90% of departmental and district hospital staff in Haiti are
recent medical graduates who lack training in rational drug use. This leads to
inappropriate use of multiple antibiotics for treatment of acute respiratory infections
(ARIs). A proposed nationwide intervention aimed at improving the quality of ARI
prescribing is based on a pilot study in which 12 social resident physicians assigned to 3
randomly selected community hospitals received training in the rational use of essential
drugs for ARIs.
proposed study (based on the results of a pilot project) aims at: (1) improving the use of
antibiotics for treatment of ARI; and more broadly, (2) changing the prescribing habits of
young physicians during and after their first year of social residency.
pilot project employed a time-series design without comparison group. For analysis,
variation in the quantity of antibiotics and other ARI treatments was monitored monthly
for 12 months beginning 3 months prior to training.
districts hospitals in the northern, central and southern departments of Haiti.
Study Population: 12 social residents physicians in 3 randomly selected districts hospitals.
quality improvement intervention was delivered to social resident physicians at the State
University Hospital during a 4-day period, and before the assignment to the district
hospitals. The intervention delivered by personnel in Haitis Essential Drug
Programme consisted of information on clinical management of ARIs involving the use of
essential drugs. The content included guidelines for reducing use of multiple antibiotics
and other potentially inappropriate ARI treatments such as multiple analgesics and cough
Outcome measure(s): Data on prescriptions written for ARIs were collected for each of the
intervention in the pilot study resulted in a decline in antibiotic prescriptions from 78%
of total ARI prescriptions to 40%.
Such an intervention/study clearly proves the need to train all physicians in rational
drug use as a way to improve their practices and decrease the inappropriate use of drugs,
especially in countries with limited resources.
ARIs account for 40 to 60
percent of visits
Typical multi-prescription for ARI treatment in the 3 selected
||1 cough syrup
||1 MTV (multivitamin) syrup or tablets
||1 to 2 antibiotics (ampicilline +
gentamycine) or cotrimoxazole
||vitamin C (very frequent)
||chloroquine (usually because of
In rural areas
Community health centres 4.6 drugs/ARI prescription.
District hospitals, dispensaries, etc.
In urban settings
Hospitals, health clinics 3.5 drugs/ARI prescription