Evaluation of Rational Drug Use Indicators at Primary Health Centres in Imo State, South East Nigeria

Rational drug use is foundational to achieving quality health outcomes and cost-effective healthcare delivery. In low-resource settings such as Nigerian primary health centres, irrational prescribing can deplete limited resources and harm patients. This study evaluated core WHO rational drug use indicators at primary health centres in Imo State, South East Nigeria. A cross-sectional prescription audit was conducted across 12 primary health centres, with 480 prescriptions reviewed over a three-month period. The study assessed average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with antibiotics, percentage with injectables, and availability of essential medicines. Results showed a mean of 4.2 drugs per prescription, exceeding the WHO reference standard of 1.6 to 1.8. Antibiotic prescribing occurred in 68 percent of encounters, compared to a WHO reference of 20 to 26 percent. Generic prescribing stood at only 39 percent. Injectable drugs were prescribed in 29 percent of encounters, well above the WHO reference of 13.4 to 24.1 percent. Drug availability from the essential medicines list was only 62 percent. These indicators reveal widespread irrational drug use practices that demand urgent intervention. Pharmacist integration into primary care teams and targeted prescriber education programs are recommended. Supply chain strengthening to improve essential medicine availability is also critical. Keywords: rational drug use, WHO prescribing indicators, primary health care, Imo State, essential medicines