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da Costa RC, Serrano I, Chambel L, Oliveira M. The importance of "one health approach" to the AMR study and surveillance in Angola and other African countries. One Health 2024; 18:100691. [PMID: 39010949 PMCID: PMC11247297 DOI: 10.1016/j.onehlt.2024.100691] [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: 09/29/2023] [Accepted: 01/29/2024] [Indexed: 07/17/2024] Open
Abstract
The dissemination of multidrug-resistant (MDR) bacterial isolates in low- and middle-income countries, including several African countries, is a major concern. The poor sanitary conditions of rural and urban families observed in certain regions may favor the transmission of bacterial infections between animals and humans, including those promoted by strains resistant to practically all available antibiotics. In Angola, in particular, the presence of these strains in human hospitals has already been described. Nevertheless, the information on antimicrobial resistance (AMR) prevalence in Angola is still scarce, especially regarding veterinary isolates. This review aimed to synthesize data on antimicrobial resistance in African countries, with a special focus on Angola, from a One Health perspective. The main goals were to identify research gaps that may require further analysis, and to draw attention to the importance of the conscious use of antimicrobials and the establishment of preventive strategies, aiming to guarantee the safeguarding of public health. To understand these issues, the available literature on AMR in Africa was reviewed. We searched PubMed for articles pertinent to AMR in relevant pathogens in Angola and other African countries. In this review, we focused on AMR rates and surveillance capacity. The principal findings were that, in Africa, especially in sub-Saharan countries, AMR incidence is high due to the lack of legislation on antibiotics, to the close interaction of humans with animals and the environment, and to poverty. The information about current resistance patterns of common pathogenic bacteria is sparse, and the number of quality studies is limited in Angola and in some other Sub-Saharan African countries. Also, studies on the "One Health Approach" focusing on the environment, animals, and humans, are scarce in Africa. The surveillance capacity is minimal, and only a low number of AMR surveillance programs and national health programs are implemented. Most international and cooperative surveillance programs, when implemented, are not properly followed, concluded, nor reported. In Angola, the national health plan does not include AMR control, and there is a consistent omission of data submitted to international surveillance programs. By identifying One Health strengths of each country, AMR can be controlled with a multisectoral approach and governmental commitment.
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Affiliation(s)
- Romay Coragem da Costa
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
- Department of Animal Health, Faculty of Veterinary Medicine, University José Eduardo dos Santos, Huambo, Angola
| | - Isa Serrano
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Lélia Chambel
- BioISI-Biosystems and Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, 1749-016 Lisboa, Portugal
| | - Manuela Oliveira
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, 1749-016 Lisboa, Portugal
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Morang’a AK, Muloi DM, Kamau SM, Onono JO, Gathura PB, Moodley A. Mapping the flow of veterinary antibiotics in Kenya. Front Vet Sci 2024; 11:1304318. [PMID: 38645649 PMCID: PMC11027570 DOI: 10.3389/fvets.2024.1304318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/14/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction To effectively regulate and reduce antibiotic use, in the livestock sector, a thorough understanding of the flow of veterinary antibiotics will help to identify key nodes in the chain for targeted interventions. The aim of this study was to understand the flow of antibiotics from import to end-user, and identify relevant governance mechanisms. Methods A mixed methods approach was used to collect data in three Kenyan counties (Nairobi, Kiambu, and Kajiado). Focus group discussions (n = 23), individual interviews (n = 148), and key informant interviews (n = 10) were conducted. Results The key actors identified include primary wholesalers, secondary wholesalers, retailers, animal health service providers (AHSPs), and farmers. Kenya imports 100% of its veterinary antibiotics: primary wholesalers legally import antibiotics as finished pharmaceutical products (90%) or active pharmaceutical ingredients (10%) after approval by the Veterinary Medicines Directorate. Secondary wholesalers play a major role in the distribution of antibiotics (60% of antibiotics) from importers to farmers, AHSPs, and retailers. Some of the illegal sources of antibiotics include unlicenced/unauthorized middlemen and online platforms that sell directly to retailers, AHSPs, and farmers. Discussion Despite the presence of various laws and regulations governing the antibiotic value chain, implementation has been a challenge due to financial and human resource constraints. This contributes to over-the-counter sale of antibiotics without prescription, unlicensed businesses selling antibiotics, illegal importation, and presence of poor-quality drugs. There is a need to review the applicability of existing policies and address policy gaps (e.g., product containing antibiotic combinations, and use of human critically important antibiotics) to ensure the prudent sale and use of antibiotics, pharmacovigilance, antimicrobial use surveillance, and developing a business model that aligns with antibiotic stewardship. Additional interventions include awareness raising and capacity building of the different stakeholders along the antibiotic distribution chain to reduce antibiotic mis- and overuse.
