 316 (80.0) % received treatment for DD 47(12.0) % received treatment for ARI 32 (8.0)

10. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Drug use indicators The average number of drugs per prescription 6.8 Average percentage of prescription with injections 72.5 Average percentage of prescription with one or more antibiotics 59.7 Percentage of prescription with non essential drugs 45.9

11. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009 Variables Additional costs to the standard treatment (Naira): Mean (SD) Malaria ARI DD 255 (164.5) 350 (201.6) 175 (93.5) Losses attributable to irrational prescribing/patient (Naira): Mean (SD) 4,500 (1,950)

12. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009  An average of 6.8 drugs per prescription, average percentage of prescription with injections of 72.5% and 59.7% of prescription with one or more antibiotics is clearly irrational and wasteful

13. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009  More than half of the drugs were on essential drug list, implying some cost savings for the consumers.  But the high 6.8 drugs on average/prescription is likely to increase the total cost of prescription and therefore cancel out the cost savings to consumers arising from prescribing essential drugs

14. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009  Irrational prescribing imposes unnecessary cost on health care users especially the poor who are the ones more prone to these diseases  Training the PMS in rational drug prescription is advocated so as to improve the quality of drug prescription and hence reduce the cost of treatment to caregivers.  Necessary to achieve the MDG goal of reducing infant mortality in Nigeria by the year 2015.

15. Inaugural Conference of the African Health Economics and Policy Association (AfHEA) Accra - Ghana, 10th - 12th March 2009