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Alenezi S, Alanazi M, Aljazaeri R, Almuzaini M, Alrasheidi S, Shamlan WB, Aljohani R, Alhawiti G, Alqarni M, Aljabri E, Qmmash M, Kanan M. Community Pharmacies in the Asian Countries of Developing Health System: Formation, Regulation, and Implication. PHARMACY 2023; 11:127. [PMID: 37624082 PMCID: PMC10460015 DOI: 10.3390/pharmacy11040127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Community pharmacies (CPs) in Asian countries are often the first point of contact for patients withinthe healthcare system and their preferred place to purchase medicines. The number of CPs may vary across Asian countries, and each country has developed its own design and functioning. The regulatory environment plays a crucial role in shaping and governing CPs. The aim of this study was to conduct a comprehensive literature review in order to enhance understanding of the establishment and regulation of CPs. By undertaking this review, the researchers, policymakers, and practitioners sought to gain a deeper insight into the performance and functions of CPs and the regulatory frameworks that govern them. Moreover, this review shed light on implementation strategies, effects on patient outcomes, and the barriers and challenges associated with their establishment. A narrative literature review method was adopted with specific inclusion and exclusion criteria. Significant disparities can be observed when comparing the stated intentions of regulations with their actual implementation. Recently, there has been an inclusion of public health practices. Unfortunately, pharmacy procedures conducted in such environments have been characterized by inadequate understanding and inappropriate care. This poor performance can be attributed to employees' focus on maximizing profits. Several shortcomings can arise, including incomplete patient history documentation, failure to refer patients who require medical attention, unauthorized dispensing of prescription-only medicines (POM), dispensing clinically inappropriate or excessive medication doses, selling incomplete antibiotic courses, and inadequate information and counseling services. Regulatory interventions can help strengthen these services.
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Affiliation(s)
- Shaymaa Alenezi
- Al-Dawaa Pharmacy, Raiydh 12211, Saudi Arabia; (S.A.); (M.A.); (S.A.)
| | - Mona Alanazi
- Department of Clinical Pharmacy, Nahdi Medical Co., Riyadh 13515, Saudi Arabia; (M.A.); (R.A.); (R.A.); (M.A.); (E.A.)
| | - Reaam Aljazaeri
- Department of Clinical Pharmacy, Nahdi Medical Co., Riyadh 13515, Saudi Arabia; (M.A.); (R.A.); (R.A.); (M.A.); (E.A.)
| | - Marwah Almuzaini
- Al-Dawaa Pharmacy, Raiydh 12211, Saudi Arabia; (S.A.); (M.A.); (S.A.)
| | | | - Wafa Bin Shamlan
- Community Pharmacist, United Pharmaceutical Company, Jeddah 22230, Saudi Arabia;
| | - Raghad Aljohani
- Department of Clinical Pharmacy, Nahdi Medical Co., Riyadh 13515, Saudi Arabia; (M.A.); (R.A.); (R.A.); (M.A.); (E.A.)
| | - Ghadeer Alhawiti
- Department of Clinical Pharmacy, Alkadi Medical Group, Tabuk 47311, Saudi Arabia;
| | - Meaad Alqarni
- Department of Clinical Pharmacy, Nahdi Medical Co., Riyadh 13515, Saudi Arabia; (M.A.); (R.A.); (R.A.); (M.A.); (E.A.)
| | - Ehdaa Aljabri
- Department of Clinical Pharmacy, Nahdi Medical Co., Riyadh 13515, Saudi Arabia; (M.A.); (R.A.); (R.A.); (M.A.); (E.A.)
