title: Inappropriate prescription of cough remedies among children hospitalised with respiratory illness over the period 2002-2015 in Kenya.
abstract: To examine trends in prescription of cough medicines over the period 2002-2015 in children aged 1 month to 12 years admitted to Kenyan hospitals with cough, difficulty breathing or diagnosed with a respiratory tract infection.
  
  
  
  We reviewed hospitalisation records of children included in four studies providing cross-sectional prevalence estimates from government hospitals for six time periods between 2002 and 2015. Children with an atopic illness were excluded. Amongst eligible children, we determined the proportion prescribed any adjuvant medication for cough. Active ingredients in these medicines were often multiple and were classified into five categories: antihistamines, antitussives, mucolytics/expectorants, decongestants and bronchodilators. From late 2006, guidelines discouraging cough medicine use have been widely disseminated and in 2009 national directives to decrease cough medicine use were issued.
  
  
  
  Across the studies, 17 963 children were eligible. Their median age and length of hospital stay were comparable. The proportion of children who received cough medicines shrank across the surveys: approximately 6% [95% CI: 5.4, 6.6] of children had a prescription in 2015 vs. 40% [95% CI: 35.5, 45.6] in 2002. The most common active ingredients were antihistamines and bronchodilators. The relative proportion that included antihistamines has increased over time.
  
  
  
  There has been an overall decline in the use of cough medicines among hospitalised children over time. This decline has been associated with educational, policy and mass media interventions.
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Michuki
authors.initials: M
authors.lastname: Maina
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Samuel
authors.initials: S
authors.lastname: Akech
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Paul
authors.initials: P
authors.lastname: Mwaniki
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Susan
authors.initials: S
authors.lastname: Gachau
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Morris
authors.initials: M
authors.lastname: Ogero
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Thomas
authors.initials: T
authors.lastname: Julius
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Phillip
authors.initials: P
authors.lastname: Ayieko
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.|Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Grace
authors.initials: G
authors.lastname: Irimu
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.|Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D000996:Antitussive Agents / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003371:Cough / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004417:Dyspnea / Q000188:drug therapy*; D005100:Expectorants / Q000627:therapeutic use; D006633:Histamine Antagonists / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing; D007223:Infant; D007630:Kenya; D014663:Nasal Decongestants / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D019141:Respiratory System Agents / Q000627:therapeutic use*; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000996:Antitussive Agents; D001993:Bronchodilator Agents; D005100:Expectorants; D006633:Histamine Antagonists; D014663:Nasal Decongestants; D019141:Respiratory System Agents
keywords: Kenya; cough medicines; hospitalised children; prescription practices; respiratory tract infection