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M.
MALIK
&
col

2.
MATERIALS
AND
METHODS

Study
design

A
comparative,
cross-­-sectional
study
was
designed
to
evaluate
the
case

records
of
patients
from
October
2010-­-
2011
including
(daily
registers,
medical

records,
prescriptions,
patient-­-held
records)
treated
for
malaria
in
public
and

private
tertiary
healthcare
facilities
in
the
twin
cities,
namely
Islamabad
(federal

capital)
and
Rawalpindi.

Study
tool

The
case
records
were
collected
from
the
male
and
female
medicine
wards

and
out-­-patient
departments
(OPD)
of
the
healthcare
facilities.
A
pre-­-validated
tool

i.e.
WHO
prescribing
indicator
form
was
used
to
collect
data
regarding
current

prescribing
practices
for
the
treatment
of
malaria(7).

The
prescribing
form
included
five
core
indicators
such
as
%
of
encounters

having
diagnosis,
average
number
of
drugs
per
encounter,
%
average
number
of

antibiotics
and
injections
prescribed
per
encounter
and
%
of
drugs
prescribed
by

generic
names.
Beside
this
few
additional
indices
such
as
demographics
of
patient,

type
of
drug
combinations
prescribed
and
availability
of
standard
treatment

guidelines
in
the
healthcare
facilities
were
also
assessed.

Prescriptions
were
also
assessed
for
the
prescribed
anti-­-malarial
drugs,

their
doses,
strengths,
frequencies
and
durations
of
use
to
check
whether
if
they

followed
national
standard
treatment
regimen
or
not.
The
minimum
requirement

for
the
adherence
of
prescriptions
with
standard
treatment
regimen
was

elaborated
and
transformed
into
measurable
adherence
indicators
scale.
The
scale

included
five
indicators
including
correct
prescribing
of
right
anti-­-malarial
drug,

its
dose,
strength,
frequency
and
duration
of
use.
The
composite
score
for
the
scale

was
5-­-10
and
lower
score
referred
to
better
adherence
with
the
standard

treatment
regimen.

Data
collection
was
planned
and
permission
for
survey
was
obtained
from

relevant
district
health
officers
(DHO)
and
Medical
superintendents
(MS)
of

respective
healthcare
facilities.
The
study
was
also
approved
by
Malaria
Control

Program,
Ministry
of
Health,
Government
of
Pakistan.

Sampling
of
facilities
and
patient
encounters

Keeping
in
view
the
federal
administrative
and
regulatory
structure
of
the

country
and
due
to
location
and
operation
of
Malaria
Control
Program
in
the

capital
city,
two
main
cities
of
Pakistan
namely
Islamabad
and
Rawalpindi
were

selected
for
the
study.
The
public
healthcare
facilities
providing
services
at

provincial
and
district
levels
are
categorized
as:
primary
level
health
care
facilities

(basic
health
units,
rural
health
centers,
mother
&
child
health
centers,
TB
clinics

502