Promoting Appropriate Drug Use in Missionary Health Facilities in Cameroon - EDM Research Series No. 028: 11. Appendices: Appendix 10. Results of indicator study for individual facilities

Promoting Appropriate Drug Use in Missionary Health Facilities in Cameroon - EDM Research Series No. 028
(1998; 80 pages)

Table of Contents

	Acknowledgements
	Abbreviations
	Executive summary
		Background
		Methodology
		Key findings
		Conclusion
	1. Introduction
	2. Background
	3. Literature review
	4. Objectives and significance
		4.1 Study objectives
		4.2 Significance
	5. Overall approach and design
		5.1 Study design and study population
		5.2 Variables
		5.3 Sample size and power calculations
		5.4 Sampling frame and data collection methods
		5.5 Data processing and analysis
		5.6 Pilot test
		5.7 Limitations of data
	6. Results
		6.1 Drug indicators
		6.2 Patient care indicators
		6.3 Health facility indicator
		6.4 Prescriber characteristics
		6.5 Dispenser characteristics
	7. Analysis
		7.1 Correlations of drug indicators and independent variables
		7.2 Correlation of patient care indicators with independent variables
	8. Discussion
		8.1 Drug indicators
		8.2 Patient care indicators
		8.3 Diagnosis and treatment
		8.4 Consulting time
		8.5 Dispensing time
		8.6 Patient knowledge
		8.7 Adequate labelling
	9. Recommendations
		9.1 Education and training
		9.2 Supervision
		9.3 Other recommendations and suggestions for further research
	10. Conclusion
	11. Appendices
		Appendix 1. Characteristics of individual Cameroon Baptist Convention facilities
		Appendix 2. List of antibiotics
		Appendix 3. Key essential drugs for Cameroon Baptist Convention
		Appendix 4. Case scenarios
		Appendix 5. Acceptable answers for case scenarios
		Appendix 6. Structured provider interview
		Appendix 7. Structured dispenser interview
		Appendix 8. Structured patient interview
		Appendix 9. Operational definitions
		Appendix 10. Results of indicator study for individual facilities
	References

Appendix 10. Results of indicator study for individual facilities

DRUG INDICATORS

Table 1. Busy facilities (patients per day > 100)

	BBH	MBH	Nkwen	Mutengene	Etoug-Ebe
	n = 360 prescriptions	n = 360 prescriptions	n = 360 prescriptions	n = 360 prescriptions	n = 360 prescriptions
Average number of drugs	2.0 SD 0.9	2.4 SD 1.0	2.5 SD 1.2	3.0 SD 1.2	2.5 SD 1.2
% Antibiotics	32.9	28.9	34.2	26.1	33.9
Quinine: chloroquine ratio	1:0.8	1:2.4	1:1.1	1:0.3	1:0.1
% of laboratory referrals	34.6%	39.5%	40.5%	46.5%	47.3%
Average cost '96	CFAF 1663	CFAF 1567	CFAF 2002	CFAF 2492	CFAF 2412

Table 2. Moderately busy facilities (100 < patients per day > 30)

	Kumba	Ashong	Ndu	Ngounso	Bangolan	Kouhouat
	n = 360 prescriptions	n = 360 prescriptions	n = 360 prescriptions	n = 360 prescriptions	n = 360 prescriptions	n = 360 prescriptions
Average number of drugs	2.9 SD 1.2	2.6 SD 1.1	3.0 SD 1.3	3.7 SD 1.4	2.7 SD 1.1	3.1 SD 1.3
% of antibiotics	27.8	33.1	29.4	50.6	29.6	32.8
Quinine: chloroquinine ratio	1:0.2	1:1.4	1:2	1:1.4	1:0.4	1:1.8
% of laboratory referrals	37.9	22.2	42.6	41.2	44.9	37.5
Average cost '96	CFAF 2668	CFAF 1727	CFAF 1904	CFAF 2621	CFAF 1801	CFAF 2178

Table 3. Less busy facilities (patients per day < 30)

	Jikijem	Akeh	Nyamboya
	n = 360 prescriptions	n = 360 prescriptions	n = 360 prescriptions
Average number of drugs	2.3 SD 1.1	3.0 SD 1.3	3.3 SD 1.4
% of antibiotics	29.2	39.0	45.0
Quinine: chloroquine ratio	1:11.3	1:4.4	1:4.4
% of laboratory referrals	16.7	2.9*	19.5
Average cost '96	CFAF 1414	CFAF 1570	CFAF 1538

*Akeh has no laboratory facilities.

PATIENT CARE INDICATORS

Table 4. Busy facilities (patients seen per day > 100)

	BBH	MBH	Nkwen	Mutengene	Etoug-Ebe
	n = 34	n = 35	n = 29	n = 35	n = 40
Average nurse consultation (min)	6.60 SD 4.22	3.92 SD 1.85	5.85 SD 3.52	4.41 SD 1.77	5.23 SD 2.69
Average doctor consultation (min)	2.20 SD.91	4.95 SD 3.04	N/A	N/A	N/A
Average waiting time (min)	21.30 SD 11.24	29.36 SD 15.53	10.67 SD 5.87	29.91 SD 16.45	10.29 SD 4.85
Average dispensing time (min)	.66 SD.62	1.72 SD 1.71	1.15 SD 1.10	1.86 SD 1.63	.64 SD.44
% Knew how/when to take	81.3	96.4	90.6	84.2	93.8
% Adequately labelled	81.3	78.6	100	100	100