| | - Majd Qmmash
- College of Pharmacy, King Khalid University, Abha 62529, Saudi Arabia;
| | - Mohammed Kanan
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh 12211, Saudi Arabia
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Jahan N, Akter S, Heme MA, Chandra D, Polly A, Siddiqua L, Rahman R, Mohsin KF, Hossain MT. Healthcare-seeking behaviour of marginalised older people in urban slums: a cross-sectional survey study in Khulna City, Bangladesh. BMJ Open 2022; 12:e066376. [PMID: 36368763 PMCID: PMC9660562 DOI: 10.1136/bmjopen-2022-066376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to measure healthcare-seeking behaviour and determine its associated factors among older people in the slums of the Khulna City Corporation (KCC) areas of Bangladesh. DESIGN Cross-sectional survey. SETTINGS Four slums in the KCC areas of Bangladesh. PARTICIPANTS The participants were selected following a two-stage area probability sampling with the following specifications: they must be aged ≥60 years and must have lived in the slums of KCC for at least 5 consecutive years. OUTCOME MEASURES A semistructured interview schedule was administered to determine participants' healthcare-seeking behaviour, with healthcare-seeking behaviour measured through a dichotomous response of 'yes' or 'no'. RESULTS 636 participants were included in the study. Gastrointestinal problems (75.3%) and aches and pains (71.5%) were the two most common health problems among older people in the slums of KCC. Older adults in their 80s had higher adjusted odds of attaining healthcare services (adjusted OR (AOR)=2.028; 95% CI: 1.140 to 3.609; p<0.05) than other older people, while educated older people (AOR=0.664; 95% CI: 0.441 to 1.000; p<0.05) and those with greater satisfaction with domains of life (SDL index; AOR=0.860; 95% CI: 0.811 to 0.912; p<0.01) were less inclined to seek healthcare services than their counterparts. Additionally, widows/widowers (AOR=2.218; 95% CI: 1.080 to 4.556; p<0.05) and married people (AOR=2.750; 95% CI: 1.329 to 5.689; p<0.01) had higher adjusted odds of seeking healthcare services than those who were divorced/separated. CONCLUSION Age, education, marital status and SDL index were significant predictors for the healthcare-seeking behaviour of older people in KCC slums. Effective strategies need to be implemented to reduce existing access barriers to healthcare services for older people in the slum areas of urban Bangladesh.
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Affiliation(s)
- Nusrat Jahan
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Shahinur Akter
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Morsheda Akter Heme
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Dipika Chandra
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Afsana Polly
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Laila Siddiqua
- Architecture Discipline, Science, Engineering and Technology School, Khulna University, Khulna, Bangladesh
| | - Rumana Rahman
- English Discipline, Arts and Humanities School, Khulna, Bangladesh
| | - Kaniz Fatima Mohsin
- Economics Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Md Tanvir Hossain
- Sociology Discipline, Social Science School, Khulna University, Khulna, Bangladesh
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Afari-Asiedu S, Abdulai MA, Tostmann A, Boamah-Kaali E, Asante KP, Wertheim HF, Hulscher M. Interventions to improve dispensing of antibiotics at the community level in low and middle income countries: A systematic review. J Glob Antimicrob Resist 2022; 29:259-274. [PMID: 35342021 DOI: 10.1016/j.jgar.2022.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Inappropriate antibiotic dispensing is one of the key drivers of antibiotic resistance. This review documents the effectiveness of interventions aimed at improving antibiotic dispensing practices at the community level by drug dispensers in low and middle income countries (LMIC). METHODS We conducted a systematic search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science (November 11, 2019). Studies were included if they reported data on the outcome measure: appropriate dispensing of medicine including antibiotics. The effectiveness of studies was assessed based on quantitative results reported in the studies included. RESULTS A total of 1158 papers were screened. Thirteen studies from Asia (6), Africa (5), South America (one) and one study from both Africa and Asia were included in this review. Nine (69.2%) studies reported significant effectiveness of interventions on all or more than 50% of antibiotic related outcomes. Cochrane Effective Practice and Organization of Care interventions frequently applied were educational meetings (9/13), distribution of educational materials (7/13), educational outreach meetings (7/13), reminders (6/13), local consensus processes (6/13), distribution of supplies (6/14) and clinical practice guidelines (4/14), Nine studies reported on stakeholder involvement. CONCLUSION This review shows that it is possible to improve antibiotic dispensing practices at the community level in LMIC. Stakeholders' involvement was key in the design and implementation of interventions.
