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Household Survey on Medicine Use in Oman

Report of survey conducted in 2009

Directorate of Rational Use of Medicines Ministry of Health

Muscat, Sultanate of Oman

In collaboration with WHO/EMRO JPRM, 2008 - 2009

November 2009

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CONTENTS Acknowledgement ………………………………………………………. 3

Forward ……………………………………………………...……………. 4

Executive Summary …………………………………………………..….. 5

Background …………………………………………………..…………… 7 Introduction …………………………………………….……………… 7

Country background …………………………………...……………… 9

Objectives …………………………………………………………...…… 11

Research questions ……………………………………………………… 11

Methodology ………………………………………………….…………. 12

Results …………………………………………………………………… 16 Socio-demographic characteristics of households ………………… 16

Chronic conditions in the households …………….…………….…… 17

Traditional medicines used by households ………………………….. 18

Medicine use and medicine at home ………………………………… 20

The channels through which households treated ………………….. 22

The channels through which households obtained medicines…….. 23

Reasons for choosing health provider & place for treatment …….. 24

Storage of medicines at homes …………………………………..….. 24

Labeling of medicines found in households …………………..…….. 25

Households' knowledge of correct dosage ………………….………. 25

Left-over medicines in households …………………………...……… 25

Expiry dates of medicines in households ……………………...…….. 26

Discussion ………………………………………………………….…….. 27

Conclusion & recommendation ………………………………………… 32

References ……………………………………………………………….. 33

Annexes ……………………………………………………….…………. 35

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ACKNOWLEDGEMENTS This investigation received technical and financial support from the World

Health Organization (WHO), Regional Office for the Eastern Mediterranean

(EMRO). Sincere thanks and deep gratitude to the directors general of health

services, directors and supervisors of pharmacy and medical supply, field

researchers and data collectors as well as decent respondents from all the

governorates and regions where the survey was conducted for their

cooperation and contribution for the success of this work. Without them this

study would not have been possible.

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FORWARD The main objectives of the National Medicine Policy are to improve the availability, affordability and accessibility of essential medicines of appropriate quality, safety and efficacy to the whole population at all times and the rational use of medicines by health providers and public. Much progress has been made in the availability, affordability and accessibility of essential medicines in the Sultanate, and measures were also taken to promote the rational use of medicines by health providers, whereas promoting rational use of medicines in the community has been given a little attention. More and more efforts are needed to improve the way that medicines are prescribed, dispensed and used. It is important therefore, to have continuing structural programmes for assessing the medicine use situation in order to have evidences that will help in improving interventions and planning. There are very few studies focused on community medicine use, although it is known that there is a number of common areas of inappropriate medicine use that have negative impact on the health consumers. This survey was aimed to identify problems in the use of medicines at the community. It examined the appropriateness of use of medicines at homes. The study results pointed inappropriate use of medicines in the community that needs interventions to improve the use of medicines in households. The directorate of rational use of medicines (DRUM) team accomplished this work and urge all partners to make use of this report. Lastly I acknowledge with gratitude the financial and technical support from WHO – EMRO that enabled us to make this work a reality.

Ph. Batool Jaffer Suleiman Director,

Directorate of Rational Use of Medicines

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EXECUTIVE SUMMARY Background Irrational use of medicines in the community is a problem faced worldwide. It often leads to health hazards and needless expenditure. Few household surveys on medicine use were conducted in developing and transitional countries and non in Oman. Conducted household surveys on medicine use were rarely published or not fully documented. Objectives The aim of the present household survey was to assess the use and storage of medicines in the community and identifying related problems. Methods A cross-sectional study was conducted using a structured household interview questionnaire with a written pre-tested interview forms. The survey included 1050 households from 12 urban and rural villages in 6 wilayat located in 4 governorates and regions in the Sultanate. Key results Results showed that half (50.19%)| of the parents in surveyed households had at least basic education. Almost one fifth (19.63%) of the households have one or more family member or relative working in the health sector. There were 44.39% of households with members suffering from one or more chronic disease, mainly hypertension (36.78%) followed by diabetes mellitus (31.54%). 52.80% of households with persons using traditional medicines mainly herbal medicines (49.78%) followed by burn (34.40%). Almost all households (95%) had medicines at homes. The medicines most frequently located in the homes were musculoskeletal/joint medicines (24.91%), respiratory medicines (14.60%) and cardiovascular system medicines (12.05%). Antibiotics were found in almost half (45.83%) of households. Most (86.06%) of medicines available at homes were advised by physicians. Patients received the majority (70.32%) of their medicines from public pharmacy at no cost. The reasons for choosing the sources of treatment and the channels from which medicines obtained are the type and severity of symptoms and illness, familiarity with the required treatment, beliefs about medicines and advise from others. 30.65 of the medicines at home were stored in a refrigerator. Only 7.95% of medicines were with adequate labels. Respondents had correct knowledge of dosage of 65.86% of

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the medicines at homes. 31.64% medicines found at homes were not used at all during the survey. Unused medicines were found in 61.31% of households, they probably kept for future use, and only 4.86% households return left-over medicines to a pharmacy. 84.49% of respondents mentioned that they check the expiry date of medicine before its use, but 30.64% only sometimes check the expiry date and 12.41% of medicines at homes were already expired.

Conclusion & recommendations

The overall results suggest an inappropriate use of medicines among the sampled population. Self-medication with herbal medicines and modern pharmaceuticals; informal sources of treatment and channels of obtaining medicines; abundance of expired, unused or deteriorated medicines in the households; as well as absence of proper labeling or clear instructions for use may be contributing factors of medicine wastage, ineffective and unsafe treatment.

Based on the results of the survey the following recommendations have been suggested:

• Increase the awareness of health providers and public about the problems of inappropriate use of medicines.

• Plan and implement effective public education program for promotion of rational use of medicines in the community.

• Conduct more researches to evaluate factors involved in the irrational use of medicines by public.

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HOUSEHOLD SURVEY ON MEDICINE USE IN OMAN

Ahmed Abdo-Rabbo, Manal Al-Ansari, Brian C Gunn, Hawraa Al-Lawati, Batool J Suleiman

BACKGROUND Introduction The Conference of Experts on Rational use of medicines (RUM), convened by the World Health Organization (WHO) in Nairobi in 1985, defined RUM as follow: the rational use of medicines requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.1 Irrational use of medicines is a global problem and occurs in both developing and developed countries. In developing countries this problem is enormous and not well documented. It often leads to problems such as ineffective treatment, health risks, medicine resistance, patient non-compliance, and overall decreases the quality care of population and increases morbidity and mortality, also excessive spending on pharmaceuticals and wastage of financial resources, by both patients and health care system. Many interrelated factors influence medicine use. The health system, prescriber, dispenser, patient, and community are all involved in the therapeutic process and all can contribute to irrational use in a variety of ways. Published researches suggested that medications wastages may be due to excessive and irrational prescribing and dispensing, or the lack of control of the sales of prescription medications in the community pharmacies and poor compliance of the patients.2-5 In previous household surveys conducted in other countries, the type, quality, storage and use of medicines in hands were studied. The studies founded therapeutic duplication, medication wastages, and unnecessary hoarding of medications. About half of medicines in the households were not in current use and around 40% of these medicines were expired.6,7 In anther study, nearly 25% of adults surveyed admitted to having unused medicines in their homes.8

