Prevalence and types of medication errors among children under five (5) years in 3 primary health care facilities in the Western region of Ghana: a retrospective quantitative study

Baolenwo et al. BMC Primary Care (2025) 26:369 https://doi.org/10.1186/s12875-025-03072-w BMC Primary Care Open Access RESEARCH Prevalence and types of medication errors among children under five (5) years in 3 primary health care facilities in the Western region of Ghana: a retrospective quantitative study Atiase Blandina Baolenwo1*, Senoo-Dogbey Vivian Efua2 and Addae Vida3 Abstract Background Medication errors (MEs) remain a leading cause of preventable harm in healthcare systems worldwide, contributing to adverse drug events, morbidity, increased healthcare costs, prolonged hospitalization, and mortality. The paediatric population is particularly susceptible to MEs due to the need for individualized dosing based on weight and age, which introduces additional complexity for healthcare providers. Although considerable research has been conducted on this issue, existing studies have predominantly focused on secondary and tertiary healthcare institutions, where specialized personnel and resources are more readily available. In contrast, in certain settings, primary healthcare facilities are staffed by non-specialist healthcare professionals who face unique challenges in paediatric care due to limited training and insufficient clinical support. This disparity highlights a critical gap in the literature and underscores the urgent need for targeted interventions to improve medication safety in primary care settings. Objective The study was undertaken with the aim of determining the prevalence and types of medication errors committed by nurses among children under 5 years at three (3) primary healthcare facilities in the western region of Ghana. Materials and methods Six (6) months retrospective data was taken to assess the prevalence and types of medication errors. Data was gathered using a checklist from records of paediatric patients aged ≤ 5years who visited the three primary health care facilities from 1st July 2020–31st December 2020 and attended to by a nurse clinician. MEs were categorised into dosage error, frequency error, prescribing error and administration error. Based on the number of errors occurring per treatment, errors were classified as No error, one error and two or multiple errors. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 23. *Correspondence: Atiase Blandina Baolenwo Full list of author information is available at the end of the article © The Author(s) 2025. 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To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/. Baolenwo et al. BMC Primary Care (2025) 26:369 Page 2 of 10 Results Out of the 341 paediatric folders examined, the prevalence of MEs among children under 5years from the three primary health facilities was 59.3%. Dosage errors accounted for 47.3% of identified errors, followed by frequency errors (17.8%), prescribing errors of 14.8% and administering errors 6.1%. Conclusion The prevalence of medication errors among children under five years across the three primary health care facilities was significantly high (59.3%). Keywords Medication errors, Paediatrics, Ghana, Primary health care Introduction Medication errors (MEs) are defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer” [1]. MEs can occur at any stage of the medication use process, such as prescribing, transcribing, dispensing, administration or monitoring [2, 3]. Common forms include overdoses, underdoses, incorrect medications, wrong patients, and improper administration routes [4–7]. Globally, MEs are a major contributor to avoidable morbidity and mortality, affecting approximately 1.3 million individuals annually in the United States and costing an estimated USD 42 billion per year [8]. These figures are likely even higher in low- and middle-income countries. Paediatric patients are disproportionately affected due to weight-based dosing requirements and developmental vulnerabilities [9], with estimated error rates ranging from 5% to 27% of medication orders in the U.S [10] and as high as 62.7% of administrations in Ethiopia [11]. MEs are the commonest ways paediatric patients can be harmed and have a much higher risk of causing death in paediatrics than in adults [12]. Inconsistencies in healthcare systems and workforce structure also contribute significantly to variability in ME rates across countries. In the United Kingdom, paediatric care is typically provided by general practitioners (GPs) who receive targeted training in child health as part of their curriculum. In contrast, the United States relies on board-certified paediatricians as primary care providers, with more extensive paediatric-specific training and clinical exposure [6]. These structural differences influence prescribing accuracy and medication safety. For example, UK hospitals report prescribing errors in approximately 1.5% of prescriptions and administration errors in 3–8% of doses [6]. A systematic review found a median prescribing error rate of 6.5%, with dose errors reaching 11.1% among hospitalised children [13]. In comparison, Kaushal et al. reported that 5% to 27% of paediatric prescriptions in the U.S. are affected by medication errors, with administration errors similarly prevalent [14]. More recently, DeCoster et al. documented over 124,000 paediatric medication errors related to ADHD therapies between 2000 and 2021, with a 299% increase in annual frequency and 4.2% resulting in serious medical outcomes [15]. These discrepancies reflect differences in provider training, documentation practices, and the integration of safety technologies such as Computerized Physician Order Entry (CPOE) systems [16]. The healthcare system in Ghana is tiered into primary, secondary, and tertiary levels. Primary Health Care (PHC) is further stratified into district hospitals, subdistrict health centres, and post and Community-Based Health Planning and Services (CHPS) zones. T (...truncated)