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Affiliation(s)
- Samuel Afari-Asiedu
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana; Radboud University Medical Center, Center for Infectious Diseases Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Microbiology, Nijmegen, The Netherlands.
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | - Alma Tostmann
- Radboud University Medical Center, Center for Infectious Diseases Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Microbiology, Nijmegen, The Netherlands
| | - Ellen Boamah-Kaali
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | - Heiman Fl Wertheim
- Radboud University Medical Center, Center for Infectious Diseases Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Microbiology, Nijmegen, The Netherlands
| | - Marlies Hulscher
- Radboud University Medical Center, Center for Infectious Diseases Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands
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Abstract
OBJECTIVES To survey on the availability and use of primary care services in slum populations. DESIGN Retrospective, cross-sectional, household, individual and healthcare provider surveys. SETTING Seven slum sites in four countries (Nigeria, Kenya, Pakistan and Bangladesh). PARTICIPANTS Residents of slums and informal settlements. PRIMARY AND SECONDARY OUTCOME MEASURES Primary care consultation rates by type of provider and facility. RESULTS We completed 7692 household, 7451 individual adult and 2633 individual child surveys across seven sites. The majority of consultations were to doctors/nurses (in clinics or hospitals) and pharmacies rather than single-handed providers or traditional healers. Consultation rates with a doctor or nurse varied from 0.2 to 1.5 visits per person-year, which was higher than visit rates to any other type of provider in all sites except Bangladesh, where pharmacies predominated. Approximately half the doctor/nurse visits were in hospital outpatient departments and most of the remainder were to clinics. Over 90% of visits across all sites were for acute symptoms rather than chronic disease. Median travel times were between 15 and 45 min and the median cost per visit was between 2% and 10% of a household's monthly total expenditure. Medicines comprised most of the cost. More respondents reported proximity (54%-78%) and service quality (31%-95%) being a reason for choosing a provider than fees (23%-43%). Demand was relatively inelastic with respect to both price of consultation and travel time. CONCLUSIONS People in slums tend to live sufficiently close to formal doctor/nurse facilities for their health-seeking behaviour to be influenced by preference for provider type over distance and cost. However, costs, especially for medicines are high in relation to income and use rates remain significantly below those of high-income countries.
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Watson S. Pharmacies in informal settlements: a retrospective, cross-sectional household and health facility survey in four countries. BMC Health Serv Res 2021; 21:945. [PMID: 34503501 PMCID: PMC8431901 DOI: 10.1186/s12913-021-06937-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. METHODS We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. RESULTS We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a "pharmacy" across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. CONCLUSIONS Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.
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Affiliation(s)
| | - Sam Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Unicomb LE, Nizame FA, Uddin MR, Nahar P, Lucas PJ, Khisa N, Akter SMS, Islam MA, Rahman M, Rousham EK. Motivating antibiotic stewardship in Bangladesh: identifying audiences and target behaviours using the behaviour change wheel. BMC Public Health 2021; 21:968. [PMID: 34022819 PMCID: PMC8140425 DOI: 10.1186/s12889-021-10973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Asia is a hotspot for antimicrobial resistance due largely to over-the-counter antibiotic sales for humans and animals and from a lack of policy compliance among healthcare providers. Additionally, there is high population density and high infectious disease burden. This paper describes the development of social and behavioural change communication (SBCC) to increase the appropriate use of antibiotics. METHODS We used formative research to explore contextual drivers of antibiotic sales, purchase, consumption/use and promotion among four groups: 1) households, 2) drug shop staff, 3) registered physicians and 4) pharmaceutical companies/medical sales representatives. We used formative research findings and an intervention design workshop with stakeholders to select target behaviours, prioritise audiences and develop SBCC messages, in consultation with a creative agency, and through pilots and feedback. The behaviour change wheel was used to summarise findings. RESULTS Workshop participants identified behaviours considered amenable to change for all four groups. Household members and drug shop staff were prioritised as target audiences, both of which could be reached at drug shops. Among household members, there were two behaviours to change: suboptimal health seeking and ceasing antibiotic courses early. Thus, SBCC target behaviours included: seek registered physician consultations; ask whether the medicine provided is an antibiotic; ask for instructions on use and timing. Among drug shop staff, important antibiotic dispensing practices needed to change. SBCC target behaviours included: asking customers for prescriptions, referring them to registered physicians and increasing customer awareness by instructing that they were receiving antibiotics to take as a full course. CONCLUSIONS We prioritised drug shops for intervention delivery to all drug shop staff and their customers to improve antibiotic stewardship. Knowledge deficits among these groups were notable and considered amenable to change using a SBCC intervention addressing improved health seeking behaviours, improved health literacy on antibiotic use, and provision of information on policy governing shops. Further intervention refinement should consider using participatory methods and address the impact on profit and livelihoods for drug shop staff for optimal compliance.
