FACTORS  INFLUENCING   IRRATIONAL  USE OF DRUGS AMONG PATIENTS  SUFFERING  FROM  CHRONIC  ILLNESSES ATTENDING   MENDE HEALTH  CENTRE  III,

W AKISO DISTRICT

ABSTRACT

In Uganda, more than 60% of the patients with chronic illness are using drugs irrationally and 43% are experiencing negative consequences such as reduced quality of drug therapy leading to increased morbidity and mortality, increased risk adverse drug reactions, emergence of drug resistance and 10% have been reported dead (Mol-I, 2014). In Mende Health Centre III, almost 45.9% of the patients suffering from chronic illness are involved in irrational use of drugs while at home or even when they are still at the Health Centre (Self Observations/interactions made in 2018).

The target study population was patients with chronic illnesses attending Mende Health Centre III. The study population represented the entire body of patients with chronic illness attending Mende Health Centre III. The sample size for this study was 30 respondents. The research was employed convenience sampling procedure during the study.

The study made the following conclusion; The health facility should add more medical practitioners so that they are able to reduce on the time the patient spends at the facility. The respondents indicate that they sometimes find that they are no drugs in the Health Centre and this has thus resulted into misuse of drugs. The results further indicate that majority of the respondents hold the view that they misuse drugs because they are sometimes affected by the distance to move to the health facility.

The health facility should add more medical practitioners so that they are able to reduce on the time the patient spends at the facility. Basing on this therefore the hospital should ensure that there are enough health workers at the facility. The respondents indicate that they sometimes find that they are no drugs in the Health Centre and this has thus resulted into misuse of drugs, therefore the government should ensure that drugs are always in the health facility to prevent irrational use of drugs. The results further indicate that majority of the respondents hold the view that they misuse drugs because they are sometimes affected by the distance to move to the health facility, therefore the study should ensure that that health facilities are near the respondents.

DECLARATION

I, Kyobutungi   Patience   affirm that, this research proposal has been done by myself and has never been submitted to any institution of learning for an academic award. All references

used in this document have been acknowledged by my supervisor.

Signature:                                                          . Kyobutungi   Patience

(Researcher)

Date:                                                       .

APPROVAL

Name of Student:                                 Kyobutungi Patience

Title of Research Study           :     Factors Influencing Irrational Use of Drugs Among Patients

Suffering From Chronic Illnesses Attending Mende Health Centre III, Wakiso District

I hereby accept this proposal for the above research study and approve it for submission to

Public Health Nurses College.

Signature:                                                 .

Mr.  Baryayebwa   Herbert

Research Supervisor

Public Health Nurses College

Date:                                     .

Signature: ………………………………..                                            .

Milly  Bulwa  (Mrs.)

Principal

Public Health Nurses CollegeDate:                                     .

LIST OF ABBREVIATIONS

DHIS                          : District  Health  Information   Systems

HIV                            : Human Immune Virus

MoES                         : Ministry of Education   and Sports

MoH                           : Ministry of Health

PHNC                         : Public Health Nurses College

SSA                            : Sub Saharan Africa

UNMEB                     : Uganda Nurses and Midwives   Examinations’    Board

VHT                           : Village Health Teams

WHO                          : World Health Organization

DEFINITION OF KEY TERMS

Convenient  Sampling:  A  non-probability  sampling  method  that  relies  on  selecting  or choosing  a  sample  size from population  members  who are conveniently  available  in the sampling frame.

Dependent  Variable:  Is  one  that  varies  with  changes  In other  variables  that  are being measured in a relationship .

Factor: A characteristic or a variable that influences an outcome or an event or an occurrence

Independent Variable: Is one that stands alone and cannot be controlled by the other variables that are being measured.

Irrational        Use of Drugs: Is inappropriate or improper use of drugs amongst patients, which can cause negative health effects like drug interactions, drug poisoning, drug toxicity, cardiac arrest or even death.

Patient: In this study refers to any individual with a chronic illness like HIV, Tuberculosis, Diabetes, Cancers among others seeking health care services at Mende Health Centre III.

Variable:  Are  the  properties  of  which  one  depends  on  the  other  which  the  researcher measures in a study

Table of contents

Table of Contents

ABSTRACT  i

DECLARATION   ii

APPROVAL  3

LIST OF ABBREVIATIONS  0

DEFINITION OF KEY TERMS  1

Convenient  Sampling: 1

Dependent  Variable: 1

Factor: 1

Independent Variable: 1

Irrational        Use of Drugs: 1

Patient: 1

Variable: 1

Table of contents  0

List of  tables  4

CHAPTER ONE  6

INTRODUCTION   6

1.0 Introduction  6

1.1 Background of the Study  6

1.2 Problem Statement 7

1.3 Purpose of the Study  8

1.4 Specific Objectives  8

1.5 Research Questions 9

1.6 Justification for the Study  9

CHAPTER TWO   11

LITERATURE REVIEW    11

2.1 Introduction  11

2.2 Personal Factors Influencing Irrational Use of Drugs Among Patients Suffering  11

From Chronic Illnesses  11

CHAPTER THREE  11

METHODOLOGY   11

3.1 Introduction  11

3.2 Study Design and Rationale  11

3.3 Study Setting and Rationale  11

3.4 Study Population  12

3.4.1 Sample Size Determination  12

3.4.2 Sampling Procedure  12

3.4.3 Inclusion Criteria  12

3.5 Definitions of Variables  12

Variables: 12

Independent variables: 13

Dependent Variables  13

3.6 Research Instruments  13

3.7 Data Collection Procedures 13

3.7.1 Data Management 14

3.7.2 Data Analysis  14

3.8 Ethical Considerations 14

3.9 Limitations of the Study  14

3.10 Dissemination of Results  15

CHAPTER FOUR: RESULTS  16

4.1 Introduction  16

4.2 Demographic characteristics of respondents  16

4.2.1 Findings on gender of respondents  16

4.2.2 Findings on the age category of respondents  16

4.2.3 Findings on the level of education of the respondents 17

4.2.4 Findings on marital status of respondents  17

4.3 Personal factors influencing irrational use of drugs among patients suffering from chronic illness  18

CHAPTER FIVE: 30

DISCUSSION, CONCLUSION AND RECOMMENDATIONS  30

5.1 Introduction  30

5.2 Discussion of findings on; 30

5.2.1 Demographic characteristics of respondents  30

5.2.1 Personal factors influencing irrational use of drugs among patients suffering from chronic illness  31

5.2.2 Social-economic factors  33

5.2.3 Health facility related factors influencing irrational use of drugs among patients suffering from chronic illness 35

