fitche hospital is located in fitche town , north shoa , oromia region , ethiopia .
the town is at a distance of 112 km from the capital city , addis ababa , with 36,768 ( 19,472 males and 17,296 females ) population according to the 1999 census .
fitche hospital is the only zonal hospital in the town and provides antenatal and delivery care , antiretroviral follow - up , pediatrics , internal medicine and surgery services .
the hospital was selected because of diversified health care deliveries and high patient loads , which can easily help us to evaluate anti - malarial drug use .
the study populations were systematically selected out - patients cards of anti - malarial drugs in the hospital visited in the last 1-year while patient cards of anti - malarial drugs in the hospital in the last 1-year ( from january 2012 to 2013 g.c ) were taken as source of study . during the study , the inclusion criteria were all complete patient cards of anti - malarial drugs in the hospital within the specified 1-year ( from january 2012 to 2013 g.c ) .
incomplete patient cards of anti - malarial drugs , cards with anti - malarial out of the specified 1-year , patient cards with no malaria , and cards of antibiotic not related to malaria were excluded from the study .
data collection forms were designed by collecting and reviewing different literature done in the same area and the instruments were further strengthened by pretest to make the language more clear and concise .
then , information such as sociodemographic characteristics , drug - related information ( name , route of administration , and drug naming ) , prescription pattern information ( dose , durations and frequency ) , and commonly prescribed antibiotics / analgesics with anti - malarial drugs were extracted from the records onto the data collection forms .
the joint commission on the accreditation of health care organization ( jcaho ) criteria was employed to determine sample size .
this criteria recommend to take 5% , 30% and 100% of cases for study if quarterly patient , respectively loads are more than 600 , lower than 600 and fewer than 30 .
the annual numbers of cases at fitche hospital was 417 ( 104.25 average numbers of cases per quarter ) .
patient cards were selected by systematic random sampling by taking the first unit randomly among the total sample size .
the data were collected by the principal investigator and analyzed after being checked for completeness and consistency .
the following variables were used for the study : age , sex , weight , dosage form , route of administration , and irrational prescriptions .
brand name - is a name assigned to the drugs by the company owning the patent .
generic name - is a name given to pharmaceutical substance as designated by the world health organization .
incorrect use of anti - malarial drugs - the use of antimalarials not in line with standard guideline of the country .
correct prescribing - prescription of anti - malarial drugs as per the standard treatment guideline of ethiopia .
ethical clearance obtained from department of pharmacy , college of public health and medical sciences , jimma university .
then , officials at different levels in fitche hospital were communicated , and letters of permission were presented . after the purpose of the study had been explained , informed consent was obtained from responsible bodies prior to the reviews .
brand name - is a name assigned to the drugs by the company owning the patent .
generic name - is a name given to pharmaceutical substance as designated by the world health organization .
incorrect use of anti - malarial drugs - the use of antimalarials not in line with standard guideline of the country .
correct prescribing - prescription of anti - malarial drugs as per the standard treatment guideline of ethiopia .
ethical clearance obtained from department of pharmacy , college of public health and medical sciences , jimma university .
then , officials at different levels in fitche hospital were communicated , and letters of permission were presented . after the purpose of the study had been explained , informed consent was obtained from responsible bodies prior to the reviews .
a total of 125 patient cards with malaria were reviewed of which 41 ( 32.8% ) , 27 ( 21.6% ) , 19 ( 15.2% ) belongs to age range of 2029 , 1019 , and 3039 , respectively , as shown in table 1 .
the lowest percentage was documented with the ages of < 10 , 4049 , 5059 , and above 60 .
overall , the majority of the patients were males ( 54% ) while that of females accounts for 46% .
regarding the parasite , p. vivax ( 60 , 48% ) was the cause of the majority of the infection followed by p. falciparum ( 45 , 36% ) while 16% had mixed infection [ table 2 ] .
age distribution of malaria patients collected from 1-year patient cards in fitche hospital , oromia region , 2013 parasites identified from 1-year patient cards in fitche hospital , oromia region , 2013 when the result was analyzed from the perspective of anti - malarial drugs information from 125 patient cards it was identified that treatment with chloroquine was the leading one ( 50.4% ) as depicted in figure 1 . however , quinine was prescribed correctly of eight patient cards . as shown in figure 2 below , of the prescribed drugs the most common dosage form was tablet ( 61.6% ) .
even though syrup was prescribed less ( 8% ) , injection prescribing was high ( 30.4% ) .
specific antimalarial drug prescribed of total antimalarials in fitche hospital , oromia region , 2013 dosage form of anti - malarial drugs in fitche hospital , oromia region , 2013 of total 125 study subjects , 89 ( 71.2% ) and 98 ( 78.4% ) received antibiotics and analgesics , respectively , with anti - malarial drugs .
of antibiotics amoxicillin accounts for 28% while paracetamol was the leading ( 51% ) of analgesic prescribed .
a total of 312 drugs ( anti - malarial , analgesics , and antibiotics ) were prescribed .
most ( 242 , 77.6% ) were prescribed by generic name , despite significant brand prescription ( 22.39% ) .