Table 5. Moderately busy facilities (30 < patients per day > 100)

	Kumba	Ashong	Ndu	Ngounso	Bangolan	Kouhouat
	n = 26	n = 30	n = 31	n = 22/14/18	n =17/9/13	n = 19/19/23
Average nurse consultation (min)	7.82 SD 4.95	4.41 SD 1.77	5.28 SD 4.30	5.37 SD 3.94	4.77 SD 2.02	5.95 SD 3.94
Average doctor consultation (min)	N/A	4.25 SD 2.24*	N/A	N/A	N/A	N/A
Average waiting time (min)	12.07 SD 7.31	10.54 SD 8.32	5.35 SD 2.89	14.15 SD 10.83	10.69 SD 5.98	17.57 SD 11.29
Average dispensing time (min)	.96 SD.63	1.22 SD.96	1.36 SD.93	.78 SD.76	.72 SD.64	1.37 SD 1.31
% Knew how/when to take	100	48.3	87.1	83.3	89.5	63.6
% Adequately labelled	100	100	77.4	83.3	100	100

* Data collected during monthly doctor's visit

Table 6. Less busy facilities (patients per day < 30)

	Jikijem	Akeh	Nyamboya
	n = 31/15/18	n = 0*	n = 0*
Average nurse consultation (min)	8.01 SD 5.52	N/A	N/A
Average doctor consultation (min)	N/A	N/A	N/A
Average waiting time (min)	22.64 SD 12.86	N/A	N/A
Average dispensing time (min)	1.01 SD.78	N/A	N/A
% Knew how/when to take	95.2	N/A	N/A
% Adequately labelled	81.0	N/A	N/A

* Too few patients seen during facility visit to collect data

PRESCRIBING PERSONNEL CHARACTERISTICS

Table 7. Busy facilities (patients per day > 100)

	BBH	MBH	Nkwen	Mutengene	Etoug-Ebe
	n = 8	n = 8	n = 5	n = 3	n = 4
Average age	38.5	41.2	47.4	35.0	44.0
% personnel with at least secondary school	87.5	50.0	20.0	66.6	50.0
Average years screening	9.3	13.4	9.6	6.1	9.7
% personnel with screening course	25.0*	62.5*	100	100	75.0
% personnel with standard treatment guidelines training	25.0	50.0	60.0	100	50.0
Average weeks of training	10.0**	7.8**	8.0	6.5	4.3
Average months since training	116.7*	131.0*	36.4	42.0	32.0

*Includes doctors.** Does not include doctors.

Table 8. Moderately busy facilities (30 < patients per day > 100)

	Kumba	Ashong	Ndu	Ngounso	Bangolan	Kouhouat
	n = 2	n = 1	n = 2	n = 2	n = 2	n = 2
Average age	29.5	42.0	37.5	34.0	36.0	33.5
% of personnel > secondary school	100	0	50	50	100	100
Average years screening	4.0	11.0	12.4	6.7	7.2	6.5
% of personnel with screening course	50.0	100	0	50	100	0
% of personnel with standard treatment guidelines training	100	100	0	50	100	0
Average weeks of training	6.5	13.0	0.5	1.0	6.0	0
Average months since training	55.5	60.0	24.0	24.0	18.0	N/A

Table 9. Less busy facilities (patients per day < 30)

	Jikijem	Akeh	Nyamboya
	n = 3	n = 1	n = 1
Average age	36.3	30.0	27.0
% of personnel with at least secondary school	0	100	100
Average years screening	7.7	0.4	2.0
% of personnel with screening course	66.7	0	0
% of personnel with standard treatment guidelines training	66.7	0	100
Average weeks of training	2.1	N/A	N/A
Average months since training	36.0	N/A	N/A

DISPENSING PERSONNEL CHARACTERISTICS

Table 10. Busy facilities (patients per day > 100)

	BBH	MBH	Nkwen	Mutengene	Etoug-Ebe
	n = 5	n = 3	n = 2	n = 3	n = 3
Average age	39.2	30.0	38.0	29.3	33.0
% of personnel with only primary school	20.0	33.3	0	100	66.7
Average years' dispensing experience	6.3	1.5	3.5	2.3	1.7
% of personnel with dispensing course	100	66.7	50.0	33.3	66.7
Average weeks of training	10.2	4.7	0.5	5.3	2.0
Average months since training	24.0	4.0	5.0	1.0	78.0

Table 11. Moderately busy facilities (30 < patients per day > 100)

	Kumba	Ashong	Ndu	Ngounso	Bangolan	Kouhouat
	n = 3	n = 2	n = 3	n = 2	n = 2	n = 3
Average age	31.6	32.0	23.6	31.0	29.0	22.3
% of personnel with only primary school	33.3	50.0	0	100	50.0	33.3
Average years dispensing experience	2.1	5.0	2.9	2.4	6.0	2.3
% of personnel with dispensing course	0	0	33.3	0	0	0
Average weeks of training	N/A	N/A	2.6	N/A	N/A	N/A
Average months since training	N/A	N/A	108.0	N/A	N/A	N/A

Table 12. Less busy facilities (patients per day < 30)

	Jikijem	Akeh	Nyamboya
	n = 2	n = 3	n = 2
Average age	28.5	31.3	23.3
% of personnel with only primary school	50.0	66.7	50.0
Average years dispensing experience	7.5	2.7	3.5
% of personnel with dispensing course	0	0	0
Average weeks of training	N/A	N/A	N/A
Average months since training	N/A	N/A	N/A