PRESCRIBING PATTERNS AND RATIONAL USE OF MEDICINES IN EAST AFRICA: A SYSTEMATIC REVIEW

Abstract

Background: Irrational prescribing including polypharmacy, over-use of antibiotics and injections, and low adherence to essential medicines lists (EML) remains a persistent problem across low- and middle-income countries, with important implications for Antimicrobial Resistance (AMR), treatment cost, and patient safety in general.

Objective: To synthesize published evidence on prescribing patterns and rational medicine use in East African countries using WHO/INRUD core prescribing indicators, and to compare practices across countries and healthcare settings under WHO supervision.

Methods: This review follows a PRISMA 2020-guided protocol. Eligible studies were cross-sectional, retrospective, or prospective observational studies reporting one or more WHO/INRUD prescribing indicators in Tanzania, Kenya, Uganda, Rwanda, Burundi, South Sudan, or Ethiopia. This manuscript reports a narrative synthesis based on ten primary studies and one regional multi-country synthesis identified through structured searches; formal multi-database screening and quality appraisal using the JBI checklist are outlined as next steps.

Results: Across identified studies, the average number of medicines per encounter ranged from 1.8 to 3.2 (WHO optimal: 1.6-1.8), generic-name prescribing ranged from approximately 51% to 98% (optimal: 100%), antibiotic-encounter prevalence ranged from 23% to 84%, injection-encounter prevalence ranged from 7% to 14%, and EML conformity ranged from approximately 96% to 100%. No eligible studies were located for Rwanda, Burundi, or South Sudan in this search.

Conclusion: Published data indicate persistent deviation from WHO optimal prescribing values in East Africa, particularly for polypharmacy and antibiotic over-prescribing, alongside comparatively strong performance on EML conformity. Findings support continued antimicrobial stewardship and prescriber-education interventions, and highlight an evidence gap for several East African countries.

                 

Peer Review History:

Received 28 July 2026;   Reviewed 5 September 2026; Accepted  9 October; Available online 15 November 2026

Academic Editor: Dr. Nuray Arı, Ankara University, Turkiye, [email protected]

Reviewers:

Dr. Vanina Doris Edo’o, University of Yaounde I, Yaounde, Cameroun, [email protected]

Dr. Tamer Elhabibi, Suez Canal University, Egypt, [email protected]