PROFILE OF DRUG-USE IN URBAN AND RURAL INDIA

Information on pharmacoepidemiology is particularly important in devel oping countries where a rational drug policy has not been adopted. In the present study, a profile of 1769 doctors' prescriptions and 763 se lf-orders(1) were monitored at pharmacy outlets in the twin cities of Hyderabad and Secunderabad and 4 rural areas of Andhra Pradesh with th e aim of identifying urban and rural differences, if any, in the self- medication rate, prescription costs, types of drugs purchased and fact ors influencing self-medication. Self-medication, expressed as the per centage of the total population that self-medicates, was found to be h igh in urban areas (37%) compared with rural areas (17%), and the majo rity of the over-the-counter sales were for prescription-only drugs. T he majority of physicians' prescriptions were incomplete with respect to diagnosis and dosage regimen. The mean cost of the drugs purchased on doctors' prescriptions was 2-fold higher than the cost of drugs sol d over the counter. A higher proportion of patients from rural areas ( 80%) purchased all the prescribed drugs compared with those from urban areas (54%). Financial constraints in urban areas were a major determ inant in the partial purchase of prescribed drugs. In addition, the ur ban elite (i.e. professional people with high incomes, who comprise 18 % of the total population) considered that all of the prescribed drugs were not necessary for their present disease. Nutritional products, p otent compounds with analgesic, antipyretic and antiinflammatory effec ts, and broad spectrum antibiotics constituted a high proportion of pr escriptions in both urban and rural areas. The consumption of food sup plements was higher in rural areas than in urban areas. Based on WHO c riteria, most of the drugs (60%) prescribed in rural areas were noness ential, compared with 47% in urban areas. The results of this study em phasise the need for comprehensive measures, including information, tr aining, legislation and education at all levels of the drug delivery s ystem, to rationalise drug therapy by improving prescribing patterns a nd influencing self-medication.