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The directorate of rational use of medicines (DRUM) conducted a baseline public knowledge, attitudes and practices (KAP) study towards rational use of medicines in Oman.9 This study suggested a certain lack of knowledge and information about the proper use of medicines by the public. Also highlighting some unsound medicine use behaviour and inappropriate benefits and practices. Of all the partners in the 4 P's of rational use of medicines, the public themselves probably play the largest role. However, despite irrational use of medicines in the community is enormous, promoting RUM by public is often forgotten and the most neglected target for all the RUM efforts. Public education has received very little attention and has often not been allocated the necessary human and financial resources. Also studies in this field received little attention and rarely published or fully documented and as a result, experience gained cannot be shared or built on. These may be due to logistics, language or literacy and other problems. On the other hand the RUM by health providers received high priority. In the Sultanate of Oman the National Medicine Policy (NMP) introduced in 2000 contained guidelines for rational use of medicines by both health care providers and the public.10 In the same year, Oman was the first country in the world to establish a national body dedicated to the rational use of medicines named the directorate of rational use of medicines.11 Public and private health facilities as well as private traditional remedy shops and healers are located through the country. The public health facilities are predominately under governmental control and are available to all citizens and expatriates working for the government at almost no cost. Prescriptions which dispensed from the public health facilities are free of charge whereas, prescriptions and over-the-counter (OTC) medications dispensed from community pharmacies are paid by the consumers i.e. out-of-the-pocket.

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Country background*

The Sultanate of Oman is located in the extreme southeastern corner of the Arabian Peninsula. It borders the United Arab Emirates on the northwest, Saudi Arabia on the west, and Yemen on the southwest.

The total area of the Sultanate of Oman is approximately 309,500 square kilometers and is composed of varying topographic areas consisting of plains (3%), mountains (15%) and wadis (dry river beds) and desert (82%). Oman is classified as an upper - middle income country with Gross Domestic Product (GDP) at market price 15,5120 R.O in 2007. The currency is the Omani Rial - OR (further divided into 1,000 baisas). The Sultanate of Oman is

administratively divided into 5 Regions and 4 governorates with 61 Wilayats and each wilayat consists of a number of villages. The regions are: Al- Dakhliyah, Al- Sharqiyah, Al- Batinah, Al- Dhahirah, and Al-Wusta, and the governorates are: Muscat, Dhofar, Musandam and Al-Buraymi governorates. The regions of Al-Sharqiyah and Al-Batinah have each been further subdivided into two, for health administrative purposes, giving a total of 11 health regions.

In 2003, the second General Census of Population, Housing and Establishments was carried out in the Sultanate of Oman. Results showed that the total population was 2,340,815 of which 23.9% are non-Omani. The health sector The Ministry of Health (MOH) is the main health care provider and is responsible for ensuring the availability of health policies and plans and monitoring their implementation. *Source: monthly statistical Bulletin, Ministry of national economy, volume 18(4), april30, 2007

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Other health care providers in the country include: Armed Forces Medical Services (AFMS), Royal Oman Police Medical Services (ROPMS), Sultan Qaboos University Hospital (SQUH), Diwan Medical Services (Diwan MS), Petroleum Development Oman Medical Services (PDOMS) and the Private Sector. The public sector provides preventive, curative, promotive and rehabilitative services through high-quality hospital and health centers that cover the Sultanate. Treatment at all government institutions is free for Omanis and for expatriates working in government services. The private sector is small compared to the public sector and caters mainly to expatriates employed outside the government sector. It has been expanded in the last few years as many Omanis also seek health care from this sector. The Pharmaceutical Sector The pharmaceutical sector consists of:

• The Directorate General of Pharmaceutical Affairs & Drug Control • The Directorate General of Medical Supply • Directorate of Rational Use of Medicines

The Directorate General of Pharmaceutical Affairs & Drug Control (DGPA&DC) comes under the Office of Undersecretary of Health Affairs. DGPA&DC is the Drug Regulatory Authority within the Ministry of Health with the task to ensure that the drugs are safe, effective and meet the required standards.

The Directorate General of Medical Supply (DGMS) comes under the Office of the Undersecretary for Administrative and Financial Affairs. The main responsibility of (DGMS) is the procurement, storage and distribution of all supplies of drugs, surgical and laboratory consumable items for all MOH Health Units. The Directorate of Rational use of medicine (DRUM) comes under the office of Undersecretary of Health Affairs. Acts as advisory and educational department in rational use of medicines. Aimed at improving the use of medicines by health providers through rational prescribing and dispensing and promoting the appropriate use of medicines.

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Rational/Significance of study In Oman as well as in very many developing and transitional countries there is a dearth of studies to investigate and quantify the magnitude of the problems of inappropriate use of medicines in the community. Also many of the conducted studies were rarely published or not fully documented. In Oman this is the first household survey on medicine use. OBJECTIVES General objectives

• To assess the use and storage of medicines in the community and identifying related problems

Specific objectives

• To determine certain characteristics of surveyed households • To know the prevalence and types of chronic conditions in the surveyed

households • To determine the prevalence and type of traditional remedies used by

households • To identify medicines available in surveyed households, their

therapeutic uses, by whom and for what they were/are used • To know the channels through which the people treated and obtained

their medicines and reasons for choosing these sources • To identify store places and conditions of stocked medicines and

knowledge and practices towards left-over medicines and expiry dates of medicines at homes

• To evaluate the adequacy of labeling and households' knowledge of correct dosage of medicines found in households

RESEARCH QUESTIONS

• What are the relevant socio-demography of surveyed households? • What are the common chronic diseases in the surveyed households? • Do people in the households using traditional remedy, what are their

types and how frequently used? • What are the most frequent categories of medicines found at surveyed

homes and by whom they were/are used? • What are the sources of advice on treating illness episodes and where

do people obtain their medicines?

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• What are the reasons for choosing the source of treatment (such as health facility, traditional healer, self-medication)?

• Where do people store the stocked medicines at home? • Do people check expiration date, are there any expired medicines and

how households deal with left-over medicines? • Do medicines available in the households containing adequate labels

and do people know the correct dosage regimen and route of administration of stocked medicines?

METHODOLOGY The method of data collection was a structured household interview. The study design was a cross sectional baseline study based on the methods contained in WHO manual "How to investigate the use of medicines by consumers.12 The study instrument was a written interview questionnaire in a pre-defined order for interviewing the respondents. The interview was accompanied with direct structured observation in order to have more liable information on actual behaviour than interview alone. For example in order to know what medicines they have at home, the interviewers asked the respondents to show the medicines they have at home, instead of asking "what medicines they have at homes". In this case the data collector can see what medicines are available in the households, how they stored, their expiry dates, medicines left from past treatment, adequacy of labeling and households' knowledge of correct dosage. The interview questionnaire was short and simple, but technically correct terminology and short questions were used. It was produced in Arabic language and translated into English to be ready for use when needed. A pilot test was conducted in the field. The aim of the pre-test was mainly to test the questions and things to be observed and to identify the constrains. According to the results of the pilot test the draft protocol was revised and the weaknesses were addressed before the actual survey was conducted. The data collected in the pilot test did not form a part of the survey sample. Details of the interview questionnaire is illustrated as Annexes on page 35. Basically the interview questionnaire consists of the following parts:

• The socio-demographic data of interviewed households (including nationality of the family, education of the parents and the presence of member/s in the family or relative/s working in the health sector and his/her job.

