Published in PLOS One on 2026-07-29, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Robi Cynthia Chacha, Ermias Mergia Terefe
Source: PLOS One • DOI 10.1371/journal.pone.0354373
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Suboptimal medicine use practices remain a major global health challenge, particularly in low- and middle-income countries, where it contributes to increased healthcare costs, and the growing burden of antimicrobial resistance. This study aimed to evaluate drug use patterns at Thika Level 5 Hospital in Kenya using World Health Organization (WHO) core drug use indicators.
A facility-based cross-sectional study was conducted in the outpatient department. Data were collected from 600 prescriptions, 100 patient encounters, and facility-level assessments using standardized WHO/INRUD data collection tools. Descriptive and inferential analyses were performed using IBM SPSS Statistics (version 29), and findings were descriptively compared with WHO reference standards.
The mean number of drugs per prescription was 3.18, which was higher than the WHO recommended range of 1.6–1.8. Generic prescribing was 45.86% while antibiotic prescribing was observed in 58.7% of encounters. Injection use was 13.0% and 76.86% of prescribed medicines were from the Essential Medicines List (EML).
Patient-care indicators showed a mean consultation time of 4.26 minutes and a mean dispensing time of 122.8 seconds, which was below the WHO- recommended reference value. Only 30.0% of medicines were adequately labelled, and 44.0% of patients demonstrated complete knowledge of their medications. Significant associations were observed between dispensing time and patient knowledge (p = 0.001), as well as between labelling adequacy and patient understanding (p < 0.001).
In contrast, all facility indicators met WHO standards, with full availability of essential medicines, treatment guidelines, and stock records.
Despite strong facility readiness, important gaps were identified in prescribing and patient-care practices. These findings highlight opportunities for interventions aimed at strengthening antimicrobial stewardship initiatives, promoting generic prescribing, improving dispensing practices, and enhancing patient counselling to support improved medicine use practices..
1 Introduction
The rational use of medicines (RUM) is a cornerstone of effective healthcare delivery, ensuring that patients receive medications appropriate to their clinical needs, in correct doses, for an adequate duration, and at the lowest possible cost to both individuals and health systems [1]. Despite its critical role in improving patient outcomes, suboptimal medicine use practice remains a major global health challenge. This issue is particularly pronounced in low- and middle-income countries (LMICs), where it contributes to increased morbidity, mortality, antimicrobial resistance (AMR), and unnecessary healthcare expenditure. Recent global analyses continue to indicate that a substantial proportion of medicines are prescribed or used inappropriately, highlighting persistent gaps in prescribing and dispensing practices [2,3].
In this study, rational medicine use refers to the appropriate prescribing, dispensing, and use of medicines according to patients’ clinical needs, in correct doses, for adequate duration, and at the lowest possible cost. Polypharmacy was operationally defined as the prescribing of multiple medicines per patient encounter, particularly when the average number of medicines per prescription exceeds the WHO/INRUD recommended range of 1.6–1.8 medicines per encounter.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Robi Cynthia Chacha, Ermias Mergia Terefe. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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