A multicentric cross-sectional study to characterize the scale and impact of polypharmacy in rural Indian communities, conducted as part of health workers training

Context: Polypharmacy and inappropriate medication usage is one of the world's most important public health issues. Yet in rural India, where medications are readily available, little is known about polypharmacy. Aim: This study explores factors related to polypharmacy in rural India to inform the response. Settings and Design: A household survey was conducted by community health trainees, across 515 Indian villages collecting medication prescription and usage information for single illness in the past month. Methods and Material: Polypharmacy was defined as the concurrent usage of four or more medications for single illness. Data from 515 rural India villages were collected on medication usage for their last illness. Respondents who consulted one healthcare provider for this illness were included for analysis. Statistical Analysis Used: Bivariate logistic regression and multivariate generalized estimating equation analysis were used to explore associations with polypharmacy. Results: Prevalence of polypharmacy was 13% (n = 273) in the sample and ranges between 1% and 35% among Indian states. Polypharmacy was common among prescriptions for nonspecific symptoms (15%, N = 404). People aged over 61 years compared with people aged between 20 and 60 years (OR 1.11, 95% CI 1.03–1.19) and people with income of over 3,000 INR/month (OR 1.04, 95% CI 1.00–1.07) were more likely to be prescribed four or more medications. Conclusions: The study demonstrates high rates of polypharmacy, identifies vulnerable populations, and provides information to improve the response to polypharmacy in rural India.