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• The common chronic diseases in the surveyed households (their prevalence and types).

• The use of traditional remedy in the surveyed households (their prevalence and types).

• The available medicines in the households (including modern pharmaceuticals and traditional remedy), their therapeutic uses and by whom they are/were used.

• The various channels through which people in the communities treated and obtained their medicines and the reasons for choosing them.

• The different storage places of the stocked medicines at homes • The expiry dates of the stocked medicines, and the left-over medicines

(left from past treatment) and how households deal with them • The adequacy of labels for the stocked medicines The households' knowledge of the correct dosage regimen and route of

administration of stocked medicines The population and sample design based on a multiple stage sampling via aggregates. In the first stage 2 governorates namely Muscat and Dhofar and one region namely North Al-Batinah were selected by convenience sampling as "survey areas" representing the Sultanate. Also another region namely North Al-Sharqyah volunteered to participate in the study and accepted. Selection of these governorates and regions was based on stratified sampling i.e. they are located in different parts of the country. Muscat governorate is the capital of the country and the largest urban area in the country. North Al-Batinah region and Dhofar governorate are located on the north and the south of the country respectively. Next, within these governorates and regions it was planned to have 2 wilayat from each governorate and region, but because of certain logistic difficulties only one wilayat was involved in the survey conducted in each of Dhofar governorate and North Al-Sharqyah region. A total of six wilayat were involved in the survey. In the third stage, each wilayat was represented by two villages, one rural with a secondary and/or tertiary health facility and urban community and the other rural with no or only primary health facility and rural community. The total number of villages in which the household was conducted were 12 villages. In the forth stage around one hundred households was surveyed in each village except the two villages of Al-Seeb wilayat in Muscat governorate and the rural village in Al-Sewiq wilayat in North Al-Batinah region only fifty households from each village were surveyed due to certain difficulties they faced to have the planned samples.

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The wilayat, villages and interviewed households were chosen by random sampling. One respondent in each family home was interviewed, usually the parents or other member of the family aged between about 20 to 60 year old. Data collectors informed that the survey should be completed if the 'house informant' or appropriate substitute is absent. Therefore, some data collection took place in the second or third visit when the family to be visited or the person to be interviewed was not present at home during the first visit. Also when a household was not able to participate in the survey; the next household was chosen as a replacement. A total of 1050 households were involved in the survey. Details of governorates, regions, wilayat and villages in which the survey was conducted and the number of surveyed households are illustrated in table 1 and figure 1. Table 1. The governorates/regions, wilayat, villages in which the survey was conducted and the number of households surveyed

Village Households Governorate / Region

Wilayat Urban Rural Urban Rural

Al-Mawaleh 50

Al-Seeb Al-Khodh 50 Hai Aldahir 100

Muscat

Qurayat Al-Sawaqum 100 Al-Multaqa 100

Sohar Wadi Ahen 100 Al-Shariseh 100

North Batinah

Al-Sewiq Wadi Al-Gahawer 50 Murbat 100

Dhofar

Murbat Twi Atter 100 Sinaw 100

North Sharqiah

Al-Medhibi Al-Aflag 100

Total 4 6 6 6 550 500 Grand Total 1050

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Figure 1. Number of surveyed households in each studied governorate and region

050

100150200250300350400

Muscat North Batinah Dhofar North Sharqiah

Governorate/Region

Hou

seho

lds

The data collectors were advised to visit around 5 houses per day and avoid visiting many houses in the same day to assure the quality of collected data. The answers of the interview and the observations were recorded immediately into the questionnaire forms by interviewers trained for this purpose. Respondents were assured of anonymity and informed that only aggregate data would be reported. Area supervisors checked all completed questionnaires at the end of each day of data collection. Study period The study was carried out over a period of approximately one year, started in October 2008. Selection and training of data collectors (interviewers) The area supervisors and data collectors were recruited from the same governorates and regions were the survey was conducted. They received training in the standard survey methodology and data collection at one day workshop. The aim of the training was to standardize the procedure for approaching the sampled residences (households) and to understand the contents of the interview questionnaire and handle it properly.

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Data processing and analysis The collected data was entered into a computerized database using "the Statistical Package for Social Science (SPSS Version 10, SPSS Inc.) Programme". The data was analysed by frequency and reported as percentage. The average calculations in respect to each indicator was made for each village, wilayat and governorate or region. The overall results of all studied governorates and regions as a representative of the Sultanate were obtained. Ethical consideration The ministry of health and the health services of the regions where the survey was conducted as will as other concerned authorities were informed before the implementation of the survey. The survey was announced via the national TV, radio and newspapers. Respondents were free to accept or refuse to participate at any time. They assured of anonymity and that any information provided will be kept confidential and also informed that only aggregate data will be reported. RESULTS Socio-demographic characteristics of surveyed households One thousand fifty (1050) households were surveyed. A slightly higher than half (52.34%) of the households represented urban community and a little less than half (47.66%) represented rural community. Almost all (98%) surveyed families were Omani citizens. Almost a half (50.19%) of the fathers and slightly less than a half (48.22%) of the mothers of interviewed families had at least completed basic or secondary education and can read and write. 15.19% and 9.53 of the mothers and fathers in surveyed households were completed colleges/universities respectively. About one third (30.93%) of the fathers and two fifth (41.78%) of the surveyed mothers were illiterate. In about one fifth (19.63%) of the surveyed households there was one or more person in the family or relative working in the health sector. In the majority (87.38%) of the households with members or relatives working in the health sector there was only one person working in the health sector, while in 10.75% of the households there was more than one person working in the health sector. The higher percent (35.91%) of the household members or relatives who worked in the health sector were nurses and 24.09%, 10.45%, 9.55%, 8.18% and 2.73% were administrators, dressing technicians, physicians, assistant pharmacists and pharmacists respectively.

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Details of certain socio- demographic parameters of the households are illustrated in table 2. Table 2. Socio-demographic characters of surveyed households

Characteristic Parameter Households Urban 52.34%

Community Rural 47.66% Omani 98.04% Non-Omani 1.50%

Nationality

Not written 0.47% University 15.33% Secondary 23.46% Basic 26.73% Illiterate 30.93%

Educational level: Father

Not written 3.55% University 9.53% Secondary 21.78% Basic 26.45% Illiterate 41.78%

Educational level: Mother

Not written 0.47% Yes 19.63% No 80.28%

Working in health sector

Not written 0.09% Family members 68.98%

Relation with households Relatives 31.12%

Chronic conditions in the surveyed households With regards to the prevalence of chronic conditions in the surveyed households, there were 44.39% of households with members suffering from chronic diseases. These households reported one or more chronic diseases in one or more members of a family (maximum chronic disease in a household was 5 diseases). The most frequent reported chronic diseases were hypertension (36.78%), diabetes mellitus (31.54%), cardiac diseases (8.63%), bronchial asthma (7.78%) and epilepsy (3.11%). Details of the common chronic diseases in surveyed households are shown in table 3 and figure 2.