5.3 Conclusion  36

5.4 Recommendations 37

REFERENCES  38

APPENDICES  41

APPENDIX 1: CONSENT FORM   41

List of  tables

Table 1: Showing findings on gender of respondents              ( n=30) 16

Table 2: Shows the age category of respondents    (n=30) 16

Table 3: Findings on the level of education   n=30. 17

Table 4:Findings on the marital status    n=30. 17

Table 5: showing Type of chronic illness respondents suffer  from.. 18

Table 6:Table showing if the respondents Used drugs as prescribed. 18

Table 7: Table showing if the respondents have knowledge of side effects of irrationally using drugs  19

Table 8:Table showing Perceptions about prescription drugs used to treat chronic illness. 19

Table 9:Table showing if the findings if the respondents understand prescription dosages given by health workers 20

Table 10:Table showing findings on how often respondents take prescription drugs. 20

Table 11:Table showing findings if the respondents have ever been educated on dangers associated with irrational use of drugs. 21

Table 12:Table showing the findings on the monthly income of the respondents. 22

Table 13:Table showing findings if the monthly income is enough to support medication needs. 22

Table 14:Table showing If no to 17 has the lack of support contributed to irrational use of drugs. 23

Table 15:Table showing if findings if respondents easily access drugs from Mende Health Centre III 24

Table 16:Table showing Findings on the place were respondents access drugs other than drug shop  24

Table 17:Table showing the distance covered by the respondents to Mende health Centre III 25

Table 18:Table showing findings on the means of transport the respondents use to mendley. 25

Table 19:Table showing findings on the quality of services offered by mende hospital 26

Table 20:Table showing findings on the state of wards at Mende Health Centre III 27

Table 21:Table showing findings if the health facility always is adequately staffed. 27

Table 22:Table showing findings on the attitudes and behaviors of health workers in the health facility. 28

Table 23:Table showing findings if the drugs are available in the health facility. 28

Table 24:Table showing findings on the duration of time that it takes for the respondents to be attended to by the client 29

CHAPTER ONE

INTRODUCTION

1.0 Introduction

This chapter presents the background of the study, problem statement, purpose of the study, specific objectives, research questions and justification for the study.

1.1 Background of the Study

Irrational use of drugs is defined as inappropriate or improper use of drugs amongst patients, most especially those suffering from chronic illness (World Health Organization [WHO, 2015]). Drugs are an essential part of health care in terms of reducing mortality and morbidity from various diseases but on the other hand they can cause negative health effects like drug interactions, drug poisoning, drug toxicity and cardiac arrest or even death when used improperly or irrationally (Prnar et al., 2013).

Globally, 53% of all drugs prescribed, dispensed or sold are used inappropriately especially among patients with chronic illnesses (WHO, 2015). Irrational use of drugs continues to be a serious and widespread public health problem in especially Africa and Asia (WHO, 2014). In relation to this, of the world’s Seven Billion people, 75% of who live in Africa and Asia, have little or no access to drugs and thus irrationally use drugs (antibiotics and analgesics) when faced with a chronic illness (WHO, 2015). In most circumstances lack of awareness on drug dosage and side effects, patient drug misinformation, lack of physician’s professional advice on drugs, high drug costs and no support to reach distant health facilities are among the factors leading to irrational use of drugs among patients with chronic illnesses, (Pinar et al., 2013).

In Africa, most especially Sub-Saharan Africa, World Health Organisation (WHO) estimates that 87% of patients with chronic illnesses irrationally use drugs due to drug misinformation, misleading beliefs, overly patient demands and expectations of drugs efficacy, lack of education and training among the prescriber, inappropriate role models in drug use, lack of objective drug information, misleading beliefs about drugs efficiency, heavy patient load and pressure to prescribe among others (WHO, 2014; Ozkan et al., 2015).

In East Africa, medically inappropriate, ineffective and economically inefficient use of pharmaceuticals is commonly observed in health care systems (Njoroge, et.al, 2016). A previous study in Mbeya Hospital Tanzania,reported that 56% of patients with chronic diseases like HIV, Diabetes Mellitus, Cancer and Tuberculosis irrationally and inappropriately used prescription drugs, due to poor perceptions of drug efficacy, poor interpretation of health workers prescriptions and over reliance on unprofessional sources of information for medication, (Makwengu & Osmane, 2015).

In Uganda, the misuse of medicines tends to be determined by socio-economic, patient and health facility factors (Ministry of Health [MOH, 2014]). Economic factors include considerations such as the price of the drug and the purchaser’s financial means, financial incentives to prescribers and drug supply at a health facility (Mugisha, 2011) and factors such as the health system, prescriber and dispenser knowledge are all involved in the therapeutic process and can contribute to irrational use in a variety of ways (Mugisha, 2011; MOH, 2014).