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Affiliation(s)
- Alexina K. Morang’a
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Dishon M. Muloi
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Simon M. Kamau
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Joshua O. Onono
- Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Peter B. Gathura
- Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Arshnee Moodley
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
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Hamill MM, Onzia A, Parkes-Ratanshi RM, Kyambadde P, Mande E, Nakate V, Melendez JH, Gough E, Manabe YC. Antibiotic overuse, poor antimicrobial stewardship, and low specificity of syndromic case management in a cross section of men with urethral discharge syndrome in Kampala, Uganda. PLoS One 2024; 19:e0290574. [PMID: 38489281 PMCID: PMC10942085 DOI: 10.1371/journal.pone.0290574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/11/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE High prevalence of sexually transmitted infections (STIs) combined with poor antimicrobial stewardship are drivers of STI antimicrobial resistance (AMR) especially in resource-limited settings where syndromic case management (SCM) is the norm. We characterized patterns of antibiotic use prior to clinic attendance and study enrollment in Ugandan men with urethral discharge syndrome (UDS), evaluated in-clinic prescribing, and the performance characteristics of SCM. METHODS Participants were recruited from government clinics participating in an existing gonococcal surveillance program in Kampala, Uganda. Questionnaires including antimicrobial use prior to attendance, prior episodes of UDS, penile swabs, and blood samples were collected. Bivariable and multivariable logistic regression models were used to estimate odds ratios (OR) for preselected factors likely to be associated with antibiotic use. In-clinic antibiotic treatment data were extracted from clinical notes, and the performance of SCM against laboratory-based STI diagnoses was evaluated. FINDINGS Between October 2019 and November 2020, 100(40%) of 250 men with UDS reported taking antibiotics in the 14days prior to attending the clinic. Of these 210(84%) had at least one curable STI and 20% had a reactive point-of-care HIV test. Multivariable analysis demonstrated significant associations between recent antimicrobial use and duration of UDS symptoms <6 days (OR 2.98(95%CI 1.07,8.36), p = 0.038), and sex with women only (OR 0.08(95%CI 0.01,0.82),p = 0.038). The sensitivity of SCM ranged from 80.0% to 94.4%; specificity was low between 5.6% and 33.1%. The positive predictive value of SCM ranged from 2.4(95%CI 0.7,6.0) for trichomoniasis to 63.4(95%CI 56.5,69.9) for gonorrhea. CONCLUSION Pre-enrollment antibiotic use was common in this population at high risk of STI and HIV. Combined with the poor specificity of SCM for male UDS, extensive antibiotic use is a likely driver of STI-AMR in Ugandan men. Interventions to improve antimicrobial stewardship and deliver affordable diagnostics to augment SCM and decrease overtreatment of STI syndromes are required.
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Affiliation(s)
- Matthew M. Hamill
- Division of infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Annet Onzia
- Infectious Disease Institute, Kampala, Uganda
| | | | - Peter Kyambadde
- Ministry of Health, National Sexually Transmitted Infections Control Program, Kampala, Uganda
| | | | | | - Johan H. Melendez
- Division of infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Ethan Gough
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Yukari C. Manabe
- Division of infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
- Infectious Disease Institute, Kampala, Uganda
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Sahilu T, Kano Z. Antibiotics prescribing practice among patients with urinary tract infection at outpatient department, the case of Dilchora referral hospital, Eastern Ethiopia: an institutional retrospective cross-sectional study. J Pharm Policy Pract 2023; 16:23. [PMID: 36810136 PMCID: PMC9945606 DOI: 10.1186/s40545-023-00539-y] [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: 08/15/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Inappropriate prescription of antibiotics is a global public health challenge. Widespread use, misuse, or inappropriate prescribing has resulted in unnecessary expenditure on drugs, raised risk of adverse reactions, the development of antimicrobial resistance, and increment in health care costs. There is a limited practice in rational prescribing of antibiotics in the management of Urinary tract infection (UTI) in Ethiopia. OBJECTIVE To assess antibiotic prescribing practice in the treatment of patients with UTI at outpatient department (OPD), Dilchora referral hospital, Eastern Ethiopia. METHODS A retrospective cross-sectional study was conducted from January 7 to March 14, 2021. Data were collected from 600 prescription papers using systematic random sampling method. World Health Organization's standardized core prescribing indicators was used. RESULTS A total of 600 prescriptions containing antibiotics prescribed for patients with UTIs were observed during the study period. Of these, 415 (69.19%) were females and 210 (35%) were in the age group of 31-44 years. The number of generic drugs and antibiotics prescribed per encounter was 1.60 and 1.28, respectively. The percentage of antibiotics per prescription was found to be 27.83%. About 88.40% of antibiotics were prescribed by generic names. Fluoroquinolones were the most frequently prescribed class of drugs for the treatment of patients with UTIs. CONCLUSION The prescribing practice of antibiotics in patients with UTIs was found to be good as the drugs were prescribed in generic name.