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Affiliation(s)
- Leanne E Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Fosiul Alam Nizame
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Rofi Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Papreen Nahar
- Department of Global Health and Infection, Brighton and Sussex Medical School, Sussex University, Brighton, UK
| | | | - Nirnita Khisa
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S M Salim Akter
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Aminul Islam
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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van der Heijden J, Gray N, Stringer B, Rahman A, Akhter S, Kalon S, Dada M, Biswas A. 'Working to stay healthy', health-seeking behaviour in Bangladesh's urban slums: a qualitative study. BMC Public Health 2019; 19:600. [PMID: 31101099 PMCID: PMC6525448 DOI: 10.1186/s12889-019-6750-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/04/2019] [Indexed: 12/03/2022] Open
Abstract
Background Kamrangirchar and Hazaribagh are the largest slum areas in Dhaka, Bangladesh. In 2013, Médecins Sans Frontières initiated an urban healthcare programme in these areas providing services for factory workers and responding to the sexual and reproductive health needs of young women. Little in-depth information is available on perceptions of health and health seeking behaviour in this population. We aimed to provide a better understanding of community perceptions toward health and health care in order to inform programme strategies. Methods In-depth interviews were conducted with women (n = 13); factory workers (n = 14); and key informants (n = 13). Participants were selected using purposive maximum variation sampling and voluntarily consented to take part. Topic guides steered participant-led interviews, which were audio-recorded, translated and transcribed from Bangla into English. By comparing cases, we identified emerging themes, patterns and relationships in the data. NVivo11© was used to sort and code the data. Results Emerging themes indicated that in Kamrangirchar and Hazaribagh, health is seen as an asset necessary for work and, thus, for survival. Residents navigate a highly fragmented health system looking for ‘quick fixes’ to avoid time off work, with the local pharmacy deemed ‘good enough’ for ‘common’ health issues. Health care seeking for ‘serious’ conditions is characterised by uncertainty, confusion, and unsatisfactory results. Decisions are made communally and shaped by collective perceptions of quality care. People with limited socio-economic capital have few options for care. ‘Quality care’ is perceived as comprehensive care ‘under one roof,’ including predictive biomedical diagnostics and effective medication, delivered through a trusting relationship with the care provider. Conclusions Health seeking behaviour of slum dwellers of Kamrangirchar and Hazaribagh is based on competing priorities, where quick and effective care is key, focussed on the ability to work and generate income. This takes place in a fragmented healthcare system characterised by mistrust of providers, and where navigation is informed by word-of-mouth experiences of peers. Improving health in this context demands a comprehensive and integrated approach to health care delivery, with an emphasis on rapid diagnosis, effective treatment and referral, and improved trust in care providers. Health education must be developed in collaboration with the community to identify knowledge gaps, support decision-making, and be channelled through existing networks. Further research should consider the effectiveness of interventions aiming to improve the practice of pharmacists. Electronic supplementary material The online version of this article (10.1186/s12889-019-6750-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Nell Gray
