How are young children treated? Multiprovincial patterns of prescribing for children under 5 in Sri Lanka

Rational prescribing is essential for children under 5 years of age due to their vulnerability to dosing errors and adverse drug effects. Poor adherence to WHO prescribing guidelines may contribute to medication errors and antimicrobial resistance. This study evaluated paediatric prescribing patterns and adherence to WHO prescribing indicators across diverse healthcare settings in Sri Lanka.

A descriptive, cross-sectional, multicentre study was conducted across six provinces in Sri Lanka. A total of 1400 outpatient prescriptions issued for children under 5 years were systematically sampled from public and private healthcare facilities. Prescriptions were assessed against WHO prescribing criteria, including patient information, drug-related details, prescriber identifiers and antibiotic use. Comparisons across healthcare sectors (government vs private) and prescription formats (handwritten vs typed) were performed using χ² tests.

Of the 1400 prescriptions analysed, 94.6% were handwritten and 53.1% originated from the private sector. Critical patient details were incompletely documented, with weight recorded in only 43.0% and diagnosis in 36.0% of prescriptions. Antibiotics were prescribed in 57.2% of prescriptions. Government sector prescriptions showed significantly better documentation of patient identifiers and diagnoses (p<0.00001) and greater use of generic drug names (58.6% vs 26.6%, p<0.00001). In contrast, private sector prescriptions more frequently documented accurate dosing (92.9% vs 76.4%, p<0.00001), treatment duration (98.1% vs 86.3%, p<0.00001) and prescriber credentials (p<0.01). Typed prescriptions demonstrated superior documentation of patient identifiers, treatment duration, route of administration and prescriber identifiers compared with handwritten prescriptions (all p≤0.005).

Prescribing practices across the studied facilities showed notable gaps in prescription documentation and variability between healthcare sectors and prescription formats. These findings highlight areas that may benefit from improved prescribing practices, strengthened regulatory oversight and wider adoption of digital prescribing systems to enhance prescription quality and patient safety.