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Affiliation(s)
- Tamiru Sahilu
- Department of Pharmacy, College of Health Science, Assosa University, Assosa, Ethiopia.
| | - Zenebe Kano
- grid.192267.90000 0001 0108 7468School of Pharmacy, College of Medical and Health Science, Haramaya University, Dire Dawa, Ethiopia
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Onguka S, de Meijer F, Basnight-Brown DM. Overdue Assignment: A Case Study on Academic Writing Development for Postgraduate Health Professional Trainees in Kenya. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231206220. [PMID: 38025028 PMCID: PMC10656809 DOI: 10.1177/23821205231206220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/30/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES Though essential for research capacity building, development of authorial identity for thesis projects and publications has been overlooked in African postgraduate residency programs. This study aims to explore authorial identity among postgraduate health professional trainees at two universities in Kenya. It also evaluated the effect of Age of Acquisition of English on confidence in writing. METHODS This exploratory case study utilized quantitative and qualitative data. Pre- and post-workshop surveys were generated from learning objectives and evaluated confidence in writing and plagiarism awareness, both important attributes of authorial identity. As confidence in writing might be influenced by the English Age of Acquisition, the questionnaire also included items from the Language Experience and Proficiency Questionnaire. Pre- and post-workshop responses were analyzed using planned comparisons. Focus group discussions further explored authorial identity among participants and were analyzed thematically. RESULTS A total of 57 postgraduate trainees from nine medical specialties participated in the study. Both confidence in writing and plagiarism awareness improved significantly after the workshop: confidence in writing pre-test (M = 3.20, SD = 0.59) and post-test (M = 3.97, SD = 0.61), t(56) = 6.93, P < .001, d = 0.9; plagiarism awareness pre-test (M = 3.01, SD 0.72) and post-test (M = 3.92, SD 0.65), t(56) = 6,8, P < .001, d = 0.9. The average English Age of Acquisition was 4.98 years and showed no correlation with confidence in writing. Participants recognized that authentic authorship requires hard work and suggested plagiarism is driven by inadequate writing instruction. They proposed that changing perceptions of research and writing could overcome a graduation requirement mindset among trainees. CONCLUSIONS Interactive workshops using procedural and enculturation approaches may be useful to develop authorial identity among postgraduate health professionals in Kenya. Further research is needed on evaluating workshop effectiveness using direct indicators of learning and other curricular reforms to promote authorship.
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Affiliation(s)
- Stephanie Onguka
- Department of Family Medicine, Kabarak University, Kabarak, Kenya
| | - Fleur de Meijer
- Department of Family Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Dana M Basnight-Brown
- Department of Psychology, United States International University – Africa, Nairobi, Kenya
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Gabriel S, Manumbu L, Mkusa O, Kilonzi M, Marealle AI, Mutagonda RF, Mlyuka HJ, Mikomangwa WP, Minzi O. Knowledge of use of antibiotics among consumers in Tanzania. JAC Antimicrob Resist 2021; 3:dlab183. [PMID: 34859224 PMCID: PMC8634462 DOI: 10.1093/jacamr/dlab183] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/05/2021] [Indexed: 11/14/2022] Open
Abstract
Background Studies assessing consumers' knowledge of the rational use of antibiotics are essential to understand the knowledge gap before intervention strategies are instituted. Objectives To assess the knowledge of rational use of antibiotics among consumers in Dar es Salaam, Tanzania. Methods A cross-sectional study assessing knowledge of rational use of antibiotics among 960 consumers was conducted in Dar es salaam in March 2021. Participants were consecutively enrolled from outpatient pharmacies in selected public and private hospitals and marketplaces in Ilala Municipality. Data were collected using the WHO-validated questions on knowledge of consumers of antibiotic uses. Results Overall, 196 (20.4%) and 503 (52.4%) participants demonstrated good knowledge of rational antibiotic use and conditions that can be treated with antibiotics, respectively. However, 678 (70.6%) responded that they stopped using antibiotics after dose completion, 515 (53.6%) would request the same antibiotic if it had helped to treat a similar condition in the past and 406 (42.3%) are willing to use the same antibiotic if a friend or family member used the medication previously to treat similar signs and symptoms. Besides, the following conditions were mentioned as being treatable with antibiotics: influenza (50.7%), sore throat (61.4%) and urinary tract infection (60.5%). Conclusions The majority of the consumers had poor knowledge of the rational uses of antibiotics and a moderate proportion had good knowledge of the conditions that are treatable with antibiotics. Those with a high level of education and with health insurance had good knowledge of rational uses of antibiotics.