67.4% of antibiotics and 58.2% of analgesics were prescribed by generic name . regarding routes of drug administration , two hundred fifty ( 80.1% )
were taken through oral route ( po ) while only 19.9% were via intravenous routes [ table 4 ] .
drug use evaluations are one of the most important tools in standardizing use of medicines . in the use of anti - malarial drugs ,
microorganisms may become resistant to drugs through different mechanisms such as : enzyme elaboration , target modification , decreased influx , increased efflux , and change in cellular structure .
of several factors to be mentioned for the spread of resistance , patterns of drug use is the major one . according to the present study
, the sociodemographic characteristics showed that males ( 54% ) were more susceptible to plasmodium infection than a female ( 46% ) which was almost comparable to study done in gezira state , sudan . and also the study revealed age range of 2039 was the most affected group .
this is an indicator of the effect of malaria on country 's economy through affecting the productivity of young generation . of all anti - malarial drugs , chloroquine and coartem ( artemether and lumefantrine )
these finding are somewhat in agreement with the study done in rural ugandan hospital and mukalla ( yemen ) where the most frequently prescribed anti - malarials were artemether - lumefantrine ( 88.5% ) and chloroquine ( 42.9% ) , respectively . the high prescription rate for the two drugs might be explained in terms of high prevalence of p. vivax in the study area [ table 2 ] .
literature revealed that p. vivax grows easily in the tropical area as compared with the p. faciparum .
thus , the climate at our study site could be one factor for the prevalence of p. vivax .
previously , chloroquine was the first - line treatment for malaria according to the standard treatment guideline of ethiopia . but to date
nowadays it is recommended to use artemisinin - based combination therapy because of their efficacy and safety .
of the patients diagnosed with malaria , majority used anti - malarial with antibiotics and analgesics as described in table 3 .
antibiotics like tetracycline , doxycycline , clindamycin , azithromycin , fluoroquinolones , and erythromycin were sometimes may be combined with anti - malarial agents to shorten the duration of therapy and minimize toxicity .
they also used as an adjunct to treat malaria caused by chloroquine - resistant p. falciparum or p. vivax .
however , the 2010 standard treatment guideline stated the use of doxycycline for the prophylaxis of p. falciparum .
thus , the rest of the prescribed antibiotics were maybe for other diseases or prescribers use of current who or other research findings .
paracetamol was reported to have a negative effect on parasite clearance as it reduces the amount of tumor necrosis factor and oxygen radicals .
antibiotics and analgesics used with anti - malarial drugs as collected from 1-year patient cards in fitche hospital , oromia region , 2013 routes of administration of drugs and percentage of drugs prescribed in generic and brand name in fitche hospital , oromia region , 2013 regarding the dosage form , the tablet was the most common formulation followed by an injection .
patients belief , health professionals lack of knowledge , and patient load may be one of the factors for the high injection prescription than oral anti - malarial drugs . if used inappropriately , injections are toxic , dangerous , and life - threatening .
this study also revealed that all anti - malarials , 67% of antibiotics , and 58% of analgesics were prescribed by generic name .
brand prescription can cause doubling of medications , creates confusion , and makes communication difficult which may contributes a lot to decreased adherence to drugs .
the strength of the study is its input for study , which is going to be conducted on rational use of anti - malarial drugs and the study was conducted focusing on whether the health facilities were aware of current drug resistance to chloroquine . and
also this study reveals the use of chloroquine over coartem despite the guideline recommendation of coartem use for uncomplicated malaria . this study is a great input for health policy makers to control the use of anti - malarial agents in the care of patients to prevent resistance .
the cross - sectional nature of the study , incomplete patient cards , timing of data collections , poor records at health facilities , and the sample size were the limitations of the study .
according to study in fitche hospital , anti - malarial agents were not used in complete agreement with the guideline of ethiopia even though the practice is judged as good .
71.2% and 78.4% received antibiotics and analgesics , respectively , with anti - malarial drugs .
though all anti - malarial drugs were prescribed by generic name , drugs combined with anti - malarials were prescribed by both generic and brand name .
therefore , rational use of anti - malarial drugs should be promoted by the governing body particularly during prescribing and dispensing of drugs through a continuous in service trainings , seminars , and workshops .
there should also be future research direction on the rational use of anti - malarial agents to identify the root cause of irrational anti - malarial drugs use .
 objective : retrospective evaluation of anti - malarial drugs use in fitche hospital , north shoa , oromia region , ethiopia.methods:retrospective cross - sectional study design was conducted using selected patients cards of 1-year ( january 2012january 2013 g.c ) with anti - malarial agents from january 18 to 30 , 2013 . 
 the sample size was calculated by using joint commission on the accreditation of health care organization criteria and sampling was done by using a systematic random sampling technique.results:one hundred and twenty - five patient cards with anti - malarial drugs were reviewed of which 32.8% , 21.6% , 15.2% belongs to age range of 2029 , 1019 , and 3039 , respectively . 
 chloroquine prescription accounts for 50.4% from total anti - malarial drugs . 
 71.2% and 78.4% of patients received antibiotics and analgesics , respectively , with anti - malarial drugs . 
 77.6% of drugs were prescribed by generic name while the brand name was 22.39%.conclusions : the study done in fitche hospital revealed that the use of anti - malarial agent was not in complete agreement with the current guideline of ethiopia despite good practice . 
Methods
Operational/standard definitions
Ethical consideration
Results
Discussions
Conclusions
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