In rural areas of Uganda including Wakiso District, it is common to find prescription drugs being sold in the markets and open areas by unqualified people (Mol-I, 2012). The irrational use of drugs continues to be widespread and this has serious health and economic implications. Knowing the exact burden of irrational drug use and factors contributing to the burden is critical for developing strategies and interventions to improve rational drug use among non-users is very important. It is against this background that the researcher is compelled to carry out this study in Mende Health Centre III Wakiso District.

1.2 Problem Statement

Globally, irrational drug use is a serious health problem that has negatively affected the user’s health and continues to be among the major public health challenges in health care delivery (WHO, 2015). It is estimated that 53% of patients with chronic illness develop drug poisoning, drug toxicity and drug resistance annually, while 8.6% die due to cardiac arrest resulting from irrational drug use (WHO, 2015).

In Uganda, more than 60% of the patients with chronic illness are using drugs irrationally and 43% are experiencing negative consequences such as reduced quality of drug therapy leading to increased morbidity and mortality, increased risk adverse drug reactions, emergence of drug resistance and 10% have been reported dead (Mol-I, 2014).

In Mende Health Centre III, almost 45.9% of the patients suffering from chronic illness are involved in irrational use of drugs while at home or even when they are still at the Health Centre (Self Observations/interactions made in 2018). This has resulted into increased morbidity and mortality among these patients. Despite right drug prescriptions given to such patients, irrational drug use seems not reducing; this therefore compels the researcher to establish the factors influencing irrational use of drugs among patients with chronic illnesses attending Mende Health Centre III, Wakiso District.

1.3 Purpose of the Study

To establish the factors influencing irrational use of drugs among patients suffering from chronic illnesses attending Mende Health Centre III, Wakiso District

1.4 Specific Objectives

1. To assess the personal factors influencing irrational drug use among patients suffering from chronic illnesses attending Mende Health Centre III, Wakiso District.
2. To identify Socio-Economic factors influencing irrational use of drugs among patients suffering from chronic illnesses attending Mende Health Centre III, Wakiso District.

• To determine health facility factors influencing irrational use of drugs among patients suffering from chronic illnesses attending Mende Health Centre III, Wakiso District.

1.5 Research Questions

1. What personal factors influence irrational use of drugs among patients suffering from chronic illnesses attending Mende Health Centre III, Wakiso District?
2. What socio-economic factors influence irrational use of drugs among patients suffering from chronic illnesses attending Mende Health Centre III, Wakiso District?

• What health facility factors influence irrational use of drugs among patients suffering from chronic illnesses attending Mende Health Centre III, Wakiso District.

1.6 Justification for the Study

The study findings were to provide respondents with empirical evidence and contribute to the growing body of knowledge, change of behaviors towards irrational use of drugs among patients with chronic illnesses attending Mende Health Centre III, Wakiso District.

The study findings were also to influence Mende Health Centre III to formulate appropriate guidelines aimed at addressing the factors contributing to irrational use of drugs in patients with chronic illnesses through community sensitization.

The findings were to motivate Mende Health Centre III, in formulating sensitization programs for community health workers (VHTs) aimed at promoting awareness on the dangers associated with irrational use of drugs.

The study findings were also to make important contribution to future research by contributing to the existing literature particularly on factors contributing to irrational use of drugs in patients with chronic illnesses.

The researcher was also to benefit from the study as it would be be a partial fulfillment of the requirement for the award of a Diploma in Nursing by Uganda Nurses and Midwives Examinations Board.

CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

This chapter presents the literature review extracted from research reports, health reports, journals and internet. The literature is presented according to the study objectives.

2.2 Personal Factors Influencing Irrational Use of Drugs Among Patients Suffering

From Chronic Illnesses

A study conducted in Iran, (Tufan, Ramazan et al., 2016) among patients with chronic illness such as Tuberculosis, Diabetes, Hypertension and HIV among others revealed that 53% of patients with chronic diseases irrationally used drugs. However, the findings indicated that, patients lacked knowledge on drug dosage and side effects, thus were not following the prescriber’s instructions.

Similarly, Patel (2015) conducted a study in Mumbai, India and noted that patients with chronic diseases irrationally used drugs due to poor perceptions of drug efficacy. In the study findings, 56% of HIV patients were taking twice the prescribed dose per day because of the perception that it would be more effective in treating their health condition.

Another study conducted by Yousif and Abubaker (2015) on the determinants of irrational use of drugs among patients with chronic illnesses in Taif, Kingdom of Saudi Arabia indicated that, misunderstanding of health workers’ prescription information and use of a multiplicity of drugs to treat the same disease condition influenced patient’s irrational use of drugs.

In Oman, a study by Abdo-Rabbo, Al-Ansari, Gunn and Suleiman (2017) revealed that relying on non- professional sources of information regarding drugs were contributory factors towards irrational use of medicines. In the findings 68% of patients with chronic illnesses such as HIV/AIDS, Hypertension and Diabetes relied on relatives and friends who lacked knowledge about drugs as major sources of information for medication, while the rest got information from health workers and on-line medical information.

A study undertaken in Nigeria, (Carter, Duong, Ho, Ngo, Greer & Weeks, 2014), on knowledge, attitudes and practices of patients with chronic diseases regarding drug use, showed a high prevalence of irrational drug use at 65%. In the findings majority (86%) of patients with chronic illnesses lacked knowledge about drug side effects such as drug poisoning, drug toxicity, drug resistance or death due to cardiac arrest, (Carter et al., 2014).

Another study conducted in Khartoum, Sudan (Awad, 2015) on irrational use of drugs among the patients with chronic illness in the community revealed that lack of health education and awareness campaigns on dangers of irrational use of drugs provided by community health workers were factors that contributed to irrational use of drugs among patients. This is not far from Amal and Salma (2014) that revealed that patient’s non-adherence to drug prescriptions, in preference for multiple drugs on the open market contributed to irrational use of drugs both while at home and within the hospital premises.