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Table 3. Prevalence of most frequent chronic diseases reported in surveyed households

Chronic disease Number Percentage/average Hypertension 260 36.78% Diabetes mellitus 223 31.54% Cardiac diseases 61 8.63% Bronchial asthma 55 7.78% Epilepsy 22 3.11% Total 707 Households with chronic diseases 44.39% Figure 2. Prevalence of most frequent chronic diseases reported in surveyed households

0%

5%

10%

15%

20%

25%

30%

35%

40%

Hypertension Diabetes

mellitus

Cardiac

diseases

Bronchial

asthma

Epilepsy

Chronic Disease

perc

enta

ge

Traditional medicines used by surveyed households In 52.80% of the surveyed households there was one or more person in the household use traditional medicines. Of the respondents who use traditional medicines, 9.91% always use traditional medicines while the majority (81.24%) answered with sometimes. The most common types of traditional medicines used by the interviewed households were herbal medicines (49.78%), burn (kei) 34.40%, cupping (hejameh) (14.08%) and acupuncture (1.31%). Details on the use of traditional remedies by surveyed households are illustrated in table 4.

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Table 4. Traditional remedy used by surveyed households

Households Percentage with persons using traditional remedy 52.80 always use traditional remedy 9.91 sometimes use traditional remedy 81.24 using herbal medicines 49.78 using Burn (Kei) 34.40 using Cupping (Hejameh) 14.08 using acupuncture 1.31

There were different types of herbal medicines in the surveyed households. The most herbal medicines found and used by the households were Zamoteh (14.62%), Merqadosh (13.85%), Alhebeh Alsoda (5.38%), and Ma Werd (3.85%). Details on the herbal medicines found in the interviewed households are shown in table 5. Table 5. The types of herbal medicines found in the surveyed homes

Herb's name % Herb's name % Herb's name % Jujuba 1.54 Helol 2.31 Karawiah 0.77 Pabron 0.77 Dehen

Alhandhel 0.77 Cream Alzahra 0.77

Rumassine oil 0.77 Alhebeh Alsoda 5.38 loban 0.77 Saptasaram 0.77 Dehen Alshefa 1.54 Ma Alteekheh 0.77 Maramiah + Babong

0.77 Dehen Almeah Alsoda

0.77 Ma Zater 1.54

Altelineh Alnabawiah

0.77 Dehen Alafiah 0.77 Ma Oshbet Mosem Alamtar

2.31

Al-Hergel 0.77 zamoteh 14.62 Ma Nakheel 0.77 Alhalweh 0.77 Zeabeq cream 0.77 Ma Werd 3.85 Al-mur 0.77 Zangabeel 1.54 Merqadosh 13.85 Alneel 0.77 Alkhardel 0.77 Marhem

Algendarieh 0.77

Babong 1.54 Bader Ketan 0.77 Yenson 0.77 Bakhor Alasfal 0.77 Hebet Albarakeh 0.77 Sael Thyme 0.77 Bakhor Alshefa 0.77 Zeet Zeeton +

Hebeh Soda 0.77 Areq Alkeef 0.77

Helf Ber 0.77 Zeet Loqman 2.31 Gheliah 1.54 Unknown 23.08

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The herbal medicines found in the households were previously or currently used for different diseases. The most common uses of these by households were for gastrointestinal tract problems (65.92%), for musculoskeletal/joints pain (9.23%) and for skin diseases (8.46%). Details on the therapeutic uses of herbal medicines found in the households are shown in table 6. Table 6. The therapeutic uses of herbal medicines found in the households as mentioned by surveyed families

Therapeutic use % Therapeutic use % Hyperlipidaemia 1.54 Common cold 0.77 Cough 2.31 Muscular pain 9.23 Diabetes 2.31 Skin 8.46 Ear infection 0.77 Respiratory 3.08 GIT problems 56.92 Central Nervous System 3.08 Hypertension 1.54 Obstetric/gynecology 3.85 Knee pain 2.31 Ear, Nose & Throat 0.77 Unknown 3.08 Medicine use and medicine at home Medicines were found in almost all (95%) of the surveyed households. The overall average number of medicines per household was 6 medicines (maximum 45 medicines). 39.04% of medicines at homes used by males and 55.33% used by females. With regards to different ages of household members who use the medicines found in the households 27.02%, 8.95%, 48.88%, and 9.14% of medicines were used by children (<12 years), adolescents (12-20 years), adults (>20-60 years) and geriatrics (> 60 years) respectively. For 6.01% of medicines found at homes the data collectors did not fill in the survey forms the ages of medicines users. 31.64% of medicines found in the surveyed households were not used at all, 51.93% and 0.50% were used for the same illness/symptoms and different illnesses respectively. For 0.53% of medicines found at homes the data collectors did not fill in the survey forms their current uses. Also the households did not mention the use of 15.41% of the stored medications. Information on medicine use and medicine at home are shown in table 7.

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Table 7. Medicines in surveyed households and their use

% families who had medicines at homes 95.00 Average # of medicines found/household 6.0 Maximum # of medicines found in a household 45 % medicines at homes used by males 39.04 % medicines at homes used by females 55.33 % medicines at homes used by children (< 12 years) 27.02 % medicines at homes used by adolescents (12-20 years) 8.95 % medicines at homes used by adults (> 20-60 years) 48.88 % medicines at homes used by geriatrics (> 60 years) 9.14 % medicines at homes not used at all 31.64 % medicines at homes used for same illness 51.93 % medicines at homes used for different illness 0.50 Medications were also categorized according to their pharmacologic or therapeutic class using the classification of medicines adopted in the Omani National Formulary (ONF).13 Medicines found in the households were used for different diseases. The most frequent categories of medicines located in homes were musculoskeletal/joints drugs (24.91%), followed by respiratory drugs (14.60%), anti-infective drugs (13.72%), cardiovascular drugs (12.05%), and gastro-intestinal drugs (8.26%). Details of the pharmacologic classes of medicines found in households are shown in table 8. Table 8. Pharmacologic classes of medicines found in surveyed homes

Pharmacologic class % Pharmacologic class % Anti-infective drugs 13.72 Gastrointestinal drugs 8.26 CNS drugs 3.16 Muscloskeletal /joints

drugs 24.91

Cardiovascular drugs 12.05 Nutrition & blood 4.21 Cytotoxic & immunosupressant 0.17 Obs/gyne/UT drugs 1.22 Endocrine drugs 5.07 Respiratory drugs 14.60Ear, nose & throat drugs 3.24 Skin preparations 3.35 Eye preparations 2.44 Herbal medicines 3.60 In 45.83 % of the surveyed households there was one or more antibiotics and the percentage of antibiotics from all medicines found at homes was 12.55%. The most frequent class of antibiotics found in the households was