- Manson Unit, Médecins Sans Frontières, Chancery Exchange, 10 Furnival St, London, EC4A 1AB, UK
| | - Beverly Stringer
- Manson Unit, Médecins Sans Frontières, Chancery Exchange, 10 Furnival St, London, EC4A 1AB, UK
| | - Aminur Rahman
- International Centre for Diarrhoeal Disease Research, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Sadika Akhter
- International Centre for Diarrhoeal Disease Research, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Stobdan Kalon
- Médecins Sans Frontières OCA, Plantage Middenlaan 14, 1018 DD, Amsterdam, Netherlands
| | - Martins Dada
- Médecins Sans Frontières OCA, Plantage Middenlaan 14, 1018 DD, Amsterdam, Netherlands
| | - Animesh Biswas
- Centre for Injury Prevention and Research Bangladesh (CIPRB), House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
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Ongarora D, Karumbi J, Minnaard W, Abuga K, Okungu V, Kibwage I. Medicine Prices, Availability, and Affordability in Private Health Facilities in Low-Income Settlements in Nairobi County, Kenya. PHARMACY 2019; 7:pharmacy7020040. [PMID: 31022841 PMCID: PMC6631117 DOI: 10.3390/pharmacy7020040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 01/07/2023] Open
Abstract
Medicine prices are a major determinant of access to healthcare. Owing to low availability of medicines in the public health facilities and poor accessibility to these facilities, most low-income residents pay out-of-pocket for health services and transport to the private health facilities. In low-income settlements, high retail prices are likely to push the population further into poverty and ill health. This study assessed the retail pricing, availability, and affordability of medicines in private health facilities in low-income settlements within Nairobi County. Medicine prices and availability data were collected between September and December 2016 at 45 private healthcare facilities in 14 of Nairobi’s low-income settlements using electronic questionnaires. The International Medical Products Price Guide provided international medicine reference prices for comparison. Affordability and availability proxies were calculated according to existing methods. Innovator brands were 13.8 times more expensive than generic brands. The lowest priced generics and innovator brands were, on average, sold at 2.9 and 32.6 times the median international reference prices of corresponding medicines. Assuming a 100% disposable income, it would take 0.03 to 1.33 days’ wages for the lowest paid government employee to pay for treatment courses of selected single generic medicines. Medicine availability in the facilities ranged between 2% and 76% (mean 43%) for indicator medicines. Prices of selected medicines varied within the 14 study regions. Retail medicine prices in the low-income settlements studied were generally higher than corresponding international reference prices. Price variations were observed across different regions although the regions comprise similar socioeconomic populations. These factors are likely to impact negatively on healthcare access.
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Affiliation(s)
- Dennis Ongarora
- Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi 19676-00202, Kenya.
| | | | - Warnyta Minnaard
- Stichting PharmAccess International, Amsterdam 22700 1100 DE, Netherlands.
| | - Kennedy Abuga
- Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi 19676-00202, Kenya.
| | | | - Isaac Kibwage
- Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi 19676-00202, Kenya.
- Administration, Planning and Development, Egerton University, Njoro 20115, Kenya.