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Affiliation(s)
- Salvador Gabriel
- School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Loyce Manumbu
- School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Omary Mkusa
- School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Alphonce Ignace Marealle
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Ritah F Mutagonda
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
| | - Omary Minzi
- Department of Clinical Pharmacy & Pharmacology, School of Pharmacy, Muhimbili University of Health & Allied Sciences, PO Box 65013, Dar es Salaam, Tanzania
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Frempong BK, Amalba A, Donkor N, Akuffo KO. Regulatory compliance among over-the-counter medicine sellers facilities within the Upper East Region of Ghana. J Pharm Policy Pract 2021; 14:72. [PMID: 34429161 PMCID: PMC8383477 DOI: 10.1186/s40545-021-00363-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background Easy access to medicines provided by private medicine retailing facilities including that of over-the-counter medicine retailers, have gained prominence in sub-Saharan Africa. Although over-the-counter medicine-sellers (OTCMS) facilities play an indispensable role in healthcare delivery, there is inadequate information about their regulatory environment and whether their operations conform to regulatory provisions. Hence, this study sought to investigate the characteristics and predictors of regulatory practices among over-the-counter medicine sellers in Ghana. Methods This was a cross-sectional study involving participants from 208 OTCMS facilities in eight (8) municipalities and districts (MDA’s) of the Upper East Region of Ghana. An initial census of facilities in the region was conducted between May and August 2016 and a follow-up conducted between December 2016 and March 2017. This ensured the identification and location of all OTCMS facilities within the selected MDA’s for study planning and data collection. The main outcome variable was regulatory compliance which is a composite of three indicators for regulatory practices (retention of medicine supplier’s invoices and receipts on-premises), licensing and registration requirements (appropriate signage), and equipment and material requirements (availability of reference material). Regulatory compliance was assessed using bivariate and multivariate logistic regression analyses. Results In this survey, 21.5%, 38.2%, and 23.1% of the facilities surveyed had a good state of repair, had the owner of the facility available on the premises, and had received regulatory visit(s) in less than 12 months, respectively. Only 29.2% of facilities were regulatory compliant. After statistical adjustment, OTCMS facility location (compared with Rural: Urban, AOR = 4.2, 95% CI 1.74–10.17, p = 0.001) and staff trained in less than 1 year (AOR = 2.78, 95% CI 1.02–7.62, p = 0.046) were significantly associated with regulatory compliance. Conclusions Regulatory compliance was low in the Upper East Region of Ghana, particularly across rural locations, where most of the facilities failed to meet the laid down provisions of the Pharmacy Council regarding practice, staff and premises requirements. This could be attributed to the fact that these areas are poorly resourced. Policymakers are been called on to put in place pragmatic measures in relation to OTCMS facility’s location and regulatory requirements to address the inequities in compliance.
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Affiliation(s)
| | - Anthony Amalba
- Department of Health Professions Education and Innovative Learning, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Nina Donkor
- Department of Pharmacy Practice, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwadwo Owusu Akuffo
- Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Atif M, Ahmad M, Malik I, Mushtaq I, Ahmad N, Mehjabin, Babar ZUD. How medicines sales staff is responding to presumptive COVID-19 patients attending drug retail outlets: An exploratory qualitative study. Int J Health Plann Manage 2021; 36:2297-2312. [PMID: 34390010 PMCID: PMC8426854 DOI: 10.1002/hpm.3293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 12/25/2022] Open
Abstract
The objective of this qualitative study was to explore how the medicine sales staff responded to presumptive COVID‐19 patients in Pakistan. The data were obtained from the medicine sales staff working at drug retail outlets of Bahawalpur, Punjab, Pakistan, through in‐depth face‐to‐face interviews using a semi‐structured interview guide. A two‐step sampling strategy was used, including purposive and convenient sampling techniques. Sample size was determined by applying the saturation point criteria. A total of 17 interviews were audio‐recorded, transcribed verbatim and analysed using the thematic analysis. Analysis of data yielded six themes and seven sub‐themes. The themes included (1) knowledge about various aspects of COVID‐19, (2) practices of sales staff in response to COVID‐19 pandemic, (3) attitude of sales staff towards COVID‐19 pandemic, (4) services offered to presumptive COVID‐19 patients, (5) challenges encountered during pandemic and (6) suggestions to improve delivery of pharmacy services by sales staff. In Pakistan, non‐pharmacist sales staff had superficial knowledge about COVID‐19. Presumptive COVID‐19 patients were provided with only basic pharmacy services. Professional training is advised among pharmacy sales staff as a short‐term solution to improve their knowledge. As a long‐term goal, the availability of pharmacists at drug retail outlets is warranted.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Muhammad Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Irem Mushtaq
- Department of Education, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Mehjabin
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Cuevas C, Batura N, Wulandari LPL, Khan M, Wiseman V. Improving antibiotic use through behaviour change: a systematic review of interventions evaluated in low- and middle-income countries. Health Policy Plan 2021; 36:594-605. [PMID: 33822953 PMCID: PMC8488384 DOI: 10.1093/heapol/czab021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
Antibiotic resistance (ABR) has been identified as a critical threat to global health at the highest policy fora. A leading cause of ABR is the inappropriate use of antibiotics by both patients and healthcare providers. Although countries around the world have committed to developing and implementing national action plans to tackle ABR, there is a considerable gap in evidence about effective behaviour change interventions addressing inappropriate use of antibiotics in low- and middle-income countries (LMICs), where ABR is growing at an alarming rate. We conducted a systematic review to synthesize evidence about the effectiveness and cost-effectiveness of behaviour change interventions to reduce inappropriate use of antibiotics in LMICs. Three databases were searched using a set of predefined search terms and exclusion criteria. The search identified 43 relevant articles. A narrative synthesis of results was conducted using the Behaviour Change Wheel framework to categorize intervention components. The majority of the reviewed studies were set in lower-middle-income or low-income countries located in Sub-Saharan Africa or East Asia and the Pacific. Twenty-four articles evaluated multi-faceted interventions over a period of 12 months or less. Despite the widespread use of antibiotics in the community, interventions were primarily implemented in public health facilities, targeting health professionals such as doctors, nurses, and other allied medical staff. Although education for providers was the most widely used strategy for influencing antibiotic use, it was shown to be most effective when used in conjunction with training or other enabling and supportive measures to nudge behaviour. Six articles included an evaluation of costs of interventions and found a reduction in costs in inpatient and outpatient settings, and one article found a training and guidelines implementation-based intervention to be highly cost-effective. However, the small number of articles conducting an economic evaluation highlights the need for such analyses to be conducted more frequently to support priority setting in resource-constrained environments.
