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									Books & electronic media
                                                       nursing staff were as good as those of       antibiotic use are also covered. Studies
Medicines use in primary                               doctors. These studies used the WHO/         using interventions to improve the use
care in developing and                                 International Network for the Rational       of medicines are discussed.
transitional countries: fact                           Use of Drugs (INRUD) indicators to                 The last chapter suggests recom-
                                                       measure drug use. Educational pro-           mendations for future action. Annexes
book summarizing results from
                                                       grammes for health providers were the        present the summary of data included
studies reported between 1990                          most common interventions carried            in figures, the results according to
and 2006                                               out to improve drug use. The most            WHO region and describe in detail
                                                       effective interventions used multiple        the WHO indicators database manual.
Publisher: World Health Organization, Geneva,
                                                       intervention components. The meth-                 The strength of the book lies in
                                                       odologies followed during the creation       the “snapshot” picture it provides of
WHO reference number: WHO/EMP/MAR/
                                                       of the WHO database form the focus           medicine use in primary care in vari-
                                                       of chapter 2. Chapter 3 describes the        ous regions and according to various
168 pages; available free from http://www.
                                                       studies, using pie charts according to       parameters. Workers can compare their
                                                       year of data collection, World Bank          findings with their region, in a similar
Promoting rational use of medicines is                 region, WHO regions, income level of         type of health facility, in countries with
becoming a priority issue for govern-                  countries, prescriber type and facil-        a similar income range and among
ments and other organizations all over                 ity type. Chapter 4 concentrates on          similar prescriber types and health
the world. Evidence suggests, however,                 studies using WHO/INRUD prescrib-            facilities. The findings of studies con-
that more than half of all medicines are               ing indicators and describes results of      ducted over a 17-year period have been
not used appropriately. Due to various                                                              systematically analysed and presented
                                                       studies using these indicators under
reasons, irrational use of medicines                                                                in an easy-to-comprehend manner.
                                                       the various parameters mentioned in
is more common in developing and                                                                          A problem is that the studies
                                                       chapter 3. The key points summarizing
transitional countries. Measuring how                                                               are restricted to primary health care.
                                                       each graph are interesting. For example
medicines are used is the first step to-                                                            Studies in secondary and tertiary
                                                       on page 27, the authors state that the
wards understanding and documenting                                                                 health-care institutions have not been
                                                       WHO African region has the highest
these problems. Drug utilization and                                                                analysed. It would be very helpful for
                                                       percentage of medicines prescribed           researchers in developing countries if
pharmaco-epidemiological studies can                   from a WHO Essential Medicines List
investigate problems with use of medi-                                                              the authors could provide a complete
                                                       or formulary and the highest percent-        list of studies included in the book and
cines, suggest possible interventions                  age of patients treated according to
to improve their use and measure the                                                                the database, with access to these stud-
                                                       clinical guidelines. The region also had     ies on the WHO web site.
impact of these interventions. Although                the highest percentage of patients who
the situation is improving, it is difficult                                                               This book is well produced and
                                                       were prescribed with an injection.           would be a valuable addition to the
for researchers in developing countries                     Analysis of studies in primary
to obtain information about published                                                               libraries of pharmaco-epidemiologists,
                                                       health-care settings using WHO/              health-care managers (especially in
drug utilization studies.                              INRUD patient care and health
     In association with Harvard                                                                    primary care) and all those interested
                                                       facility indicators, treatment of            in promoting the rational use of
Medical School and Harvard Pilgrims
                                                       important public health problems like        medicines. ■
Health, WHO recently published a
                                                       respiratory infections, acute diarrhoea
fact book summarizing studies dealing
                                                       and malaria and inappropriate                review by P Ravi Shankar a
with medicine use in primary care in
developing and transitional countries
between the years 1990 and 2006. The
fact book describes the findings from a
WHO database of all published surveys                    Letters
and interventions of medicine use at the
primary health-care level in develop-                  Please visit to read
ing and transitional countries. A total                the following letters received in response to Bulletin papers:
of 679 studies from 97 countries are
                                                       Ivermectin worthy of further investigation, by Andrew C Steer, Therese Kearns,
identified and described.
                                                       Ross M Andrews, James S McCarthy, Jonathan R Carapetis & Bart J Currie
     Certain parameters in medicine
                                                       responding to:
use have improved while others have
either remained static or deteriorated                 Ly F, Caumes E, Ndaw CA, Ndiaye B, Mahe A. Ivermectin versus benzyl
over the years. According to the book,                 benzoate applied once or twice to treat human scabies in Dakar, Senegal:
use of medicines was of a higher                       a randomized controlled trial. Bull World Health Organ 2009;87:424-30.
standard in the public sector and pre-                 PMID:19565120 doi:10.2471/BLT.08.052308
scription practices of paramedical and                 with author reply.

 Department of Pharmacology, KIST Medical College, Lalitpur, Nepal.
Correspondence to P Ravi Shankar (e-mail:

804                                                                                   Bull World Health Organ 2009;87:804 | doi:10.2471/BLT.09.070417

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