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Zawahir S, Lekamwasam S, Aslani P. Community pharmacy staff's response to symptoms of common infections: a pseudo-patient study. Antimicrob Resist Infect Control 2019; 8:60. [PMID: 30976387 PMCID: PMC6439995 DOI: 10.1186/s13756-019-0510-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/19/2019] [Indexed: 01/21/2023] Open
Abstract
Background Inappropriate over-the-counter supply of antibiotics in pharmacies for common infections is recognised as a source of antibiotic misuse that can worsen the global burden of antibiotic resistance. Objectives To assess responses of community pharmacy staff to pseudo-patients presenting with symptoms of common infections and factors associated with such behaviour. Methods A cross-sectional pseudo-patient study was conducted from Jan-Sept 2017 among 242 community pharmacies in Sri Lanka. Each pharmacy was visited by one trained pseudo-patient who pretended to have a relative with clinical symptoms of one of four randomly selected clinical scenarios of common infections (three viral infections: acute sore throat, common cold, acute diarrhoea) and a bacterial uncomplicated urinary tract infection. Pseudo-patients requested an unspecified medicine for their condition. Interactions between the attending pharmacy staff and the pseudo-patients were audio recorded (with prior permission). Interaction data were also entered into a data collection form immediately after each visit. Results In 41% (99/242) of the interactions, an antibiotic was supplied illegally without a prescription. Of these, 66% (n = 65) were inappropriately given for the viral infections. Antibiotics were provided for 55% of the urinary tract infections, 50% of the acute diarrhoea, 42% of the sore throat and 15% of the common cold cases. Patient history was obtained in less than a quarter of the interactions. In 18% (44/242) of the interactions staff recommended the pseudo-patient to visit a physician, however, in 25% (11/44) of these interactions an antibiotic was still dispensed. Pharmacy staff advised the pseudo-patient on how to take (in 60% of the interactions where an antibiotic was supplied), when to take (47%) and when to stop (22%) the antibiotics supplied. Availability of a pharmacist reduced the likelihood of unlawful antibiotic supply (OR = 0.53, 95% CI: 0.31-0.89; P = 0.016) but not appropriate practice. Conclusions Illegal and inappropriate dispensing of antibiotics was evident in the participating community pharmacies. This may be a public health threat to Sri Lanka and beyond. Strategies to improve the appropriate dispensing practice of antibiotics among community pharmacies should be considered seriously.
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Affiliation(s)
- Shukry Zawahir
- The University of Sydney School of Pharmacy, Sydney, NSW Australia
| | - Sarath Lekamwasam
- Population Health Research Centre, Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Parisa Aslani
- The University of Sydney School of Pharmacy, Sydney, NSW Australia
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Konduri N, Delmotte E, Rutta E. Engagement of the private pharmaceutical sector for TB control: rhetoric or reality? J Pharm Policy Pract 2017; 10:6. [PMID: 28116106 PMCID: PMC5241918 DOI: 10.1186/s40545-016-0093-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/13/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Private-sector retail drug outlets are often the first point of contact for common health ailments, including tuberculosis (TB). Systematic reviews on public-private mix (PPM) interventions for TB did not perform in-depth reviews specifically on engaging retail drug outlets and related stakeholders in the pharmaceutical sector. Our objective was to better understand the extent to which the World Health Organization's (WHO) recommendation on engaging retail drug outlets has been translated into programmatic policy, strategy, and intervention in low- and middle-income countries. METHODS The study included a content analysis of global-level documents from WHO and the Stop TB Partnership in five phases. A country-level content analysis from four data sources was performed. Global-level findings were tabulated based on key messages related to engaging retail drug outlets. Country-level findings were analyzed based on four factors and tabulated. National strategic plans for TB control from 14 countries with varying TB burdens and a strong private sector were reviewed. RESULTS 33 global-level documents and 77 full-text articles and Union World Lung Health conference abstracts were included for review. Based on experience of engaging retail drug outlets that has emerged since the mid-2000s, in 2011 WHO and the International Pharmaceutical Federation released a joint statement on promoting the engagement of national pharmacy associations in partnership with national TB programs. Only two of 14 countries' national strategic plans had explicit statements on the need to engage their national pharmacy professional association. The success rate of referrals from retail drug outlets who visited an approved health facility for TB screening ranged from 48% in Vietnam to 86% in Myanmar. Coverage of retail drug outlets ranged from less than 5 to 9% of the universe of retail drug outlets. CONCLUSIONS For WHO's End TB Strategy to be successful, scaling up retail drug outlets to increase national coverage, at least in countries with a thriving private sector, will be instrumental in accelerating the early detection and referral of the 3 million missing TB cases. The proposed PPM pharmacy model is applicable not only for TB control but also to tackle the antimicrobial resistance crisis in these countries.