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Affiliation(s)
- Carla Cuevas
- Centre for Global Health Economics, Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Neha Batura
- Centre for Global Health Economics, Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth BuildingHigh Street, UNSW Australia. Sydney, New South Wales, 2052, Australia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mishal Khan
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Aga Khan University, National Stadium Road, Karachi, Pakistan
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth BuildingHigh Street, UNSW Australia. Sydney, New South Wales, 2052, Australia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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AlRukban M, AlRuthia Y, Almasaoud M, Al-Owairdhi M, Alsouan A, Alrabiah A, Alshaikh A, Alsuhaibani A, Aleidan A. Community Pharmacists' Views of the Enforced Antibiotics Dispensing Law and Its Impact on Oral Antibiotics Sales in Saudi Arabia. Risk Manag Healthc Policy 2020; 13:2899-2907. [PMID: 33335435 PMCID: PMC7737627 DOI: 10.2147/rmhp.s278404] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Objective(s) The aim of this study was to explore community pharmacists’ views toward the antibiotics dispensing law that was enforced in May 2018 and bans the sale of antibiotics without a prescription in community pharmacy settings in Saudi Arabia. Moreover, the potential impact of the law enforcement on the sales of oral antibiotics in Saudi Arabia was also explored. Methods A questionnaire-based cross-sectional study was conducted between September 2019 and March 2020 in Riyadh, Saudi Arabia. A multistage sampling technique was used to recruit community pharmacists from different districts. Pharmacists who consented to participate and reported practicing prior to the law enforcement were interviewed about their views of the law using a 14-item newly developed questionnaire. The annual sales of oral antibiotics for the years of 2017, 2018, and 2019 were retrieved from the Saudi Food and Drug Authority (SFDA) database. Results Two hundred and eighty six pharmacists consented to participate and met the inclusion criteria. After the law enforcement, approximately 51% of the participants reported that the percentage of patients seeking antibiotics without a prescription is less than 25%. Moreover, the majority (87.41%) reported a drop in the sales of antibiotics. Additionally, about 90% of the participants believed that the rate of inappropriate use of antibiotics will decrease as a result of the law enforcement. About 41% of the participants reported that the law has negatively impacted their pharmacies’ profits. The sales of oral antibiotics have seen a 16.6% drop in the year of 2019 as compared to 2017. Conclusion The antibiotics dispensing law is favorably perceived among community pharmacists in Saudi Arabia despite some concerns about its impact on their sales. Exploring different business models that delink the profits from the volume of antibiotics sales is necessary for this vital industry to thrive.
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Affiliation(s)
- Mohammed AlRukban
- Department of Family Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Majed Almasaoud
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Al-Owairdhi
- Department of Pharmacoeconomics and Drug Pricing, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Anwar Alsouan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Alan Aleidan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Sindato C, Mboera LEG, Katale BZ, Frumence G, Kimera S, Clark TG, Legido-Quigley H, Mshana SE, Rweyemamu MM, Matee M. Knowledge, attitudes and practices regarding antimicrobial use and resistance among communities of Ilala, Kilosa and Kibaha districts of Tanzania. Antimicrob Resist Infect Control 2020; 9:194. [PMID: 33287878 PMCID: PMC7720393 DOI: 10.1186/s13756-020-00862-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) represents one of the biggest threats to health globally. This cross-sectional study determined knowledge, attitudes and practices (KAP) regarding antimicrobial use (AMU) and AMR among communities of Ilala, Kilosa and Kibaha in Tanzania. METHOD A semi-structured questionnaire was used to collect socio-demographic and KAP data through face-to-face interviews. Responses related to the triad of KAP were assigned scores that were aggregated for each participant. Linear regression analysis was conducted to determine predictors of KAP scores. RESULTS The study enrolled 828 participants from the three districts. A total of 816 (98.6%) were aware of antimicrobials, and 808 (99%, n = 816) reported to have used them. Antimicrobials were mainly used to treat cough (68.0%), urinary tract infections (53.4%), diarrhoea (48.5%) and wounds (45.2%). The most frequent sources of antimicrobials were health facility (65.0%, n = 820) and pharmacies/basic drug shops (53.7%). The median AMU knowledge score was 5 (IQR = 4, 7) and that of AMR was 26 (IQR=23, 29). The median AMU attitudes score was 32 (IQR: 29, 35) and that of AMR was 19 (IQR=17, 22). The median AMU practice score was 3 (IQR: 3, 3). The KAP scores were significantly influenced by increased participant's age (βadj=0.10; 95% CI: 0.05, 0.15) and level of education, being lower among those with primary education (βadj=5.32; 95% CI: 3.27, 7.37) and highest among those with college/university education (βadj=9.85; 95% CI: 6.04, 13.67). CONCLUSION The study documented a moderate level of KAP regarding AMU and AMR in the study districts. The participant's age and level of education were significantly associated with participant's KAP scores. The observed inadequate knowledge, inappropriate attitude, and practices of AMU and AMR should be considered as alarming problems that require immediate actions including policy formulation and planning of community-based mitigation measures.