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penicillins (51.66%), followed by cephalsporins (11.70%), metronidazol (8.61%), tetracyclines (5.74%), and macrolides (5.08%). The maximum number of antibiotics found in a household was 10 antibiotics. Information on antibiotics found in the studied households were shown in table 9. Table 9. Information on antibiotics found in the surveyed households % households with antibiotics 45.83 %% antibiotics from all medicines found at homes 12.55% Maximum number of antibiotics found in a household 10 Most frequent classes of antibiotics in households:

Penicillins 51.66% Cephalosporins 11.70% Metronidazol 8.61% Tetracyclins 5.74% Macrolides 5.08% Quinolones 3.75 Aminoglycosides 3.09

Other antibiotics 10.38 The channels through which households treated Households mentioned that the medicines they had at home were advised by different health workers, traditional healers or self-medicated through self decision or advised by relatives, friends, neighbours or others. The majority (86.06%) of medicines available at surveyed homes were advised by physicians, whereas, 0.64% of medicines were advised by pharmacists/dispensers, 0.67% by nurses and 0.67% of medicines advised by traditional healers. 8.06% of medicines found in the surveyed households were self-medicated. 5.38%, 0.64%, 0.55%, 0.30%, 1.08%, and 0.11% were decided by self, advised by a family member, a relative, a neighbour, a friend and mass media respectively. For 3.91% of medicines found at homes the data collectors did not fill in the survey forms the persons who advised to use these medicines. Details of the sources who advised households to use the medicines found at their homes are shown in table 10.

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Table 10. Peoples from whom households sought health care

Health care provider Percentage Physician 86.06 Pharmacist/Dispenser 0.64 Nurse 0.67 Traditional healer 0.67 Self-medicated 8.06

Him/her-self 5.38 Family member 0.64 Relative 0.55 Neighbour 0.30 Friend 1.08

Mass media 0.11 Not mentioned 3.91 The channels through which households obtained medicines People obtained their medicines from different places. The majority (70.32%) of medicines found in the surveyed households were obtained from public pharmacy (a pharmacy at a public health facility), followed by 21.11% of medicines obtained from private (community) pharmacy. 2.05%, 0.97%, 0.11%, 0.80% and 1.00% of medicines found at homes were obtained from market stall/general shop, traditional remedy shop, prepared at home, borrowed from others and brought from abroad. For 3.63% of medicines found at homes the data collectors did not fill in the survey forms the channels through which these medicines obtained. Details of the places from where households obtained the medicines found at their homes are shown in table 11. Table 11. Places from where medicines found in households obtained

Sources of medicines Percentage Public pharmacy 70.32 Private pharmacy 21.11 Market stall 2.05 Home made 0.97 Borrowed 0.80 From abroad 1.00 Herbal shop 0.97 Not mentioned 3.63

24

Reasons for choosing health provider and place for treatment Respondents in the household survey mentioned several reasons for choosing particular sources of treatment and the places from where medicines found at homes obtained. The reasons for choosing the sources from whom health care was sought and the channels from where medicines obtained were as follow: The common reasons for choosing a public health facility by households which mentioned by respondents were as follow: affordable cost, best treatment, short distance to reach the health facility and same working place.

The common reasons for choosing a private health facility by households which mentioned by respondents were as follow: to avoid crowd in public health facility and have fast service, not having the opportunity to be treated in public health facility (expatriates not working for the government), have better treatment, good quality of medicines, long distance to reach the public health facility and the public health facility was closed.

The common reasons for choosing traditional medicines by households which mentioned by respondents were as follow: preference and belief on traditional remedy, experience and no side effects.

The common reasons for choosing self medication by households which mentioned by respondents were as follow: Personal and others knowledge and experience and small health problem. Storage of medicines at homes Medicines stored at homes in different places. One of the most common storage places where medicines found at homes during the survey was a refrigerator (30.65%). The other places where the medicines stored at homes were cupboard (23.25%), drawer (11.94%), shelf (12.52%), box (2.94%), bedroom (17.54%), kitchen (0.55%), and bag (0.11%). The common places where medicines stored at homes are illustrated in table 12.

25

Table 12. The common places where medicines stored at home

Storage place Percentage Refrigerator 30.65 Cupboard 23.25 Bedroom 17.54 Shelf 12.52 Drawer 11.94 Box 2.94 Kitchen 0.55 Bag 0.11 Not written 0.50 Labeling of medicines found in households Dispensers should put a label on the medicine packages they dispense and record essential information on it. Labels of medicines considered adequate and acceptable if they include patient name, medicine name and dosage.14 Each medicines available at homes should contain adequate label. The overall percentage of medicines found in surveyed households with adequate labels i.e. containing all the above information was 7.95%. Households' knowledge of correct dosage Health providers should give the patients or care takers information mainly on route of administration and dosage schedule (dose, frequency and duration) of the medicines they receive. Households' knowledge for each medicine considered correct if they have adequate knowledge about route of administration and dosage schedule of their medicines.14 The overall percentage of medicines found in surveyed households for whom respondents had adequate knowledge of correct route of administration and dosage was 65.86%. Left-over medicines in households Left-over medicines are medicines available in a household from previous treatment. In many of the visited houses there were medicines left from previous treatment. These medicines were not used at all or used for symptoms similar to those occurred in the past and for which the medicine was advised. 61.31% of the households did not dispose the left-over medicines but keep them at home probably for future use. A very low percentage (4.86%) of households return them to a pharmacy and about one

26

third (33.27%) of the respondents answered that they throw out the medicines left from past treatment. With regards to the type of disposed left-over medicines, 58.97% of the households dispose only expired medicines whereas 37.85% dispose any left-over medicines either expired or non-expired. Details on the left-over medicines in the surveyed households and their disposal are shown in table 13. Table 13. The left-over medicines in the surveyed households and their disposal

Households PercentageKeep left-over medicines from previous treatment 61.31 Return left-over medicines to a pharmacy 4.86 Throw out the left-over medicines 33.27 Dispose only expired medicines 58.97 Dispose both expired and non-expired medicines 37.85

Expiry dates of medicines in households The majority (84.49%) of the interviewed households mentioned that they check the expiry date of medicine before its use, while 15.51% of the respondents answered that they do not check the expiry date. Of the respondents who mentioned that they check the expiry date about two third (67.26%) said they always check the expiry date while about one third (30.64%) said they do it sometimes.

The expiry date was mentioned on 97.64% of the medicines found in the surveyed households. 12.41% of medicines found in the households were expired as seen on the medicines' packages. The expiry dates for 2.25% of the available medicines in the households were not filled in the forms by the data collectors. Information on the expiry dates of medicines found at homes are illustrated in table 14.

