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Diagnoses and prescribing for pediatric patients at two hospitals in Harare, Zimbabwe.


 During March-August 1990 in Zimbabwe, researchers reviewed the medical records of 500 consecutive patients, 0-12 years old, at Harare Hospital and Parirenyatwa Hospital to lean what the most frequent pediatric diagnoses were and to compare prescribing patterns. These hospitals were of comparable size but served different populations. Patients at Harare Hospital tended to have a lower income and be children than those at Parirenyatwa Hospital. Parirenyatwa Hospital specialized in cardiovascular, hematology, medicine, and oncology services. Clinicians identified 737 diagnoses. The most common diagnoses included respiratory infections (39.4% of patients), gastroenteritis (16.8%), malnutrition (10.4%), sepsis (9.6%), and AIDS (8.6%). 97.8% of the children received at least 1 medication (1725 prescriptions). The mean drugs prescribed per patient stood at 3.45 (range, 0-18). Patients with AIDS accounted for the high end of the range. The most frequently prescribed drug type was antibiotics (about 35%), especially penicillin. The recommended duration of antibiotic treatment is 7-14 days, but the mean duration among these children was only 5.1 days. Harare Hospital had more patients admitted for infections and neurologic conditions than did Parirenyatwa Hospital (47.1% vs. 35.% and 4.5% vs. 2%, respectively), which accounted for the higher prescription rate for anti-infective drugs and central nervous system drugs at Harare Hospital (55.4% vs. 47.3%, and 3.5% vs. 2.6%, respectively). Parirenyatwa Hospital had more surgical procedures and febrile convulsions than Harare Hospital, which explained why it had higher prescription rate for analgesics (12.5% vs. 8.7%). It also had more children diagnoses with respiratory infections. Harare Hospital had more malnutrition, sepsis, and AIDS pediatric cases. Since the two hospitals served different socioeconomic populations, it was not surprising to find differences in prescription patterns, which were appropriate and tended to abide by the Essential Drugs List recommendations.