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Affiliation(s)
- Calvin Sindato
- National Institute for Medical Research, Tabora Research Centre, Tabora, Tanzania.
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Bugwesa Z Katale
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
- Tanzania Commission for Science and Technology, Dar es Salaam, Tanzania
| | - Gasto Frumence
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sharadhuli Kimera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
- College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Taane G Clark
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Stephen E Mshana
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mark M Rweyemamu
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Mecky Matee
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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12
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Iskandar K, Molinier L, Hallit S, Sartelli M, Catena F, Coccolini F, Craig Hardcastle T, Roques C, Salameh P. Drivers of Antibiotic Resistance Transmissionin Low- and Middle-Income Countriesfrom a "One Health" Perspective-A Review. Antibiotics (Basel) 2020; 9:E372. [PMID: 32630353 PMCID: PMC7400606 DOI: 10.3390/antibiotics9070372] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
Antibiotic resistance is an ecosystem problem threatening the interrelated human-animalenvironmenthealth under the "One Health" framework. Resistant bacteria arising in onegeographical area can spread via cross-reservoir transmission to other areas worldwide either bydirect exposure or through the food chain and the environment. Drivers of antibiotic resistance arecomplex and multi-sectoral particularly in Lower- and Middle-income countries. These includeinappropriate socio-ecological behaviors; poverty; overcrowding; lack of surveillance systems; foodsupply chain safety issues; highly contaminated waste effluents; and loose rules and regulations. Inorder to examine the drivers of antibiotic resistance from a "one health" perspective, a literaturereview was conducted on three databases including PubMed, Medline and Google Scholar. A totalof 485 studies of potential relevance were selected, out of which 182 were included in this review.Results have shown that the aforementioned market failures are the leading cause for the negativeexternality of antibiotic resistance that extends in scope from the individual to the global ecosystem.Incremental and sustainable global actions can make the change, however, the problem willcontinue to prevail if governments do not prioritize the "One health" approach and if individual'saccountability is still denied in a world struggling with profound socio-economic problems.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR 1027, F-31000 Toulouse, France
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Pharmacy, Lebanese University, Beirut 1106, Lebanon
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR 1027, Université Paul Sabatier Toulouse III, F-31000 Toulouse, France;
| | - Souheil Hallit
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Massimo Sartelli
- Department of surgery, University of Macerata, 62100 Macerata, Italy;
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, 43126 Parma, Italy;
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Cisanello University Hospital, 56100 Pisa, Italy;
| | - Timothy Craig Hardcastle
- Department of Trauma service, Inkosi Albert Luthuli Central Hospital, Durban 4091, South Africa;
- Department of Surgery, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congela, Durban 4041, South Africa
| | - Christine Roques
- Departement of Bioprocédés et Systèmes Microbiens, Laboratoire de Génie Chimique, Université Paul Sabatier Toulouse III, UMR 5503, 31330 Toulouse, France;
- Department of Bactériologie-Hygiène, Centre Hospitalier Universitaire, Hôpital Purpan, 31330 Toulouse, France
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Pharmacy, Lebanese University, Beirut 1106, Lebanon
- Faculty of Public Health, Lebanese University, Beirut 1103, Lebanon
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Asghar S, Atif M, Mushtaq I, Malik I, Hayat K, Babar ZUD. Factors associated with inappropriate dispensing of antibiotics among non-pharmacist pharmacy workers. Res Social Adm Pharm 2020; 16:805-811. [PMID: 31501016 DOI: 10.1016/j.sapharm.2019.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
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Sub-Standard Pharmaceutical Services in Private Healthcare Facilities Serving Low-Income Settlements in Nairobi County, Kenya. PHARMACY 2019; 7:pharmacy7040167. [PMID: 31817394 PMCID: PMC6958324 DOI: 10.3390/pharmacy7040167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/16/2019] [Accepted: 11/25/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Quality pharmaceutical services are an integral part of primary healthcare and a key determinant of patient outcomes. The study focuses on pharmaceutical service delivery among private healthcare facilities serving informal settlements within Nairobi County, Kenya and aims at understanding the drug procurement practices, task-shifting and ethical issues associated with drug brand preference, competition and disposal of expired drugs. Methods: Forty-five private facilities comprising of hospitals, nursing homes, health centres, medical centres, clinics and pharmacies were recruited through purposive sampling. Structured electronic questionnaires were administered to 45 respondents working within the study facilities over an 8-week period. Results: About 50% of personnel carrying out drug procurement belonged to non-pharmaceutical cadres namely; doctors, clinical officers, nurses and pharmacy assistants. Drug brand preferences among healthcare facilities and patients were mainly pegged on perceived quality and price. Unethical business competition practices were recorded, including poor professional demeanour and waiver of consultation fees veiled to undercut colleagues. Government subsidized drugs were sold at 100% profit in fifty percent of the facilities stocking them. In 44% of the facilities, the disposal of expired drugs was not in conformity to existing government regulatory guidelines. Conclusions: There is extensive task-shifting and delegation of pharmaceutical services to non-pharmaceutical cadres and poor observance of ethical guidelines in private facilities. Strict enforcement of regulations is required for optimal practices.