According to WHO, (2014) irrational use of drugs among patients with chronic illnesses is sometimes influenced by excessive patient’s demands or expectations of recovery from disease conditions, thus such patients are likely to resort to other drugs that are not in line with their diagnosis and prescribed treatment. This was mentioned in a study conducted in Kagadi Hospital  Uganda (Atalyeba, 2016) which revealed that 72% of patients with chronic illnesses irrationally used drugs due to expectations of quicker recovery and healing.

Ssemakula (2014) conducted a study on irrational use of drugs among patients chronic illnesses in Mulago Hospital and found out that, lack of independent information about drugs used to treat a particular chronic illness, unrestricted availability of medicines and

inappropriate promotion of medicines always prompt patients to buy and use drugs without any information concerning its use and profit motives from quack dealers selling medicines.

2.3 Socio-economic Factors Influencing Irrational Use of Drugs Among Patients

Suffering From Chronic Illnesses.

Papakosta, Zavras and Niakas (2014) investigated factors contributing to irrational use of drugs among patients with chronic illnesses in Athens, Greece and found out that poverty and lack of finances to balance between expensive medication and household requirements such as food contributed to irrational drug use. This is also frequent in rural Uganda whereby lack of what to eat among patients with chronic illnesses negatively affects their medication requirements and instead resort to use of drugs found at home without proper prescriptions (Musoke, 2014).

A study conducted in Elazig, Turkey, (Tufan et.al, 2016) on assessment of irrational use of drugs and self-medication among patients with chronic illnesses found out that most of the patients were using drugs they had at home or borrowing from a relative in case of an illness, due to lack of resources and time to visit Doctors. Similarly, Pinar et.al, (2013), revealed that, the high rate of irrational drug use among patients, especially those with low income is inability to afford or buy the required drugs.

Previous studies in Asia and Africa (Vance & Millington, 2016), have reported that reasons for irrational use of drugs among patients with chronic illnesses include, lack of transport to reach the health facility, high costs of medication, poor affordability of services, treatment and lack of health insurance. This could be the same case among patients with chronic illnesses attending Mende Health Centre Ill, who are characterized by low socio-economic status.

Askarian and Maharlouie (2012) conducted a study entitled irrational antibiotic use among patients with chronic illnesses in Shiraz, Iran and indicated that staying far from health facilities, access to cheaper drugs from drug sellers and limited time to visit physicians prompted irrational drug use. The authors noted that fear of expenses involved in reaching health facilities influenced already weakened patients to irrationally use drugs.

This is in line with a study in Ghana, ( Auta, Omale, Folorunsho, David & Banwat, 2012) on determinants for irrational use of drugs among patients with chronic illnesses, which revealed that, easy availability of medicine vendors, trusting prescriptions from quack medicine sellers and long waiting time to see a Doctor contributed to irrational use of drugs. In addition non willingness to pay consultation fees and high costs of medications in health facilities always prompts patients to seek drugs from cheaper and nearby sources (Auta, et.al, 2012).

Another study conducted in Sudan (Nuha, 2015) on factors for irrational prescription and use of drugs revealed that availability of a large number of commercial preparations in the pharmaceutical market often made drug selection difficult for patients with chronic illnesses, who will opt for the available perceived best choice. A study in Mulago National Referral Hospital also revealed that availability of cheaper alternative drugs influenced irrational drug prescription and use among patients with chronic illnesses (Ssemakula, 2014).

2.4 Health Facility Factors Influencing Irrational Use of Drugs Among Patients

Suffering From Chronic Illnesses

An evaluation of drug usage in Brazil (Loyola Filho, et.al, 2015), indicated that 60.8% of patients with chronic illnesses irrationally used drugs because they because they believed that it saves time wasted while waiting to see a doctor. Similarly Nkem and Obinah, (2012), found out that patients with chronic diseases in the Nigeria often resorted to irrational use of drugs because of overcrowded facilities and lack of privacy for consultation and treatment.

Another study in Sudan, (Awad, Eltayb, Matowe & Thalib, 2015), found out that poor quality of services offered to patients with chronic diseases led to dissatisfaction with health services and irrational use of drugs. Also Ozkan, et.al, (2015), reported that 62% of patients with chronic diseases in Tehran reported irrational use of drugs which was indicative of continuous shortage of drugs in health facilities, resorting to quack dealers.

Esra, Nazli and Clark (2013) conducted a study on factors influencing irrational drug use among patients with chronic illnesses and found out factors such as lack of support to access health facilities and high medication costs charged in health facilities. The study further showed that every step of drugs usage requires adequate advice and drug information therefore, if patients lack access to drug information from a qualified physician, they are likely to resort to irrational use of drugs.

A study in Mulago National Referral Hospital, Uganda, (Ssemakula, 2014), reported that 42% of the patients with chronic diseases reported absenteeism of health workers as their reason for resorting to irrationally use of drugs and absconding from healthcare services. Another study in Mityana Hospital also indicated that long waiting time to see a physician and non bothered attitudes of health workers made critically ill patients resort to irrational use of drugs purchased from shops and pharmacies (Nakimuli, 2014).

CHAPTER THREE

METHODOLOGY

3.1 Introduction

This chapter presents the methodology that was used in the study including ; study design and rationale; study setting and rationale; study population, sample size determination, inclusion criteria, sampling procedure, definitions of variables, research instruments, data collection procedures, data management, data analysis, ethical considerations, limitations of the study and dissemination of results.

3.2 Study Design and Rationale

This study used a descriptive cross-sectional research design and a quantitative approach of data collection was adopted. A cross-sectional design enabled the researcher to collect information from a cross-section of a given population. This design was used because it is a time and resource saving design during data collection.

