A Third of Prescriptions in a Nigerian Hospital Contain Five or More Medicines, Study Finds
A large review of prescriptions from a secondary-care hospital in North-Central Nigeria has found that more than one in three involved polypharmacy—the concurrent use of five or more medicines—highlighting how complex treatment regimens can collide with severe financial pressure on patients. The study, conducted at Offa Specialist Hospital in Kwara State, found that 740 of 2,000 prescriptions issued during the first half of 2025 met the researchers’ definition of polypharmacy. The findings suggest that the problem is not simply a matter of counting tablets. In a healthcare system where many patients pay directly for treatment, every additional medicine can increase the risk of harmful drug interactions, missed doses and treatment abandonment. The researchers report that the medication burden was accompanied by substantial economic strain: nearly four in five surveyed patients said drug costs were a financial burden, and two-thirds said they had skipped or reduced medicines because they could not afford them.
Polypharmacy is often associated with older adults and people living with several chronic diseases, but it can occur whenever multiple conditions, symptoms or treatment guidelines converge. A patient may receive separate medicines for hypertension, diabetes, pain, infection or gastrointestinal symptoms, while different clinicians may prescribe without a complete view of the person’s current regimen. Some combinations are medically necessary and can improve survival or disease control. The concern arises when medicines are duplicated, continued after their original indication has disappeared, prescribed without adequate monitoring, or used in combinations whose benefits do not outweigh their risks. The biological challenge is cumulative: each medicine can produce intended effects as well as side effects, and one drug may alter the absorption, metabolism or elimination of another. As the number of medicines rises, the possible interaction pathways multiply, making careful medication reconciliation and periodic review increasingly important.
The Nigerian research used two complementary approaches. First, the investigators retrospectively examined 2,000 prescriptions issued between January and June 2025 to estimate how frequently patients were receiving multiple medicines. They then conducted a prospective questionnaire survey from July through August involving 100 patients and 50 healthcare providers. The prescription review provided a numerical snapshot of prescribing patterns, while the questionnaires explored the financial consequences for patients and the perceptions of professionals working in the hospital. This design allowed the team to connect prescribing complexity with reported affordability problems, although it cannot establish that polypharmacy itself caused patients to reduce their medicines. The study was cross-sectional in its survey component, meaning that it captured experiences over a defined period rather than tracking patients over time to determine whether medication changes led to later complications or hospital visits.
Of the prescriptions examined, 63 percent contained two to four medicines, a range the researchers classified as non-polypharmacy for the purposes of the study. Another 25 percent contained five to nine medicines, described as major polypharmacy, while 12 percent contained at least 10 medicines, categorized as excessive polypharmacy. Taken together, the latter two groups accounted for 37 percent of all prescriptions. These figures do not necessarily mean that 37 percent of patients were receiving inappropriate treatment. A prescription containing several medicines may be clinically justified, particularly for patients with multiple chronic conditions or acute illness. The study instead identifies the scale of medication exposure and the need to determine whether each medicine remains necessary, effective and affordable. Without detailed diagnoses, treatment indications and clinical outcomes for every prescription, the data cannot distinguish appropriate combination therapy from potentially avoidable prescribing.
The financial findings were especially striking. Among the 100 patients who completed questionnaires, 37 percent reported spending more than 20,000 Nigerian naira per month on medicines. The researchers did not convert that amount into a universal international comparison, because the real impact depends on household income, local prices and other living costs, but the responses show that medication expenditure was not a marginal concern. Seventy-nine percent of participants described drug costs as a financial burden, and 78 percent said they needed financial assistance to obtain the medicines prescribed for them. In a predominantly out-of-pocket healthcare environment, the price of each additional product can become a barrier to completing treatment. Patients may borrow money, rely on relatives, purchase only part of a prescription or substitute medicines without professional guidance, creating a cycle in which the intended therapeutic plan is never fully implemented.
