Systematic review and meta-analysis of medicine use studies in Ethiopia using the WHO patient care indicators with an emphasis on the availability of prescribed medicines

Abstract

ObjectiveTo collate the findings of studies on patient care indicators in Ethiopia using the WHO/International Network for Rational Use of Drugs indicators with a focus on the availability of medicines to patients.DesignSystematic review and meta-analysis.Data sourcesEmbase, Global Index Medicus, Google Scholar, Medline (via PubMed) and Web of Science.Eligibility criteriaMedicine use studies employing the WHO patient care indicators across health facilities in Ethiopia.Data extraction and synthesisDescriptive summary of the indicators and a random-effects meta-analysis were performed for quantitative synthesis of findings on the percentage of medicines actually dispensed. Meta-regression was performed to assess the moderator effects of different attributes of the studies.ResultsA total of 25 studies conducted in 155 health facilities with 11 703 patient exit interviews were included. The median value of average consultation time was 5.1 min (25th–75th: 4.2–6.6) and that of average dispensing time was 78 s (25th–75th: 54.9–120.0). The median percentage of medicines with adequate labelling was 22.4% (25th–75th: 5.6%–50.0%). A concerning trend of decreasing dispensing times and adequacy of labelling were observed in more recent studies. The median percentage of patients with adequate knowledge of dosage schedules of medicines was 70.0% (25th–75th: 52.5%–81.0%). In the meta-analysis, the pooled estimate of medicine availability was 85.9% (95% CI: 82.1% to 89.0%). The multivariable meta-regression showed that geographical area and quality of study were statistically significant predictors of medicine availability.ConclusionShort consultation and dispensing times, inadequate labelling, inadequate knowledge of patients on medicines and suboptimal availability of medicines were identified in health facilities of Ethiopia. Studies aimed at further exploration of the individual indicators like problems of inadequate labelling and patients’ knowledge of dispensed medicines are crucial to determine the specific reasons and improve medicine use.PROSPERO registration numberCRD42020157274.