3.3 Study Setting and Rationale

The study was carried out in Mende Health Centre III, Mende Sub County, Wakiso

District. It is a government funded health facility located 42 Kilometers by road, West of Kampala, Uganda’s Capital.

Mende Health Centre III has 6 beds, 12 health workers and offers curative, preventive and rehabilitative health care services to a population of 1,432 persons living within Mende Sub County and other neighboring areas in Wakiso District. On average the health facility receives 10 patients with chronic illnesses who are dispensed with prescription drugs.

Mende Health Centre III was chosen because there is no such kind of a study

ever been carried out in the same health facility, concerning factors influencing irrational use of drugs among patients with chronic illnesses despite an existing problem.

3.4 Study Population

The target study population was patients with chronic illnesses attending Mende Health Centre III. The study population represented the entire body of patients with chronic illness attending Mende Health Centre III.

3.4.1 Sample Size Determination

The sample size for this study will be 30 respondents. This sample size is considered appropriate for this study because of limited resources in terms of finances to cover a bigger sample size. It is further considered because it is a requirement as per the UNMEB guidelines

(UNMEB, 2009).

3.4.2 Sampling Procedure

The research will employed convenience sampling procedure during the study. Under this sampling procedure, the researcher will request the patients with chronic diseases conveniently available in Mende Health Centre Ill to participate in the study. Those willing to participate will be included in the study until 30 respondents are attained.

3.4.3 Inclusion Criteria

The study included all patients with chronic illnesses most especially those willing to give their consent by signing the consent form and found present during data collection. However, the study excluded patients without chronic illnesses, those with chronic illnesses who were not willing to give their consent, absent during the study and those unable to respond to the researcher due to excessive pain.

3.5 Definitions of Variables

Variables: Are the properties of which one depends on the other which the researcher investigates. For the case of this study, both independent and dependent variables were used.

Independent variables:

• Personal factors influencing irrational use of drugs among patients suffering from chronic illnesses
• Socio-economic factors influencing irrational use of drugs among patients suffering from chronic illnesses
• Health facility factors influencing irrational use of drugs among patients suffering from chronic illnesses

Dependent Variables

• Rational use of drugs among patients suffering from chronic illnesses

3.6 Research Instruments

The researcher administered questionnaire to collect data from the patients with chronic illnesses attending Mende Health Centre III. The instrument had both closed and open ended questions related to factors contributing to irrational use of drugs in patients with chronic illnesses. The questionnaire was preferred because of its time saving factor and easy data analysis.

3.7 Data Collection Procedures

After the approval of the research proposal by the supervisor, the researcher got an introduction letter from Public Health Nurses’ College to permit the study to be carried out in the study area.

The researcher also first sought for clearance from the administrators of Mende Health Centre III, and thereafter held discussions with respondents about the study where the purpose of the study, objectives and benefits were explained to both the administration and respondents.

After ascertaining the reliability of the instruments and the permission, the researcher proceeded to administer the questionnaires to the patients at the same time interview respondents who are unable to answer the questionnaires independently.

3.7.1 Data Management

Filled questionnaires during data collection were put together, sorted, checked, coded and edited for accuracy or completeness and kept in big water proof plastic bag until the time for data analysis to avoid losing and damage to collected data.

3.7.2 Data Analysis

Collected data was tallied manually using a pen and paper, then fed in the computer for analysis using SPSS version 16. The results have been presented in  in tables, figures and statistical texts depicting frequencies and percentages.

3.8 Ethical Considerations

After the approval of the research proposal by the supervisor, clearance was sought from the Principal before issuing of the introductory letter that was presented to the administrators of Mende Health Centre III seeking permission to carry out the study. The respondents too were explained to,about the aims and objectives of the study before seeking their consent to participate in the study. The identity and personality of the respondents were protected by ensuring high level of confidentiality during data collection, analysis and interpretation of the data.

3.9 Limitations of the Study

The researcher faced financial and time resource constraint, however this was overcome by drawing a suitable financial budget. More-so, a suitable time frame was designed during the study. The researcher, besides being required to meet the full cost of the study had very little time to develop a proposal, collect data, compile and submit the report.

The researcher is also encountered inadequate cooperation from the respondents during data collection. However, it was overcome by carrying out verbal discussion with the respondents and informed them of the purpose and objectives of this study and their confidentiality.

3.10 Dissemination of Results

Compiled work in form of the booklet was approved, and copies submitted to the following;

• Uganda Nurses and Midwives Examination Board in partial fulfillment of the requirements for the award of a Diploma in Nursing;
• Public Health Nurses’ College library for future reference;
• Mende Health Centre III to make the recommendations known.
• The supervisor and the researcher.

CHAPTER FOUR: RESULTS

4.1 Introduction

This chapter presents the results of the study conducted on factors influence irrational use of drugs among patients suffering from chronic illness attending Mende health Centre III Wakiso district. The results were presented according to study objectives.

4.2 Demographic characteristics of respondents

4.2.1 Findings on gender of respondents

Table 1: Showing findings on gender of respondents              ( n=30)

Source: Primary data

The findings in the study indicates that majority 57% of the respondents were male and only 43% were female.

4.2.2 Findings on the age category of respondents

Table 2: Shows the age category of respondents   (n=30)

Most of the respondents 14(46.7%) were in the age group of 21-27 years and only 1 (3.3%) was 36 years and above.

4.2.3 Findings on the level of education of the respondents

Table 3: Findings on the level of education   n=30

It was noted that half of the respondents 15 (50%) were educated to university level and only 6 (20%) were illiterate.

4.2.4 Findings on marital status of respondents

Table 4: Findings on the marital status          n=30

Furthermore, 17 (56.7%) of the respondents were single and only 3 (10%) were married.