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Björnsdottir I, Granas AG, Bradley A, Norris P. A systematic review of the use of simulated patient methodology in pharmacy practice research from 2006 to 2016. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:13-25. [PMID: 31397533 DOI: 10.1111/ijpp.12570] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 07/09/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Simulated patient (SP) methodology (mystery shopping) is used increasingly to assess quality of pharmacy services, and evaluate impact of interventions. Our objective was to review papers reporting on the use of SP methodology in pharmacy practice research 2006-2016 in community pharmacies worldwide. METHODS We searched EMBASE and MEDLINE for papers reporting on the use of mystery shopping in pharmacy settings, using a wide range of terms for SPs, based on previous review. We removed irrelevant papers, duplicates, papers not written in English, and review papers and reviewed remaining papers. Two reviewers carried out data abstraction, using the same tool as the previous review and inserting data into Excel, focusing on how the SP methodology is used. KEY FINDINGS A total of 148 papers from 52 countries from all regions of the world were included in the review. A wide range of terms described the method, and simulated patient was the most common (49 papers). Most studies were cross-sectional (124), and most investigated only community pharmacies (115). The most common aim was to evaluate some aspect of pharmacists' or other staff's advice and counselling (94). Number of visits is 2-7785. Many papers did not cover details, such as number of visits planned, and carried out, scenario used, training and background of SPs, and ethical approval for the study. CONCLUSIONS The use of SP methodology has increased substantially in the field of pharmacy over the past decade. This is a useful method in a wide range of countries and settings. Greater detail is required in reporting.
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Affiliation(s)
| | | | - Amanda Bradley
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Sakeena M, Bennett AA, McLachlan AJ. Non-prescription sales of antimicrobial agents at community pharmacies in developing countries: a systematic review. Int J Antimicrob Agents 2018; 52:771-782. [DOI: 10.1016/j.ijantimicag.2018.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/28/2018] [Accepted: 09/29/2018] [Indexed: 11/24/2022]
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Horumpende PG, Sonda TB, van Zwetselaar M, Antony ML, Tenu FF, Mwanziva CE, Shao ER, Mshana SE, Mmbaga BT, Chilongola JO. Prescription and non-prescription antibiotic dispensing practices in part I and part II pharmacies in Moshi Municipality, Kilimanjaro Region in Tanzania: A simulated clients approach. PLoS One 2018; 13:e0207465. [PMID: 30462700 PMCID: PMC6248976 DOI: 10.1371/journal.pone.0207465] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/31/2018] [Indexed: 11/18/2022] Open
Abstract
Antibiotic dispensing without a prescription poses a threat to public health as it leads to excessive antibiotic consumption. Inappropriate antibiotic availability to the community has been documented to be amongst drivers of antimicrobial resistance emergence. Community pharmacies are a source of antibiotics in low and middle-income countries (LMICs). We aimed at assessing antibiotic dispensing practices by community pharmacy retailers in Moshi urban, Kilimanjaro, Tanzania and recommend interventions to improve practice. Using a Simulated Client (SC) Method, an observational cross-sectional survey of antibiotic dispensing practices was conducted from 10th June to 10th July 2017. Data analysis was done using Stata 13 (StataCorp, College Station, TX, USA). A total of 82 pharmacies were visited. Part I pharmacies were 26 (31.71%) and 56 (68.29%) were part II. Overall 92.3% (95% CI 77.8-97.6) of retailers dispensed antibiotics without prescriptions. The antibiotics most commonly dispensed without a prescription were ampiclox for cough (3 encounters) and azithromycin for painful urination (3 encounters). An oral third generation cephalosporin (cefixime) was dispensed once for painful urination without prescription by a part I pharmacy retailer. Out of 21, 15(71.43%) prescriptions with incomplete doses were accepted and had antibiotics dispensed. Out of 68, 4(5.9%) retailers gave instructions for medicine use voluntarily. None of the retailers voluntarily explained drug side-effects. In Moshi pharmacies, a high proportion of antibiotics are sold and dispensed without prescriptions. Instructions for medicine use are rarely given and none of the retailers explain side effects. These findings support the need for a legislative enforcement of prescription-only antibiotic dispensing rules and regulations. Initiation of clinician and community antibiotic stewardship and educational programs on proper antibiotic use to both pharmacists and public by the regulatory bodies are highly needed.
