Knowledge, Attitude and Practice of Physicians and Nurses at the Cape Coast Teaching Hospital in the Central Region of Ghana on Spontaneous Adverse Drug Reaction Reporting

Julianne Frimpomaa Powell, Isaac Tabiri Henneh, Martins Ekor


Ghana’s rate of reporting adverse drug reaction (ADRs) over the past years has consistently been below the WHO standard despite utilizing the spontaneous or voluntary reporting system. While underreporting undermines the pharmacovigilance system and poses a huge threat to public health safety, there is limited information on the perspectives of healthcare workers directly involved in drug administration. The present study investigated the knowledge, attitude and practice of physicians and nurses at the Cape Coast Teaching Hospital (CCTH) towards spontaneous reporting of ADRs (SR-ADRs). A descriptive cross-sectional survey was employed in the study. Pre-tested (Cronbach’s alpha value of 0.72) and validated questionnaires comprising 37 open-ended and close-ended questions were administered to 44 doctors and 116 nurses at the CCTH who had been practicing for at least six months prior to study. Out of the 160 administered questionnaires, 86 was administered face-to-face and the remaining via e-mails. Descriptive analysis was performed and the results were presented in simple frequencies and percentages


The World Health Organization (WHO) defines adverse drug reaction (ADR) as an undesirable and unexpected reaction to an over-the-counter, prescription or pharmaceutical medication at a dosage normally used to prevent, diagnose, treat or modify disease or physiological function [1, 2]. Adverse drug reactions (ADRs) are becoming more prevalent in recent times and increasingly advancing into a global health issue that requires the attention of all stakeholders, regardless of practice settings [3]. ADRs have been identified as a leading cause of morbidity and mortality in people of all ages, resulting in a huge number of hospitalizations and a significant financial burden on society and healthcare systems globally [4, 5]. Recent reports show that ADRs have significantly increased drugs, laboratory and hospitalization cost of patients [5]. A cross-sectional study on mortality from ADRs in adult hospitalized patients conducted in four South African hospitals revealed that ADRs are associated with 2.5%– 18% of deaths of patients [6]

Materials and method

The research was conducted at the Cape Coast Teaching Hospital (CCTH), a 400-bed capacity referral hospital in the Central Region of Ghana. The population of Cape Coast is estimated to be 189,925 according to the 2021 Population and Housing Census [21]. The hospital offers a variety of outpatient and inpatient services including family medicine, general medicine, accident and emergency, and wound care. A wide range of specialist services are offered, including surgery, internal medicine, pediatrics and child health, obstetrics and gynecology, oncology, radiology, dentistry, orthopedics etc.


As presented in Table 1, one hundred and sixty (160) questionnaires were administered to doctors (n = 44) and nurses (n = 116) in the hospital. With a response rate of 86.4% for doctors and 59.5% for nurses, 38 (35.5%) of the respondents who completed the questionnaires and returned same were doctors and 69 (64.5%) of them were nurses. Also, out of the 160 administered questionnaires, 86 was administered face-to-face and the remaining via e-mails. The response rates were 68% (59 out of 86) and 64% (48 out of 74) respectively for face-to-face and online methods of questionnaire administration. There were more female respondents (60.7%) than male respondents. Also, almost half of the respondents had practiced between one to five years (49.5%) and those who had practiced for more than five years were 21.5%.


Adverse drug reactions (ADRs) constitute a significant cause of illness, disability and death globally. The task of detection, assessment, comprehension as well as prevention of ADRs or other drug-related mishaps are referred to as pharmacovigilance [29] and ADR reporting remains the pillar of pharmacovigilance and patient safety [17]. Conducting such studies provides very vital information that could significantly improve pharmacovigilance and medication safety in any country. There is paucity of literature on ADR reporting in Ghana and evidence from the few studies available suggests that underreporting is prevalent. To gain insight into some of the possible causes of ADR underreporting, we assessed the knowledge, attitude and practices of doctors and nurses at the Cape Coast Teaching Hospital (CCTH) on spontaneous reporting of ADR in the present study.


Physicians and nurses who participated in the study largely exhibited inadequate levels of knowledge about existing spontaneous ADR reporting systems. Gender, period of practice, profession had an impact on whether a physician or a nurse would encounter an ADR, manage ADR or fill and forward an ADR form to the appropriate authority. Antibiotics, antihypertensives, analgesics, antidiabetics and vaccines were the common drugs implicated in ADRs within the study period. The ADRs reported mostly affected the gastro-intestinal tract, cutaneous and the central nervous systems. To address these challenge of ADR under-reporting, participants suggested that continuous sensitization and training of healthcare workers on spontaneous adverse drug reactions reporting, introduction of pharmacovigilance and ADR reporting into the pharmacy curriculum, designating contact persons in health facilities, introduction of mobile phone applications are some of the key interventions that could be implemented. Considering the dire repercussions of ADRs under-reporting, intensified efforts should be institutionalized to enable physicians and nurses identify, manage and report on them to the appropriate authority


Authors extend their appreciation to the doctors and nurses of the Cape Coast Teaching Hospital for their participation in this research. The authors are also very grateful to Mr. Ebenezer Aniakwah for his technical assistance.

Citation: Powell JF, Henneh IT, Ekor M (2023) Knowledge, attitude and practice of physicians and nurses at the cape coast teaching hospital in the Central Region of Ghana on spontaneous adverse drug reaction reporting. PLoS ONE 18(7): e0288100.

Editor: Yusuf Karatas, Cukurova University: Cukurova Universitesi, TURKEY

Received: June 25, 2022; Accepted: June 20, 2023; Published: July 7, 2023

Copyright: © 2023 Powell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.



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