4.3 Personal factors influencing irrational use of drugs among patients suffering from chronic illness

Table 5: showing Type of chronic illness respondents suffer from

The results indicates that majority 43.3% of the respondents were suffering from diabetes, 33.3% HIV, 16.7% cancer and only 6.7% suffered from other diseases.

Table 6: Table showing if the respondents Used drugs as prescribed

It was noted that majority 66.6% did not use drugs as prescribed and only 34.4% followed the prescription.

Table 7: Table showing if the respondents have knowledge of side effects of irrationally using drugs

The results indicates that majority 90% of the respondents did not have knowledge on irrationality of using drugs.

If yes state any knowledge

Table 8: Table showing Perceptions about prescription drugs used to treat chronic illness

It was noted that majority 43.3% of the respondents stated that prescription drugs should be taken alongside other drugs.

Table 9: Table showing if the findings if the respondents understand prescription dosages given by health workers

The table shows that majority 66.6% of the respondents stated that they do not understand the prescription drugs given by health.

Table 10: Table showing findings on how often respondents take prescription drugs

The study results indicate that majority 66.7% of the respondents stated that they take whenever necessary.

Table showing findings on where the respondents get advice

The table shows that majority 50% get information from relatives and friends.

Table 11: Table showing findings if the respondents have ever been educated on dangers associated with irrational use of drugs

The table shows that majority 1005 of the respondents indicate that they have ever receive education on irrational use of drugs.

The table further shows that majority 36.7% of the respondents indicate that they take drugs because of personal belief on the effectiveness of the drugs and only 30% stated that they take drugs because of lack of appropriate information.

Other personal related factors contributing to the irrational use of drugs.

The study results indicate that majority of the respondents from the field indicated that they feel comfortable with the drugs that is the reason why they like taking irrationally the drugs.

4.4 Socio-economic factors influencing irrational use of drugs among patients suffering from chronic illness

Table 12: Table showing the findings on the monthly income of the respondents

Majority 75% of the respondents stated they earned income in between 50,000-100,000 while only 5% earned income less than 50,000 on monthly basis.

Table 13: Table showing findings if the monthly income is enough to support medication needs

The findings from the table above indicates that 100% of the respondent state that they monthly income is not enough to support their medication needs. The table further shows that 46.7% of the respondents indicated that they get support from family members and only 20% stated that they get support from charity organization.

Table 14:Table showing If no to 17 has the lack of support contributed to irrational use of drugs.

The table above indicates that majority 100% of the respondents’ state that lack of support has contributed to irrational use of drugs.

Table 15:Table showing if findings if respondents easily access drugs from Mende Health Centre III

The results in the study indicates that majority 73.3% of the respondents’ state that they do not easily access drugs and only 26.7% of the respondents agreed.

Table 16:Table showing Findings on the place were respondents access drugs other than drug shop

The table indicates that majority 100% of the respondents indicate that they buy drugs from pharmacies.

Table 17:Table showing the distance covered by the respondents to Mende Health Centre III

The results indicates that 50% of the respondents state that they covered a distance of 4-5 kilometer to reach Mende Health Centre and only 16.7% stated that they covered less than 2 kilometers.

Table 18: Table showing findings on the means of transport the respondents use to mendley

The results indicate that majority 90% of the respondents hold the view that they travel on foot and only 10% used bicycle and motorcycle.

What other socio-economic factors contribute to misuse of drugs among patients with chronic illness

The respondents indicate that they sometimes find that they are no drugs in the Health Centre and this has thus resulted into misuse of drugs.

The results further indicates that majority of the respondents hold the view that they misuse drugs because they are sometimes affected by the distance to move to the health facility.

4.5 Health facility related factors influencing irrational use of drugs among patients suffering from chronic illness

Table 19: Table showing findings on the quality of services offered by mende hospital

The study findings indicate that majority 53.3% of the respondents stated that the services provided were and only 3.3% stated that the service are poor.

Table 20: Table showing findings on the state of wards at Mende Health Centre III

The table shows that majority 53.3% of the respondents stated that the rooms are overcrowded with no space for consultation and treatment and only 47% stated that the rooms are clean and tidy.

Table 21: Table showing findings if the health facility always is adequately staffed

The results in the table above indicates that majority 100% of the respondents stated that Mende health facility is not adequately staffed.

Table 22: Table showing findings on the attitudes and behaviors of health workers in the health facility.

The study findings indicate that majority 80% of the respondents’ state that the health workers at Mende Health Centre are negative, rude and mocking and only 3% of the respondents stated that they are fairly good.

Table 23: Table showing findings if the drugs are available in the health facility

Majority 100% state that the drugs are not available at the hospital during refill.

Table 24: Table showing findings on the duration of time that it takes for the respondents to be attended to by the client

The study results indicate that majority 60% of the respondents indicate that they spent 1-2 hours before being attended to and only 40% stated that they had spent more than 2 hours.

Findings on the respondents’ response to the health facility to improve health services

The health facility should add more medical practitioners so that they are able to reduce on the time the patient spends at the facility.

Government through the Ministry of Health to step up sensitization programs on medicine and health in general.

CHAPTER FIVE:

DISCUSSION, CONCLUSION AND RECOMMENDATIONS

5.1 Introduction

This chapter presents the discussion of results, conclusion, recommendations and implications to nursing practice. The discussion is arranged under subheadings that include; demographic characteristics, personal, socio-economic and health facility related factors contributing to irrational use of drugs among patients suffering from chronic illness attending Mende Health Centre III.

5.2 Discussion of findings on;

5.2.1 Demographic characteristics of respondents

According to the study findings, most of the respondents 14(46.7%) were in the age group of 21-27 years. This implied that they were relatively mature enough, knew about irrational use of drugs, and however could have been involved into the irrational use of drugs because of other factors like lack of proper explanation by the health workers.