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Affiliation(s)
- Niranjan Konduri
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Management Sciences for Health, 4301 N. Fairfax Dr. Suite 400, Arlington, VA 22203 USA
| | - Emily Delmotte
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Management Sciences for Health, 4301 N. Fairfax Dr. Suite 400, Arlington, VA 22203 USA
| | - Edmund Rutta
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Management Sciences for Health, 4301 N. Fairfax Dr. Suite 400, Arlington, VA 22203 USA
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Suhail A, Azhar A. Managing Human Resources in Public Health Care System in South Asia: Case Study of Pakistan. SOUTH ASIAN JOURNAL OF HUMAN RESOURCE MANAGEMENT 2016. [DOI: 10.1177/2322093716640024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health care is considered as one of the fundamental rights of every individual. At the same time, efficient and effective delivery of health care service requires pro-active management of health care professionals. The purpose of this article is to highlight human resource issues and challenges faced by health care professionals in South Asia and identify suitable strategies for better management of health care professionals. By using data from a pilot study in Pakistan’s public health sector in the province of Punjab, the article explores ways of implementing productive reforms to upgrade human resource management system in the public health care sector in South Asian countries.
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Affiliation(s)
- Aneeqa Suhail
- Lecturer, UCP Business school, University of Central Punjab, Lahore, Pakistan
| | - Aisha Azhar
- UCP Business school, University of Central Punjab, Lahore, Pakistan
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Miller R, Goodman C. Performance of retail pharmacies in low- and middle-income Asian settings: a systematic review. Health Policy Plan 2016; 31:940-953. [PMID: 26962123 PMCID: PMC4977427 DOI: 10.1093/heapol/czw007] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In low- and middle-income countries (LMIC) in Asia, pharmacies are often patients' first point of contact with the health care system and their preferred channel for purchasing medicines. Unfortunately, pharmacy practice in these settings has been characterized by deficient knowledge and inappropriate treatment. This paper systematically reviews both the performance of all types of pharmacies and drug stores across Asia's LMIC, and the determinants of poor practice, in order to reflect on how this could best be addressed. Poor pharmacy practice in Asia appears to have persisted over the past 30 years. We identify a set of inadequacies that occur at key moments throughout the pharmacy encounter, including: insufficient history taking; lack of referral of patients who require medical attention; illegal sale of a wide range of prescription only medicines without a prescription; sale of medicines that are either clinically inappropriate and/or in doses that are outside of the therapeutic range; sale of incomplete courses of antibiotics; and limited provision of information and counselling. In terms of determinants of poor practice, first knowledge was found to be necessary but not sufficient to ensure correct management of patients presenting at the pharmacy. This is evidenced by large discrepancies between stated and actual practice; little difference in the treatment behaviour of less and more qualified personnel and the failure of training programmes to improve practice to a satisfactory level. Second, we identified a number of profit maximizing strategies employed by pharmacy staff that can be linked to poor practices. Finally, whilst the research is relatively sparse, the regulatory environment appears to play an important role in shaping behaviour. Future efforts to improve the situation may yield more success than historical attempts, which have tended to concentrate on education, if they address the profit incentives faced by pharmacy personnel and the regulatory system.
