1. Economic effect of irrational use of drugs

W. Tumwikirize, ENT Department, Mulago Hospital, P.O. Box 7051, Kampala, Uganda.

Background
Results from studies conducted in several countries, including Uganda, show that there is a high degree of irrational drug prescribing. The importance of irrational drug use is that it frequently results in unsafe use of drugs, waste of the scarce resources, poor patients compliance, and preventable resistance of organisms of commonly used antibiotics. This Paper gives results of a pilot study, conducted in Mulago Hospital, to determine the amount of avoidable cost that resulted from irrational prescribing.
Methods
Prescription charts of 4 patients were reviewed. Three categories of irrational prescription were identified. These were poly-pharmacy, prolonged medication and use of more costly drug instead of a cheaper but equally effective drug was available. Only direct costs resulting from cost of excess or unnecessary drug was determined, and all figures are given in Uganda shillings.

Results
Poly-pharmacy, as a result of irrational treatment of a case of malaria, lead to waste of Shs. 1,900 due to prolonged duration of medication. Prescribing of a more expensive drug, exemplified by two cases, resulted into a waste to Shs. 4,200 in one case, and Sh.450 in another. The total wastage for the 4 cases was 16,350 Uganda Shillings.

Conclusion
Mulago Hospital incurs a big loss as a result of irrational drug prescribing.

2. HIV- related behaviour and psychological disorder among taxi drives in Uganda

E. Kinyanda, Butabika Mental Hospital, P.O. Box 7051 Kampala, Uganda

Background
Taxi drivers in Uganda are believed to be a highrisk group for HIV/AIDS. A study was therefore undertaken to assess high HIV risk behaviour and associated psychological disorder taxi drivers in Kampala.

Methods
A cross sectional descriptive study design was employed and involved a two-stage procedure. In the first stage, 231 randomly selected respondents were interviewed with a screening questionnaire while 147 respondents were subject to a second stage psychiatric diagnostic interview. Epi info version 6.0 and SPSS were used to enter the data and in subsequent analysis.

Results
Of the 231 respondents 88.3% were married, and 52.4% were in the 25-34 year age group. Significant psychological distress was reported in 97(41.9%) of the taxi drivers assessed. The psychiatric disorders reported depression 35(23.8%), anxiety 33(22.4%), somatoform disorder 19(12.9), alcohol abuse 17(11.6%) and suicidal ideation 4(1.8%). A number of respondents 92(39.8%) used substances of abuse: alcohol 54(23.4%), cigarettes 34(7.3%), marijuana (0.8%) and khat (1 0.4%). High HIV- risk behaviour was reported in 88 (40.4%) and included: having more than one wife 14 (6.4%), sex with commercial sex workers 106 (48.6%) and a history of genital ulcers/discharge.
Although 123 (53.3%) reported that the job exposes them to the risk of contracting HIV they assessed their personal vulnerability to contracting HIV over the next few years as minimal. Factors associated with high HIV risk behaviour included: age of respondent (p<0.02), regular use of condoms (p=0.02), and psychological distress score on the GHQ-J 2(p=0.000).

Conclusion
The taxi driver occupation in Uganda is associated with high level of psychological distress and high HIV risk behaviour. There is need for psychological and psychosexual interventions among taxidrivers.

3. An audit for the management of severe pre-eclampsia

G. Alia, Department of Obstetrics and Gynaecology, Makerere Medical School, P.O. Box 7072 Kampala, Uganda.

Introduction
Severe pre-eclampsia is a major cause of maternal and infant mortality and morbidity. Good management practice is important in reducing this burden. Criteria-based audit is being used in the developed world to identify deficiencies in practice and reduce mortality and morbidity.
Objective
To improve the management of severe preeclampsia through criteria-based audit.
Methods
This study was conducted in Mulago hospital, which is a large teaching hospital in which more than 14000 deliveries are conducted annually. An expert panel developed guidelines and standards for the management of severe pre-eclampsia.
Management practices were then evaluated against set standards by evaluating 43 case files. Results of the audit were presented to those offering care and recommendation were developed and implemented. A re-audit of management practices was done 6 months later to assess whether there was an improvement
Results
The initial audit showed that most standards were rarely achieved. As a result of the audit a number of changes were made. Additional equipment and drugs were purchased following a fundraising effort, guidelines were produced, procedures in labour suite were streamlined, and staffing was increased on labour suite, There were improvements in all areas: initiation of anti-hypertensive therapy within 20 minutes improved from 30% to 58% (odds ratio 3.21; 95 CI[I.26-8.16];P<0.0520). The number of women in whom urinalysis was done within the first 2 hors increased from 33% to 63% (3.45;[1.40-8. 52],p<0. 005). Monitoring of fetal heart improved from 0% to 26% (p<0.005). The number of women with adequate monitoring of BP improved from 7% to 45%(11.01; 2.94-41.28;p<0.0005) and there was an improvement in the prescription and administration of steroids in preterm pregnancies from 9% to 1 00%(P<0.05)
Conclusion
Audit helps to improve the quality of care, promotes the development of innovative solution and optimises the use of limited resources.

4. Mental health as a basic right for prisoners in Uganda

M. Mungherera, Butabika Hospital, P. O. Pox 7019 Kampala, Uganda

5. Economic challenges in quality care in New Mulago Hospital

M. Lugemwa, Private Patients Department, Mulago Hospital, P.O. Box 7051 Kampala, Uganda