From the study findings, 17 (56.7%) of the respondents were single. This meant that they sought irrational drug use because of being lonely and this forced them to be involved into the use of drugs and lack of knowledge Similarly, (Tufan, Ramzan et al. 2016) who indicated that among patients with chronic diseases irrationally used drugs did not have proper knowledge.

5.2.1 Personal factors influencing irrational use of drugs among patients suffering from chronic illness

The results indicates that majority 43.3% of the respondents were suffering from diabetes, 33.3% HIV, 16.7% cancer and only 6.7% suffered from other diseases this findings is also in line with Patel (2015) who conducted a study in Mumbai, India and noted that patients with chronic diseases irrationally used drugs due to poor perceptions of drug efficacy. In the study findings, 56% of HIV patients were taking twice the prescribed dose per day because of the perception that it would be more effective in treating their health condition.

It was noted that majority 66.6% did not use drugs as prescribed and only 34.4% followed the prescription, this view was also in line with Yousif and Abubaker (2015) stated that on the determinants of irrational use of drugs among patients with chronic illnesses in Taif, Kingdom of Saudi Arabia indicated that, misunderstanding of health workers’ prescription information and use of a multiplicity of drugs to treat the same disease condition influenced patient’s irrational use of drugs.

The findings in the study shows that majority 90% of the respondents did not have knowledge on irrationality of using drugs, this view was also in line with Abdo-Rabbo, Al-Ansari, Gunn and Suleiman (2017) who revealed that relying on non- professional sources of information regarding drugs were contributory factors towards irrational use of medicines. In the findings 68% of patients with chronic illnesses

It was noted that majority 43.3% of the respondents stated that prescription drugs should be taken alongside other drugs, 33.3% indicated that drugs Can be effective if used in double dosages and 16.7% of the respondents stated 16.7% Are not very effective. this view was also in line with a study undertaken in Nigeria, (Carter, Duong, Ho, Ngo, Greer & Weeks, 2014), on knowledge, attitudes and practices of patients with chronic diseases regarding drug use, showed a high prevalence of irrational drug use at 65%.

The table shows that majority 66.6% of the respondents stated that they do not understand the prescription drugs given by health this findings was also in line with , (Carter et al., 2014) who indicates that majority (86%) of patients with chronic illnesses lacked knowledge about drug side effects such as drug poisoning, drug toxicity, drug resistance or death due to cardiac arrest.

According to the results in the study majority 66.7% of the respondents stated that they take whenever necessary this therefore indicates that the patients did not follow the medical workers prescription this view was also in line with Awad, (2015) who indicated that in a study carried out in Sudan on irrational use of drugs among the patients with chronic illness in the community revealed that lack of health education and awareness campaigns on dangers of irrational use of drugs provided by community health workers were factors that contributed to irrational use of drugs among patients.

The table shows that majority 50% get information from relatives and friends, 10% HEALTH WORKERS, 7% other source and 33% relatives this results indicate sthat majority of the patients get advice from people who are not trained in medical work.

The table shows that majority 100% of the respondents indicate that they have ever received education on irrational use of drugs.

The table further shows that majority 36.7% of the respondents indicate that they take drugs because of personal belief on the effectiveness of the drugs and only 30% stated that they take drugs because of lack of appropriate information, this is also in line with Amal and Salma (2014) that revealed that patient’s non-adherence to drug prescriptions, in preference for multiple drugs on the open market contributed to irrational use of drugs both while at home and within the hospital premises.

5.2.2 Social-economic factors

Majority 75% of the respondents stated they earned income in between 50,000-100,000 while only 5% earned income less than 50,000 on monthly basis, 10% of the respondents , this view was also in line Papakosta, Zavras and Niakas (2014) who investigated factors contributing to irrational use of drugs among patients with chronic illnesses in Athens, Greece and found out that poverty and lack of finances to balance between expensive medication and household requirements such as food contributed to irrational drug use.

The findings from the table above indicates that 100% of the respondent state that they monthly income is not enough to support their medication needs. The table further shows that 46.7% of the respondents indicated that they get support from family members and only 20% stated that they get support from charity organization On the same view Musoke, (2014) indicates that in rural Uganda whereby lack of what to eat among patients with chronic illnesses negatively affects their medication requirements and instead resort to use of drugs found at home without proper prescriptions.

The table above indicates that majority 100% of the respondents’ state that lack of support has contributed to irrational use of drugs this is also in line with Tufan et.al, (2016) on assessment of irrational use of drugs and self-medication among patients with chronic illnesses found out that most of the patients were using drugs they had at home or borrowing from a relative in case of an illness, due to lack of resources and time to visit Doctors.

The results in the study indicates that majority 73.3% of the respondents’ state that they do not easily access drugs and only 26.7% of the respondents agreed this is also in line with Pinar et.al, (2013), revealed that, the high rate of irrational drug use among patients, especially those with low income is inability to afford or buy the required drugs.

The results indicates that 50% of the respondents state that they covered a distance of 4-5 kilometers to reach Mende Health Centre and only 16.7% stated that they covered less than 2 kilometers this view was also shared by Vance & Millington, (2016) who have reported that reasons for irrational use of drugs among patients with chronic illnesses include, lack of transport to reach the health facility, high costs of medication, poor affordability of services, treatment and lack of health insurance. This could be the same case among patients with chronic illnesses attending Mende Health Centre Ill, who are characterized by low socio-economic status.

The results indicate that majority 90% of the respondents hold the view that they travel on foot and only 10% used bicycle and motorcycle, this view was also shared by Askarian and Maharlouie (2012) conducted a study entitled irrational antibiotic use among patients with chronic illnesses in Shiraz, Iran and indicated that staying far from health facilities, access to cheaper drugs from drug sellers and limited time to visit physicians prompted irrational drug use. The authors noted that fear of expenses involved in reaching health facilities influenced already weakened patients to irrationally use drugs.