27

Table 14. Information on expiry dates of medications found in the surveyed households Respondents mentioned they check expiry date 84.49%Respondents mentioned they do not check expiry date 15.51%Respondents mentioned they always check expiry date 67.26%Respondents mentioned they sometimes check expiry date 30.64%Medicines in households with expiry date 97.64%Medicines in households already expired 12.41% DISCUSSION Household surveys are relatively difficult to conduct. This is because high cost, time consumed, long distance to reach households, also some families of the data collectors do not accept that their daughters or sisters visit households and it was difficult for male data collectors to enter a house in the absence of a male in the house. However, studies carried out in the community are very important as they enable researchers to understand medicine use practices and its related aspects from the patient's and consumer's point of view, and may stimulate the development of adequate medicines policies.15 The current study attempted to quantify the type, quality, storage and use of medicines in the community and identifying related problems. A particular strength of the research design was the prospective nature of the study, where an inventory of medicines at homes was made for each household participating in the study. The interpretation of the study results was general in relation to different environment and characters of the studied households. The overall results of the studied households regardless the geographical location of the surveyed households, nationality of the respondents (almost all were Omani), educational level of the parents, and households with one or more family member or relative working in the health sector were calculated. This survey collected information about household morbidity particularly the chronic cases. The chronic disease was defined as an illness that will not go away or take a long time to go away, even when treated. The respondents were asked to provide if there is household member with chronic disease and its type. The chronic diseases documented as they were recalled by

28

respondents. 44.39% of the surveyed households reported at least one chronic condition. This result is similar to the results of a previous study conducted in the Arabian Gulf where the presence of chronic disease was noted in 44%, 31.9% and 49.4% of Saudi, non-Saudi, and other Gulf households respectively.7 The most frequent reported chronic diseases were hypertension, diabetes mellitus, cardiac and respiratory diseases. The medicines survey collected information about both modern pharmaceuticals and traditional medicines. In more than half of the households there was one or more person in a household used traditional medicine. The most common type of traditional medicines used by households was herbal medicines followed by burn (Kei). Treatment with home remedies is common in other countries too. The reasons sited in studies for that were easy availability, accessibility, and affordability of herbal medicines as well as previous experience of treating a similar illness.16 Traditional health care providers may have an important role to play, but this requires persons with a formal medical education and strict government regulations and enforcement. Medicines found in the households and their uses is the main important part of this survey. The medicine survey gave information on which medicines people access and use, who prescribed them, where they obtained from, where they stored, their expiry date, the adequacy of labeling and patient knowledge of correct dosage. In each household the data collectors asked the respondents to see all medicines kept at home, and recorded the information directly into the questionnaire forms. Almost all households had medicines at homes and only very few had no medicines on hand. Some of those who mentioned that they had no medicines at homes may be afraid to show their medicines. The average number of medicines found per a household (6 medicines) is considered to be relatively high and a very large number of medicines (45 medicines) was found in one of the surveyed households. The medications most frequently located in homes were musculoskeletal/joints medicines (24.91%), followed by respiratory medicines (14.60%) and cardiovascular system medicines (12.05%). Antibiotics were also one of the classes of medicines most commonly found in the household studied. Almost half (45.83%) of households had one or more antibiotics and 12.55% of the medicines found

29

at homes were antibiotics. Penicillins followed by cephalospoins were the classes of antibiotics most frequently located in the homes. People who are ill decide whether to go a head for treatment or not, a choice often influenced by the views of family, close friends, and the community. Once they decide that help is needed, people choose where to seek help. The sources of care from which patient received care at time of illness were health workers in a public or private health facility, traditional healers, or self-medicated by self, relative or other member of the community. Most (86.06%) of medicines available at home were advised by physicians and 8.06% medicines were decided by other than health workers and by self. In general people obtain their medicines from different places, some are formal and others are informal sources. Patients received the majority (70.32%) of their medicines from public pharmacy at no cost, followed by community pharmacy while other medicines obtained from other sources. Self-medication was prevalent among households participating in this study. In Arab countries, more than 50% of medicines obtained from community pharmacies are purchased either without prescription or on the advise of pharmacist.17 Problems occur when medicines obtained from unsupervised sources or through direct purchase from pharmacy or market stall without consulting a health professional. The reasons why people choose different providers for treatment and places to obtain their medicines were similar to those found in other studies. The common reasons for choosing sources through which households treated and obtained their medicines in this study were the symptoms are minor, have past experience and familiarity with the required treatment, advise from friends and relatives, and their beliefs about medicines and the type of illness. How medicines are stored is very important. Heat, moisture, light, and dirt can all harm medicines, making them unsuitable for use. Therefore, patients should ask the health care providers where and how to store their medicines at home and should follow the storage instructions. High percentage of medicines found at homes were stored in a refrigerator. People should know that only few and specific medicines need to be stored in a refrigerator in order to maintain their quality and efficacy, whereas other medicines may be spoiled and lose their activity when stored in a refrigerator. In general

30

medicines which are not stored properly, may loose their action and become toxic even before their expiry date. Also it is important that medicines should be stored out of the reach of children to avoid any accidental poisoning. Expiry date is the period extended from the date of manufacture to the date on which the medicine should not be used by the patient or consumer. The expiry date of a medicine is valid if the medicine stored at the proper conditions. Medicines which transferred from the original package or opened for use and particularly eye preparations and solutions formed by reconstitution of powders will have expiry date shorter than the stamped one. 15.51% of households did not check the expiration date of the product prior to drug administration. Also 12.41% medicines found in households were expired in addition to those which may be deteriorated but with valid expiry dates. Similar results were obtained in Saudia Arabia and other Arabian Gulf countries.7 Patients should not use any medicine after its expiry date or if changes in colour, taste or appearance occur. Left-over medicines i.e. medicines left from past treatment which were prescribed or purchased over-the-counter (OTC) are never fully consumed. They are either unused or used for previous illness or symptoms or even for different disease. Most of left-over medicines were obtained from public health facilities free of charge. A small percentage of prescription and OTC medicines dispensed from community pharmacies and paid for by consumers i.e. out-of-the-pocket. Therefore, government health facilities are partly to blame for the problem of medication wastages because of the polypharmacy where medicines or quantities prescribed and dispensed are not needed at all or more than needed.18 Another reason for left-over medicines is that many patients still entertain the idea that the outcome of their visit to public health facilities must be the dispensing of a prescription. Also it may be due to visiting more than one health facility at the same time or due to patient non-compliance with prescribed medicines or the failure to take the prescribed dosage or complete the entire course of medication therapy prescribed or dispensed by a health care provider.19 This problem is common to many other societies as well.20 61.31% households keep stocks of left-over medicines in their homes and 31.64% of medicines available at homes were not used at the time of the survey. As there is no regulation regarding unused medicines, patients decide what to do with any medicine that remain unused. People may re-use left-over medicines or give them to

