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      Factors Influencing Antenatal Haematinics Prescription Behaviour of Physicians in Calabar, Nigeria

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          Abstract

          BACKGROUND:

          Routine iron and folic acid supplementation in pregnancy have been proved to be effective in reducing the prevalence and morbidities of anaemia. However, there is limited data regarding the prescription habits of physician obstetric care givers.

          AIM:

          This study set to investigate the attitudes and factors which influence the practice among physicians in University of Calabar Teaching Hospital (UCTH).

          MATERIAL AND METHODS:

          A questionnaire based cross-sectional survey was conducted among randomly recruited physician offering antenatal services between August and September 2015. Systemic sampling was used to select 70 doctors in the departmental duty roster. Data were presented in percentages and proportion. Chi-square test was used to test the association between variables. Statistical significance was set at p < 0.05.

          RESULTS:

          The response rate was 100%. The mean age of the respondents was 30.26 ± 6.67 years. All the respondents routinely prescribed haematinics to pregnant women but 34.3% of them did not prescribe to apparently healthy clients in their first trimester. Only 30% and 11.4% of them prescribed it in the postnatal and preconception periods respectively. Brands that contained iron, folate and vitamins as a single capsule were mostly favoured, and information about brands of drugs was mostly provided by the pharmaceutical sales representatives. Younger doctors were more likely to offer haematinics with nutritional counselling compared to older respondents. However, there was no significant relationship between haematinics prescription and sex (p = 0.3560), Age (p = 0.839), current professional status (p = 0.783), and client complaint of side effect of medication (p = 0.23). Oral medication was mostly utilised.

          CONCLUSION:

          Effort to effectively control anaemia in pregnancy should involve re-orientation of physician obstetric care providers especially about prenatal and postnatal medication and counselling.

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          Most cited references16

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          Determinants of compliance with iron supplementation among pregnant women in Senegal.

          William Jackson, C Seck (2008)
          Community iron supplementation programmes for pregnant women have lacked effectiveness, partly because of low compliance. To determine factors that influence compliance among pregnant women in Senegal. Two hundred and twenty-one pregnant women, recruited from six health centres in Dakar during their first prenatal visit, were randomly assigned to receive either a prescription to purchase iron/folic acid tablets (control, n = 112) to be taken daily, according to official policy, or to receive free tablets (treatment, n = 109). Compliance was assessed 20 weeks after enrollment through interviews and pill count. Women with low or high compliance ( or=70%) were asked to explain what influenced their adherence to supplementation. Overall compliance was 69%; it was significantly higher in the treatment than in the control group (86% vs. 48%; P < 0.0001). Women with high compliance (58%) were motivated by: (1) the perception of improved health upon taking the tablets (treatment = 24%, control = 10%); (2) the insistence by midwives that they take the tablets; and (3) the mention that the tablets would improve health. Women with low compliance (42%) reported: (1) the experience of side-effects that they associated with the tablets (treatment = 13%, control = 14%); (2) misunderstanding that they needed to continue taking the tablets throughout pregnancy (treatment = 0%, control = 18%); and (3) forgetfulness. Compliance with iron/folic acid supplementation in Senegal can be increased by providing women with clear instructions about tablet intake and educating them on the health benefits of the tablets.
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            Determinants of compliance with iron supplementation: supplies, side effects, or psychology?

