Inadequate knowledge and practice of pharmacovigilance affecting adverse drug reaction reporting by health professionals in private healthcare facilities in Lusaka, Zambia

Abstract

Background: There is currently insufficient information regarding the levels of knowledge and practice of Adverse Drug Reactions (ADRs) reporting among healthcare professionals in Zambia.

Aim: The study examined knowledge, attitude and reporting practices among medical doctors, pharmacists and nurses in private healthcare facilities in Lusaka, Zambia.

Methods: A descriptive cross-sectional study was undertaken. Data was collected using a selfadministered questionnaire assessing general knowledge, attitudes and practice of ADR reporting. A rated score was used to categorize knowledge as poor, average, or good. A Kruskal-Wallis H test followed by Bonferroni test was used to compare knowledge levels among medical doctors, pharmacists and nurses, respectively. To assess practice and attitude towards the ADR reporting, proportions were used to analyze responses to items in each of the respective domain.

Results: General knowledge of ADR reporting among the medical doctors, pharmacists and nurses in the private sector was relatively low. A Kruskal-Wallis H test showed that there was a statistically significant difference in total score between the different occupations, ÷ 2 (2) = 10.839, p = 0.004, with a mean rank score of 34.08 for pharmacists (n = 18), 22.17 for doctors (n = 24) and 16.19 for nurses (n = 8). Low knowledge levels of ADR reporting were attributed to lack of pharmacovigilance training, with thirty nine (78%) of the participants indicating that they had never received any training on ADR reporting and thirty seven participants (74%) indicated that they had never reported an ADR. Factors that discouraged ADR reporting included: practitioner concern that the information reported may be wrong (46.8%); the level of clinical knowledge to decide whether an ADR had occurred (46.8%); lack of time to complete the ADR report forms (36.2%); reporting generating extra work load (25.5%); and the perceived unimportance of reporting a recognized ADR believing it would make little difference to knowledge and practice (19.1%). The major factors that encouraged ADR reporting included: seriousness of the ADR (98%); unusual reactions (77.6%); adverse reaction to a new product (83.7%); confidence in diagnosis of an ADR (73.5%), and if the reaction was well recognized for a particular drug (67.3%). The training of personnel in private practice was major indicator for improvement of ADR reporting.

Conclusion: Despite the relative positive attitudes indicated, low levels of knowledge due to lack of training was the main driver of ADR underreporting practice among private health practitioners that participated in this study. Addressing the knowledge and practice gaps identified will go a long way to further improve ADR reporting rates and medication safety in private healthcare practice settings.

Keywords: Pharmacovigilance, knowledge, attitude, practice, health professionals, reporting, private sector, Zambia