31

relatives, friends, or neighbours who need them. Left-over medicines should not be taken on the basis of previous experience and physical response or according to advise from people other than health professionals and should not exchange medicines with others. Left-over medicines from previous treatment should neither be thrown out nor kept for future use. The accumulation of unwanted or unused medicines in the households is not only an economic burden, but also represents a significant source of accidental medication poisoning, particularly for young children. Therefore, the right action is to return back the unused medicines to a public pharmacy in order to avoid any health risks and wastage. The need for appropriate methods for disposal of unwanted medication in the home is a problem. Guidelines on safe disposal of unwanted medicines are required and an organized method of collecting unused medication needs to be introduced.21 Labeling is very important to measure the degree to which dispensers record essential information on the medicine package they dispense and also important to use the medicine properly. The WHO recommends that each medicine label should contain dose regimen, drug name and patient's name. For each medicine found at home, the data collector recorded the condition of the label. Only small percentage (7.95%) of household medicines found with appropriate label. Names of the patients were not written in almost all the labels, and dose regimens were not written with all necessary details. Omission of patient's name on medicine labels is a serious matter, with potentially serious consequences such as drug misuse, drug abuse, and overdose. Medicine labeling can be improved with computerization and proper staff training. It is important to measure the information patient or care taker should know on the dosage schedule of medicines available at homes and particularly which they use. Households' knowledge for each medicine considered correct if they have adequate knowledge about route of administration and dosage schedule (dose, frequency, and duration) of medicines available at homes. In this survey households did not have adequate knowledge of correct dosage of about one-third of the medicines available at homes. In order for treatment to be effective, it is essential that the user receive adequate information on his or her medicines. Patients should also ask the prescriber and dispenser about the instructions regarding the prescribed or dispensed medicines and understand them. If the patients do not understand the instructions, and cannot read the labels, then they cannot comply with

32

the medicines that have been dispensed to them. Also it may turns effective and safe medicines into ineffective and dangerous. Patient-provider interaction is clearly critical to health care delivery and the proper use and understanding of medicines. Health care providers should improve their communication skills and give patients the information they need in language they can understand. Therefore households' knowledge about their medicines can be improved by good communication between health providers and patients or care takers and through public education on rational use of medicines. CONCLUSION AND RECOMMENDATIONS It is obvious that there is inappropriate use of medicines in the community. Therefore, there is a well-evidenced and compelling need for promoting rational use of medicines in the community to enable people to store and use medicines in an appropriate, safe and judicious way. Based on the results of the survey the following recommendations have been suggested to improve rational use of medicines in the community:

• Increase sensitization of the public and health providers about the benefits of appropriate use of medicines.

• Increase the awareness of health providers and public about potential

dangers of inappropriate use of medicines. • Plan effective public education programs for promotion of RUM in the

community providing with the necessary human and financial resources. • Relevant governmental and institutional regulations to promote RUM

should be implemented and enforced. • More and more researches are needed focusing on the factors involved in

the irrational use of medication to help in improving interventions and planning.

It is very important to consider that changing practices towards the use of medicines in the community can take a lot of time and efforts.

33

REFERENCES 1. WHO Action Programme on Essential Drugs. Report of the WHO

Expert Committee on National Drug Policies. Geneva: World Health Organization,1995.

2. Potter M. Medication compliance - a factor in the drug wastage

problem. Nurs times. 1981; 77 (suppl 5):17-20. 3. All-Party Pharmacy Group. Concordance and Wasted Medicines.

London, United Kingdom: Royal Pharmaceutical Society of Great Britain; 2002.

4. Nasser AN. Prescribing patterns in primary health care in Saudi Arabia.

DICP. 1991; 25:90-93. 5. Freihi H, Ballal SQ, Jaccarini A, et al. Potential for drug misuse in the

Eastern provinces of Saudi Arabia. Ann Saudi Med. 1987; 7:301-305. 6. Skinner RF, Shave JHL, Harris JM, et al. A survey of medicines in

patients’ homes. Presented at: British Pharmaceutical conference; September 10-13, 1988; Conventry, United Kingdom.

7. Abou-Auda HS. Aneconomic assessment of medication use and wastage

among families in Saudia Arabia and Arabian Gulf Countries, Clinical Therapeutics, 2003; 25(4):1276-92.

8. Huge waste of medicines claimed. Pharm J. 2000; 264: 238.Editorial. 9. Abdo-Rabbo A, Al-Ansari M, Gunn B, Suleiman B. The use of

medicines in Oman: public knowledge, attitudes and practices. SQU Med J 2009; 9:124-31.

10. Ministry of Health, Oman. Oman National Drug Policy. Ministry of

Health,Sultanate of Oman, the Directorate General of Pharmaceutical Affairs Drug Control, 2000.

11. Ministry of Health, Oman. Establish the Directorate of Rational Use of

Medicines. Ministerial Decree No. 31/2000. Ministry of Health, Sultanate of Oman, 2000.

34

12. Chetley A, Hardon A, Hodgkin A, Haaland A, Fresle D. How to investigate the use of medicines by consumers. (WHO/PSM/PAR/2007.2) Geneva: World Health Organization, 2007.

13. Omani National Formulary (ONF), First Edition. Directorate of

Rational Use of Medicines, Ministry of Health, Sultanate of Oman, 2003 (Reprinted 2007).

14. WHO Action Programme on Essential Drugs and Vaccines. How to

investigate drug use in health facilities: selected drug use indicators. Geneva, World Health Organisation, 1993.

15. Gest S Van Der, Hardon A. Drug use: methodological suggestions for

field research in developing countries. Health Policy and Planning 1988; 3(2):152-158.

16. Sclafer J, Salmet LS, de Visscher G. Appropriateness of self-

medication: method development and testing in urban Indonesia. J Clin Pharm Ther 1997; 22(4):261-72.

17. Benjamin H, Motawi A, Smith F. Community pharmacists and primary

health care in Alexandria. J Soc Admin Pharm 1995; 12:3-11. 18. Al-Siyabi K, Al-Riyami K. Value and types of medicines-returned by

patients to Sultan Qaboos University Hospital Pharmacy, Oman. SQU Med J 2007; 7:109-16.

19. Abdo-rabbo A, Al-Ansari M, Gunn B, Suleiman B. The use of

medicines in Oman – public knowledge, attitudes and practices. SQU Med J 2009; 9:124-131.

20. Yosselson S, Superstine E. Drug utilization patterns in Israel. Drug

Intell Clin Pharm. 1977; 11:678-680. 21. Abahussain EA, Ball ED, Matowe CW. Practice and opinion towards

disposal of unused medication in Kuwait. Med Princ Pract 2006; 15:352-7.

35

ANNEXES: Interview forms Interview forms (1) Respondent No.: -----------------------

Governorate/Region:---------------------------------

Wilayat:------------------------------------------------

Village: ------------------------------------------------

Community: Urban Rural

Date of interview: -----------------------------------

Interviewers: Name: --------------------------- Profession: ---------------------------

Name: --------------------------- Profession: ---------------------------

First: Socio-demographic information

1. Nationality: Omani Non- Omani Specify: -------------------------

2. Educational level of the father:

Illiterate Primary/intermediate secondary University

3. Educational level of the mother:

Illiterate Primary/intermediate secondary University

4. Is there any member in the family working in a health sector? Yes No

If yes, specify his/her: Relation ------------------------ Job --------------------------------

Second: Family Health condition and Treatment of health problems

1. Is there anyone in the house suffering from chronic disease?: Yes No

If Yes: Diabetes HTN Asthma Cardiac Other (Specify …………….)

2. Is there anyone in the house using traditional medicines?: Yes No

If Yes: Herbs Burn Cupping Acupuncture Other (Specify ………….)

