Assessment of prescribing in under-five pediatric outpatients in Nigeria: an application of the POPI (Pediatrics: Omission of Prescription and Inappropriate Prescription) tool

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Abstract Background Ensuring the right drug for the right clinical condition in children under five years of age will dramatically reduce morbidity and mortality rates in developing countries where these values are alarmingly high. This study evaluated prescribing in children under the age of five attending pediatric outpatient clinics at three Central hospitals in Delta State, Nigeria, using the Pediatics: Omission of Prescriptions and Inappropriate Prescription (POPI) tool. Methods This was a prospective descriptive study of prescriptions made to children from 0 to 59 months who attended the clinics between August and November 2018.Prescriptions were evaluated using the POPI tool, occurrence of potentially inappropriate prescriptions and prescribing omissions were reported as percentages and inappropriate prescription types and prescription omissions were also reported as frequencies. Relationship between inappropriate prescriptions, omissions of prescriptions, and categorical variables of age group and sex, p <.05 were considered significant. Results A total of 1,327 prescriptions from the three centers were analyzed. There was a preponderance of infants (> 1 month-12 months of age) in the study (43.0%) and a somewhat even gender distribution. Exactly 29.8% of all the prescriptions studied had at least one occurrence of inappropriate prescription. The use of H1 antagonists with sedative or atropine-like effects accounted for the majority of inappropriate prescriptions (49.5%), while the prescription of drinkable amoxicillin or other antibiotics in doses other than mg was the most frequent omission of prescription (97.2%). There was a significant relationship between the occurrence of inappropriate prescription and age group (p> 0.001). Conclusion The occurrence of inappropriate prescriptions and omissions of prescriptions was high and effectively detected by the POPI tool. Measures should be taken to improve prescribing in order to reduce morbidity and mortality in children below five years.

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