5.2.3 Health facility related factors influencing irrational use of drugs among patients suffering from chronic illness

The study findings indicate that majority 53.3% of the respondents stated that the services provided were and only 3.3% stated that the service are poor, 10% stated that the service are good, this finding is also in line with Loyola Filho, et.al, (2015) indicated that 60.8% of patients with chronic illnesses irrationally used drugs because they because they believed that it saves time wasted while waiting to see a doctor.

The table shows that majority 53.3% of the respondents stated that the rooms are overcrowded with no space for consultation and treatment and only 47% stated that the rooms are clean and tidy.

The results in the table above indicates that majority 100% of the respondents stated that Mende health facility is not adequately staffed this is also in line with Awad, Eltayb, Matowe & Thalib, (2015), who ifound out that poor quality of services offered to patients with chronic diseases led to dissatisfaction with health services and irrational use of drugs.

The study findings indicate that majority 80% of the respondents’ state that the health workers at Mende Health Centre are negative, rude and mocking and only 3% of the respondents stated that they are fairly good this view was also shared by

Majority 100% state that the drugs are not available at the hospital during refill this view was also in line with Also Ozkan, et.al, (2015) who reported that 62% of patients with chronic diseases in Tehran reported irrational use of drugs which was indicative of continuous shortage of drugs in health facilities, The study results indicate that majority 60% of the respondents indicate that they spent 1-2 hours before being attended to and only 40% stated that they had spent more than 2 hours this view was also shared by Nakimuli, (2014) who in a study in Mityana Hospital also indicated that long waiting time to see a physician and not bothered attitudes of health workers made critically ill patients resort to irrational use of drugs purchased from shops and pharmacies. On the related view Esra, Nazli and Clark (2013) conducted a study on factors influencing irrational drug use among patients with chronic illnesses and found out factors such as lack of support to access health facilities and high medication costs charged in health facilities. The study further showed that every step of drugs usage requires adequate advice and drug information therefore, if patients lack access to drug information from a qualified physician, they are likely to resort to irrational use of drugs.

The health facility should add more medical practitioners so that they are able to reduce on the time the patient spends at the facility, this view was also in line with Ssemakula, (2014) who reported that 42% of the patients with chronic diseases reported absenteeism of health workers as their reason for resorting to irrationally use of drugs and absconding from healthcare services.

5.3 Conclusion

The study made the following conclusion;

The health facility should add more medical practitioners so that they are able to reduce on the time the patient spends at the facility.

The respondents indicate that they sometimes find that they are no drugs in the Health Centre and this has thus resulted into misuse of drugs.

The results further indicate that majority of the respondents hold the view that they misuse drugs because they are sometimes affected by the distance to move to the health facility.

The study results indicate that majority of the respondents from the field indicated that they feel comfortable with the drugs that is the reason why they like taking irrationally the drugs.

5.4 Recommendations

The study made the following recommendations

The health facility should add more medical practitioners so that they are able to reduce on the time the patient spends at the facility. Basing on this therefore the hospital should ensure that there are enough health workers at the facility.

The respondents indicate that they sometimes find that they are no drugs in the Health Centre and this has thus resulted into misuse of drugs, therefore the government should ensure that drugs are always in the health facility to prevent irrational use of drugs

The results further indicate that majority of the respondents hold the view that they misuse drugs because they are sometimes affected by the distance to move to the health facility, therefore the study should ensure that that health facilities are near the respondents.

REFERENCES

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Askarian, M. & Maharlouie, N. (2012). Irrational antibiotic use among secondary school teachers and university faculty members in shiraz, Iran. Int. J. Prev.Med., 3(12): 839845.

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Awad, A., Eltayb, 1., Matowe, L. & Thalib, L. (2015). Self-medication with antibiotics and antimalarial in the community of Khartoum state, Sudan. 2015

Daban, F., Pasarin, M.I., Rodriguez-Sanz, M., Garcia-Altes, A. , Villalbi, J R., Zara, C. & Borrell, C. (2010). Social determinants of prescribed and non-prescribed medicine use. Int. J. Equity Health, 9: 12.

Esra, C, Nazli, M.S. & Clark, M.P. (2013). Factors affecting rational drug use compliance and wastage.

Karatas, Y. , Dinler, B. , Erdogdu, T., Ertug, P. & Seydaoglu, G. (2012). Evaluation of drug Use attitudes of patient and its relatives attending to cukurova university medical faculty balcall hospital. Cukurova Med. J., 37(1): 1-8.

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APPENDICES

APPENDIX 1: CONSENT FORM

Topic: Factors Influencing Irrational Use of Drugs Among Patients With Chronic

Illnesses Attending Mende Health Centre III, Wakiso District.

Dear Respondent,

I, Kyobutungi Patience a Nursing student at Public Health Nurses’ College Kyambogo carrying out a research study on the above mentioned topic, requesting you to kindly participate in this study by answering the questionnaire provided to you. You participation in this study is voluntarily and you are free to withdraw from it at any time you so wish.

The purpose of this study is to establish factors influencing irrational use of drugs among patients with chronic illnesses attending Mende Health Centre III, Wakiso District.

Your participation in this study will last for around 30-45 minutes while filling the questionnaire. In addition, your participation is completely confidential and your identity will not be revealed in the findings of this study.

I have clearly explained the purpose and objectives of the study to you and you have consented to participate

Researcher’s Signature•Date•

I have been clearly explained to the purpose and objectives of the study and I willingly consent to participate.

Respondent’s Signature:Date•

INTRODUCTION LETTER

MAP OF UGANDA

MAP OF WAKISO DISTRICT SHOWING THE LOCATION OF MENDE HEALTH CENTRE III

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