3. How frequently traditional medicines used by the family? Usually Sometimes

36

Third: Information on expiration date and left-over medicines in the households

1. Do you check the expiry date before you use the medicine? Yes No

If yes: Always Sometimes

2. How do you deal with left-over (unused medicines)?:

Keep them Return them to a pharmacy Throw them

3. Which medicines do you dispose?

Expired medicines only Both expired and non-expired medicines

Fourth: Information on medicines available in the households

(currently used or left-over)

1. Do you have medicine/s in your home? Yes No

If the answer is yes

• Request them to show you the medicine/s + traditional medicines in the household

• Fill in form (2)

37

Form 2. Information on medicines available in the households (currently used or left-over)

For whom Sex

Med#

Medicine* (name, strength,

form, quantity

Content (generic name)

M F Age

Used for (illness/ symptoms)

Who advised?**

Where obtained?***

When obtained?***

Reasons for choosing

place & ttt.*4

*The name of Western, traditional and home medicines **No advice i.e. by self, advice from: HW, Family member, relative, neighbour, friend, knowledge from mass media, other (specify) ***Public HF, private HF, community pharmacy, market stall, borrowed, other (specify) *4 Personal knowledge or experience, cost (affordable), long distance to reach HF, Prefer or belief more traditional medicines, lack of confidence in health worker/ health facility, other (specify)

38

Form 2. Information on medicines available in the households (currently used or left-over) - Continue

Used by

Storage Expiry date

Package Adequacy of labeling

Patient knowledge of Correct dosage

Other

Med

# No one

Same one sex age

Any one

What is the current use

Of the medicine

Place**

Condition*** Pre- sent

Exp-ired

Orig-inal Oth

Type Pt. name

Med.name

Dose Freq-uency

Dur-ation

Route

Dose Freq- uency

Dur-ation

*Original: The package in which the medicine was dispensed **Storage place: Medicines’ box, refrigerator, cupboard, drawer, other (specify) ***Storage condition: Good, bad (specify)

(Thank the interviewed person and assure about the confidentiality of her/his answer)

39

)1( رقم االستبياناستمارة : ...............الرقم المتسلسل للمستجوب

□ ي ريف□ ي حضر: المجتمع.......... .............:... القرية :......................الوالية:......................... المنطقة/المحافظة

:.............................المهنة:............................. االسم: خص الذي أجرى المقابلةالش:........................... تاريخ المقابلة :.............................المهنة ......................... : االسم

خاصة بالمستجوبمعلومات : أوًال : ................................... َحدد الجنسية□ غير عماني □عماني : الجنسية

□ تعليم جامعي □ تعليم ثانوي □ تعليم أساسي □غير متعلم : مستوى تعليم األب. 1

□ تعليم جامعي □ تعليم ثانوي □ تعليم أساسي □ غير متعلمة : مستوى تعليم األم. 2 □ ال □هل يوجد شخص في األسرة يعمل في قطاع الصحة؟ نعم . 3

.............................................نوع العمل؟..................................... حدد صلة القرابة؟: في حالة اإلجابة بنعم

الحالة الصحية لألسرة ومعالجة المشكالت الصحية: ثانيًا ...................) حدد (□ آخر □ القلب □ الربو □ الضغط □هل يوجد أحد بالمنزل يعاني من مرض مزمن؟ السكري . 1

□ ال □ ؟ نعم)شعبية(هل يوجد أحد بالمنزل يستخدم أو سبق وأن أستخدم عالجات تقليدية . 2 ...........)حدد( □ أخرى□ ابر صينية□ وسم□ حجامة□أعشاب طبية: ما هو نوع العالجات التقليدية : في حالة اإلجابة بنعم

□ أحيانا□باستمرار : يتم ذلك

وتاريخ صالحيتها )التي يتم استخدامها والمتبقية(األدوية الموجودة في المنزل معلومات حول: ثالثًا □ ال □ عمن: هل تتأآدوا من تاريخ صالحية الدواء قبل استعماله. 1

□ أحيانًا □نتأآد باستمرار : إذا آانت اإلجابة بنعم □ نرميها □ نرجعها إلى الصيدلية □نحتفظ بها : ؟)التي لم تستخدموها(آيف تتعاملوا مع األدوية المتبقية . 2 □ ِه تاريخ صالحيتهافة األدوية التي انتهى أو لم ينت آا□التي انتهى تاريخ صالحيتها : أي من األدوية المتبقية التي تتخلصوا منها؟. 3

ومعلومات حولها ) التي يتم استخدامها والمتبقية(األدوية واألعشاب الطبية الموجودة في المنزل : رابعًا

□ ال □نعم : أعشاب طبية في المنزل سواًء يتم استخدامها حاليًا أو متبقية من معالجة سابقة؟/هل توجد لديكم أدوية. 1

يستحسن مباشرة االستئذان من األسرة برؤية األدوية واألعشاب الطبية الموجودة في المنزل : مالحظة: (إذا آانت اإلجابة بنعم

من األسرة برؤية األدوية واألعشاب الطبية الموجودة في المنزليستأذن •

)من قبل جامع البيانات( التالية تعبأ االستمارات •

40

)2(ستمارة االستبيان رقم ا معلومات حول األدوية الموجودة في المنزل التي يتم استخدامها أو المتبقية

لمن و *الدواء

االسم، القوة، الشكل(

لمحتوىااالسم العلمي(

لماذا وصفاألعرا/المرض(

من نص

باستخدام

من أينالحصول عل

متىالحصو

أسباب اختيار

*طريقة العالج/ مكان

اآتب أسم الدواء آما هو مبين وأسم العالج الشعبي أو المنزلي إن وجد )حدد ذلك(اآتب اإلجابة مثال الطبيب، من تلقاء نفسي، أحد أفراد العائلة، جار، صديق، من خالل اإلعالنات، آخر *

)حدد ذلك(مرفق صحي حكومي، مرفق صحي خاص، صيدلية مجتمع، محل تجاري، من آخر اآتب اإلجابة مثل ** ) حدد ذلك(سبب آخر , أفِضل األدوية التقليدية, ُبعد المرفق الصحي, أقل آلفة, أآتب أسباب االختيار مثل معرفة أو خبرة شخصية***

):2(تابع االستبيان رقم )تابع(ل التي يتم استخدامها أو المتبقية معلومات حول األدوية الموجودة في المنز

يستعمل من قبل

التخزين

تاريخ الصالحية

العبوة

)مكتوب عليها( مالئمة بطاقة الدواء

معرفة المريض باإلرشادات

ال آخرونحد

نفسعمر جنس الشخص

أيشخص

لماذا يستعمل

حاليا؟

مكان 2* الخزن

حالة 3*الخزن

مكتوبة

انتهت

*األصلية

غيراألصلية

نوعها

اسمالدواء

اسم المريض

الجرعة

التكرار

الفترة

طريقةاالستخدام

الجرعة

التكرار

التي صرف فيها الدواء من المصدر: األصلية* )حدد ذلك(آخر , درج مكتب, صندوق خاص بحفظ األدوية, دوالب المالبس, الثالجة: مكان الخزن2* )وضح بكلمات مثًال تالف(سيئة , جيدة): الدواء(حالة الخزن 3*