The researchers found that 66 percent of surveyed patients had skipped doses or reduced their medicines because of cost. This behavior, known as cost-related nonadherence, can undermine treatment even when the prescription is pharmacologically sound. For medicines used to control blood pressure or blood glucose, intermittent dosing may produce unstable disease control rather than a simple reduction in benefit. For antimicrobial treatment, taking medicines inconsistently can fail to clear an infection, although the relationship between adherence and antimicrobial resistance is complex and depends on the drug, pathogen and treatment regimen. Reducing or skipping medicines can also make clinicians interpret uncontrolled symptoms as evidence that a treatment is ineffective, potentially prompting additional prescriptions and increasing polypharmacy further. The result is a dangerous feedback loop: more medicines raise costs, high costs reduce adherence, and poor adherence may lead to even more intensive treatment.
Healthcare providers surveyed in the study recognized the same pattern from the clinical side. Eighty-four percent said they frequently encountered patients taking five or more medicines, and every provider agreed that polypharmacy significantly increases treatment costs. Clinicians may face genuine pressure to address several problems during a single consultation, particularly in facilities serving communities with limited access to specialist care. Prescribing can also be shaped by fragmented records, limited consultation time, patient expectations and the availability of medicines. A complete medication review requires more than asking whether a patient is taking tablets. It involves identifying every prescription, over-the-counter product, traditional remedy and supplement; checking dose, duration, indication and duplication; considering kidney and liver function; and evaluating whether the patient can follow the schedule. Pharmacists, physicians and nurses can work together to simplify regimens, select lower-cost equivalents when appropriate and stop medicines whose risks exceed their benefits.
The study’s implications extend beyond one hospital. Nigeria, like many low- and middle-income countries, must manage rising burdens of chronic disease while healthcare financing remains uneven. As people live longer and survive illnesses that once would have been fatal, the number of patients requiring long-term treatment is likely to grow. At the same time, medicine prices, transport costs and shortages can place therapy beyond reach. Expanding health insurance coverage could reduce the direct financial shock of multiple prescriptions, but insurance alone would not solve inappropriate or unnecessarily complex treatment. The authors point to rational prescribing and strengthened medication-review practices as parallel solutions. Rational prescribing means selecting a medicine that matches a clearly defined clinical need, at the correct dose and duration, while considering safety, effectiveness, affordability and the patient’s ability to use it. Electronic prescribing systems and shared records could help, but even paper-based review protocols may identify duplication and unnecessary continuation.
The findings should nevertheless be interpreted with care. The study was conducted in a single secondary healthcare facility, so its prescribing patterns may not represent hospitals elsewhere in Nigeria or other healthcare levels. The patient survey included only 100 participants, and information about spending, skipped doses and financial assistance was self-reported, which can introduce recall or reporting bias. The researchers also measured the number of medicines rather than documenting adverse drug reactions, hospital admissions, disease outcomes or the clinical appropriateness of each combination. Further research across multiple facilities could examine which diseases and prescribing departments contribute most to polypharmacy, how much of the medication burden is clinically justified, and whether pharmacist-led reviews reduce costs without harming health outcomes. Even with these limitations, the central signal is clear: when 37 percent of prescriptions contain five or more medicines and most surveyed patients struggle to pay for them, medication management becomes both a safety issue and an economic one. The challenge is not merely to prescribe fewer drugs, but to ensure that every medicine a patient receives has a defensible purpose, a measurable benefit and a realistic path to completion.
Subject of Research: The prevalence, prescribing patterns and economic burden of polypharmacy among patients and healthcare providers at Offa Specialist Hospital in Kwara State, North-Central Nigeria
Subject of Research: Medicine
Article Title: Prevalence and economic burden of polypharmacy in a secondary healthcare facility in North-Central Nigeria: a cross-sectional study
Article References: “Prevalence and economic burden of polypharmacy in a secondary healthcare facility in North-Central Nigeria: a cross-sectional study,” BMC Health Services Research
Image Credits: AI Generated
DOI: 10.1186/s12913-026-15474-2
Keywords: polypharmacy, medication cost, economic burden, Nigeria, prescription review, medication adherence, rational prescribing, healthcare expenditure
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