Wastage of antimalarial drugs and its perceived effects on health care service delivery in public health facilities in Uasin Gishu County, Kenya

Abstract

Background: Wastage of drugs partly contributes to frequent stock outs of essential medicines in public health facilities in Kenya that negatively affects service delivery. Objectives: The study aimed to assess the nature of antimalarial drug wastages, estimate levels of antimalarial drug wastages and to illustrate the effects of antimalarial drug wastage in public health facilities in Uasin Gishu County using uncomplicated malaria as the tracer illness. Methods: Mixed methods design was used. Multilevel mixed methods sampling procedure was adopted whereby facility healthcare providers formed one level of interviewees whereas the facility in charges formed the second level of interviewees. The sampling scheme led to the use of stratified, systematic and purposive sampling of the facilities which achieved 93 questionnaires respondents in public health facilities. Purposive sampling was used to select 11 key informants including health facilities in- charges, a county health official, a Division of Malaria Control Program staff and a KEMSA staff yielding a total of 104 respondents. Data collection methods included structured questionnaires, in depth interviews and documents review. Quantitative data was analyzed using frequency distributions, proportions and cross tabulations with Chi square as the test statistic to compare wastage across the facilities tiers. Statistical significance was considered at p < 0.05. This was simplified by using SPSS. Thematic analysis was applied to analyze qualitative data. Results: The different forms of wastage reported by the questionnaires respondents across the facilities tiers manifested as; expiry wastage 17.6%; p = 0.133, channel wastage 4.8%; p = 0.669, mix wastage 9.6%; p = 0.187. In assessing the levels of the different forms of wastage, most respondents reported that wastage lay between the 1- 20% bracket which was the lowest category (81-100% - highest). This was reported as follows across the facilities tiers; expiry wastage, 68.2%; p = 0.079, channel wastage, 69.4%; p = 0.065, mix wastage, 72.9%; p = 0.064. Qualitative data revealed that mix wastage was substantial. This manifested when clinicians prescribed antimalarials irrationally. Some patients insisted on being given antimalarials regardless of the test outcome. Another observation was that drug stock outs resulted from inaccurate data entry onto the District Health Information System (DHIS) platform leading to inefficiencies in drugs ordering. These factors led to out of stock situation of the antimalarials leading to reduced access and increased healthcare costs. Conclusions: Levels of antimalarials wastage were low except for mix wastage which was substantial. Mix wastage and the systemic challenges of inaccurate data entry onto the DHIS and inefficiencies in drugs ordering led to stock outs of the antimalarials. This resulted in increased health care costs and reduced access to healthcare services in public health facilities. Recommendations: Instituting measures for strict adherence to guidelines will ensure drugs are prescribed rationally. Additionally, educating patients on the rational use of the antimalarials and ensuring that staff are qualified and adequately trained to make timely orders and provide accurate data in the DHIS. These recommendations will make the greatest impact in minimizing wastage and reducing stock outs of antimalarials in public health facilities.