Abstract:
Objective: 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.
Methods: 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.
Results: 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.
Conclusions: 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.