            R. Galloway, J. McGuire (1994)
            Iron deficiency anemia affects over 2 billion people. Particularly at risk are pregnant women and young children. Although distribution of iron supplements is practised in many antenatal care programs in developing countries, it has often been alleged that pregnant women do not take them. Poor compliance arises not only because of patient behavior but also from factors out of the patient's control. This paper presents the results of a review of the literature on medical compliance to determine whether iron supplementation is different from other medications, to assess the known levels of compliance, and to synthesize recommendations for improving compliance relevant to iron supplementation. The review showed that compliance with iron therapy is a specific case of medical compliance. Reasons for non-compliance with iron deficiency treatment include: inadequate program support (lack of political commitment and financial support); insufficient service delivery (poor provider-user dynamics; lack of supplies, access, training, and motivation of health care professionals); and patient factors (misunderstanding instructions, side effects, frustration about the frequency and number of pills taken, migration, fear of having big babies, personal problems, nausea that accompanies pregnancy, and the subtlety of anemia which makes demand for treatment low). Much has been made about the side effects (nausea, constipation, etc.) that women might experience during iron therapy as the cause of poor compliance with iron supplementation without justification according to this review. Instead, unavailability of iron supplements was the most common reason why women did not take iron supplements. Women bear a disproportionate burden from iron deficiency anemia even though the technology exists to address the problem at low cost. Governments and health care professionals must renew their commitment to iron therapy by monitoring and improving compliance. We can significantly improve compliance by: making sure that iron supplements are available at all times; providing advanced warning about the possibility of side effects; involving the patient in the therapeutic strategy; and providing reminders, such as posters and calendars, about taking supplements.
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              Factors influencing prescribing behaviour of physicians in Greece and Cyprus: results from a questionnaire based survey

              Mamas Theodorou, Vasiliki Tsiantou, Andreas Pavlakis … (2009)
              Background Over the past few decades, drug and overall healthcare expenditure have risen rapidly in most countries. The present study investigates the attitudes and the factors which influence physician prescribing decisions and practice in Greece and Cyprus. Methods A postal questionnaire was developed by researchers at the Department of Health Economics at the National School of Public Health in Greece, specifically for the purposes of the study. This was then administered to a sample of 1,463 physicians in Greece and 240 physicians in Cyprus, stratified by sex, specialty and geographic region. Results The response rate was 82.3% in Greece and 80.4% in Cyprus. There were similarities but also many differences between the countries. Clinical effectiveness is the most important factor considered in drug prescription choice in both countries. Greek physicians were significantly more likely to take additional criteria under consideration, such as the drug form and recommended daily dose and the individual patient preferences. The list of main sources of information for physicians includes: peer-reviewed medical journals, medical textbooks, proceedings of conferences and pharmaceutical sales representatives. Only half of prescribers considered the cost carried by their patients. The majority of doctors in both countries agreed that the effectiveness, safety and efficacy of generic drugs may not be excellent but it is acceptable. However, only Cypriot physicians actually prescribe them. Physicians believe that new drugs are not always better and their higher prices are not necessarily justified. Finally, doctors get information regarding adverse drug reactions primarily from the National Organisation for Medicines. However, it is notable that the majority of them do not inform the authorities on such reactions. Conclusion The present study highlights the attitudes and the factors influencing physician behaviour in the two countries and may be used for developing policies to improve their choices and hence to increase clinical and economic effectiveness and efficiency.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Access Maced J Med Sci
                Journal ID (iso-abbrev): Open Access Maced J Med Sci
                Title: Open Access Macedonian Journal of Medical Sciences
                Publisher: ID Design 2012/DOOEL Skopje (Republic of Macedonia )
                ISSN (Electronic): 1857-9655
                Publication date Collection: 15 April 2017
                Publication date (Electronic): 20 March 2017
                Volume: 5
                Issue: 2
                Pages: 250-255
                Affiliations
                [1 ] Department of Obstetrics & Gynaecology, University of Calabar, Calabar, Cross River State, Nigeria
                [2 ] Department of Community Medicine, University of Calabar, Calabar, Nigeria
                Author notes
                [* ] Correspondence: Dr Ubong Akpan, Department of Obstetrics and Gynaecology, University of Calabar. Cross River State, Nigeria. Phone: +2348039099041. E-mail: ubongabasiakpan@ 123456gmail.com
                Article
                Publisher ID: OAMJMS-5-250
                DOI: 10.3889/oamjms.2017.036
                PMC ID: 5420783
                SO-VID: ce79a593-91e8-45d7-83ec-468e8e766d41
                Copyright © Copyright: © 2017 Ubong Akpan, Thomas Agan, Emmanuel Monjok, Chinedu Okpara, Saturday Etuk.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

                History
                Date received : 19 January 2017
                Date revision received : 09 February 2017
                Date accepted : 10 February 2017
                Categories
                Subject: Public Health

                Keywords: anaemia,iron,folate,ranferron 12,prescription,counseling
                Data availability:
                Keywords: anaemia, iron, folate, ranferron 12, prescription, counseling

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