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Affiliation(s)
- Rosalind Miller
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine Goodman
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Gruebner O, Lautenbach S, Khan MMH, Kipruto S, Epprecht M, Galea S. Place of Residence Moderates the Risk of Infant Death in Kenya: Evidence from the Most Recent Census 2009. PLoS One 2015; 10:e0139545. [PMID: 26452226 PMCID: PMC4599946 DOI: 10.1371/journal.pone.0139545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 09/14/2015] [Indexed: 11/19/2022] Open
Abstract
Background Substantial progress has been made in reducing childhood mortality worldwide from 1990–2015 (Millennium Development Goal, target 4). Achieving target goals on this however remains a challenge in Sub-Saharan Africa. Kenya’s infant mortality rates are higher than the global average and are more pronounced in urban areas as compared to rural areas. Only limited knowledge exists about the differences in individual level risk factors for infant death among rural, non-slum urban, and slum areas in Kenya. Therefore, this paper aims at 1) assess individual and socio-ecological risk factors for infant death in Kenya, and at 2) identify whether living in rural, non-slum urban, or slum areas moderated individual or socio-ecological risk factors for infant death in Kenya. Methodology We used a cross-sectional study design based on the most recent Kenya Population and Housing Census of 2009 and extracted the records of all females who had their last child born in 12 months preceding the survey (N = 1,120,960). Multivariable regression analyses were used to identify risk factors that accounted for the risk of dying before the age of one at the individual level in Kenya. Place of residence (rural, non-slum urban, slum) was used as an interaction term to account for moderating effects in individual and socio-ecological risk factors. Results Individual characteristics of mothers and children (older age, less previously born children that died, better education, girl infants) and household contexts (better structural quality of housing, improved water and sanitation, married household head) were associated with lower risk for infant death in Kenya. Living in non-slum urban areas was associated with significantly lower infant death as compared to living in rural or slum areas, when all predictors were held at their reference levels. Moreover, place of residence was significantly moderating individual level predictors: As compared to rural areas, living in urban areas was a protective factor for mothers who had previous born children who died, and who were better educated. However, living in urban areas also reduced the health promoting effects of better structural quality of housing (i.e. poor or good versus non-durable). Furthermore, durable housing quality in urban areas turned out to be a risk factor for infant death as compared to rural areas. Living in slum areas was also a protective factor for mothers with previous child death, however it also reduced the promoting effects of older ages in mothers. Conclusions While urbanization and slum development continues in Kenya, public health interventions should invest in healthy environments that ideally would include improvements to access to safe water and sanitation, better structural quality of housing, and to access to education, health care, and family planning services, especially in urban slums and rural areas. In non-slum urban areas however, health education programs that target healthy diets and promote physical exercise may be an important adjunct to these structural interventions.
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Affiliation(s)
- Oliver Gruebner
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America; Center for Development and Environment (CDE), University of Bern, Bern, Switzerland
| | - Sven Lautenbach
- Institute of Geodesy and Geoinformation, University of Bonn, Bonn, Germany
| | - M M H Khan
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
| | | | - Michael Epprecht
- Center for Development and Environment (CDE), University of Bern, Bern, Switzerland
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, United States of America
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Khan MMH, Zanuzdana A, Kraemer A. Levels, trends and disparities in public-health-related indicators among reproductive-age women in Bangladesh by urban-rural and richest-poorest groups, 1993-2011. PLoS One 2013; 8:e75261. [PMID: 24086485 PMCID: PMC3783385 DOI: 10.1371/journal.pone.0075261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/13/2013] [Indexed: 11/18/2022] Open
Abstract
Background And Objectives Although Bangladesh has already achieved noticeable progress in the field of development and health, disparities in public health indicators for several markers are still reported. To assess public health development in Bangladesh during the last two decades, firstly, we analysed levels, trends and disparities in public-health-related indicators by rural versus urban as well as by the richest versus poorest group of women who have ever been married. Secondly, using the most recent data set we performed multiple analyses to check whether urban-rural and richest-poorest disparities were still significant. Methods The analysis was based on six nationally representative data sets from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94 (n=9,640), 1996-1997 (n=9,127), 1999-2000 (n=10,544), 2004 (n=11,440), 2007 (n=10,996) and 2011 (n=17,749). The outcome variables were six selected public-health-related indicators. We performed various types of analyses, including multiple logistic regressions. Results The trend of all indicators except being overweight (1993-2011) displayed gradual improvements for both markers. However, the urban and richest groups revealed a better situation than their counterparts in both simple and multiple analyses. Disparities between richest-poorest groups were more pronounced than urban-rural disparities. For instance, the prevalence of delivery at any healthcare facility in 2011 was 20.4% in rural areas and 46.5% in urban areas, whereas it was 9.1% in the poorest group and 57.6% in the richest group. Conclusion The public health sector in Bangladesh has achieved some successes over the last two decades. However, urban-rural and richest-poorest disparities are still considerable and therefore more public health strategies and efforts are clearly needed for the rural and poorest groups of women in order to reduce these gaps further.
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Affiliation(s)
- Md. Mobarak Hossain Khan
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
- * E-mail:
| | - Arina Zanuzdana
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Alexander Kraemer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
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