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Affiliation(s)
- Pius G. Horumpende
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Department of Preventive Medicine and Research, Lugalo General Military Hospital and Military College of Medical Sciences (MCMS), Dar es Salaam, Tanzania
| | - Tolbert B. Sonda
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Magreth L. Antony
- Section of HIV Viral Load and Early Infant Diagnostics, National Health Laboratory Quality Assurance and Training Centre, Dar es Salaam, Tanzania
| | - Filemon F. Tenu
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Charles E. Mwanziva
- Department of Preventive Medicine and Research, Lugalo General Military Hospital and Military College of Medical Sciences (MCMS), Dar es Salaam, Tanzania
| | - Elichilia R. Shao
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Jaffu O. Chilongola
- Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
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Chesang K, Hornston S, Muhenje O, Saliku T, Mirjahangir J, Viitanen A, Musyoki H, Awuor C, Githuka G, Bock N. Healthcare provider perspectives on managing sexually transmitted infections in HIV care settings in Kenya: A qualitative thematic analysis. PLoS Med 2017; 14:e1002480. [PMID: 29281636 PMCID: PMC5744911 DOI: 10.1371/journal.pmed.1002480] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/24/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The burden of sexually transmitted infections (STIs) has been increasing in Kenya, as is the case elsewhere in sub-Saharan Africa, while measures for control and prevention are weak. The objectives of this study were to (1) describe healthcare provider (HCP) knowledge and practices, (2) explore HCP attitudes and beliefs, (3) identify structural and environmental factors affecting STI management, and (4) seek recommendations to improve the STI program in Kenya. METHODS AND FINDINGS Using individual in-depth interviews (IDIs), data were obtained from 87 HCPs working in 21 high-volume comprehensive HIV care centers (CCCs) in 7 of Kenya's 8 regions. Transcript coding was performed through an inductive and iterative process, and the data were analyzed using NVivo 10.0. Overall, HCPs were knowledgeable about STIs, saw STIs as a priority, reported high STI co-infection amongst people living with HIV (PLHIV), and believed STIs in PLHIV facilitate HIV transmission. Most used the syndromic approach for STI management. Condoms and counseling were available in most of the clinics. HCPs believed that having an STI increased stigma in the community, that there was STI antimicrobial drug resistance, and that STIs were not prioritized by the authorities. HCPs had positive attitudes toward managing STIs, but were uncomfortable discussing sexual issues with patients in general, and profoundly for anal sex. The main barriers to the management of STIs reported were low commitment by higher levels of management, few recent STI-focused trainings, high stigma and low community participation, and STI drug stock-outs. Solutions recommended by HCPs included formulation of new STI policies that would increase access, availability, and quality of STI services; integrated STI/HIV management; improved STI training; increased supervision; standardized reporting; and community involvement in STI prevention. The key limitations of our study were that (1) participant experience and how much of their workload was devoted to managing STIs was not considered, (2) some responses may have been subject to recall and social desirability bias, and (3) patients or clients of STI services were not interviewed, and therefore their inputs were not obtained. While considering these limitations, the number and variety of facilities sampled, the mix of staff cadres interviewed, the use of a standardized instrument, and the consistency of responses add strength to our findings. CONCLUSIONS This study showed that HCPs understood the challenges of, and solutions for, improving the management of STIs in Kenya. Commitment by higher management, training in the management of STIs, measures for reducing stigma, and introducing new policies of STI management should be considered by health authorities in Kenya.
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Affiliation(s)
| | - Sureyya Hornston
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Odylia Muhenje
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Teresa Saliku
- University of California, San Francisco, Nairobi, Kenya
| | - Joy Mirjahangir
- University of California, San Francisco, San Francisco, California, United States of America
| | - Amanda Viitanen
- University of California, San Francisco, San Francisco, California, United States of America
| | | | | | | | - Naomi Bock
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Erku DA, Mekuria AB, Belachew SA. Inappropriate use of antibiotics among communities of Gondar town, Ethiopia: a threat to the development of antimicrobial resistance. Antimicrob Resist Infect Control 2017; 6:112. [PMID: 29152233 PMCID: PMC5678763 DOI: 10.1186/s13756-017-0272-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 11/01/2017] [Indexed: 12/05/2022] Open
Abstract
Background The emergence of antimicrobial resistance, the main cause of morbidity and mortality from otherwise treatable infections, is largely attributed to the inappropriate use of antimicrobials. However, data on the extent of inappropriate use of antibiotics in the community is scarce in Ethiopia. The aim of present study is to document the extent of inappropriate use of antibiotics and its associated factors among the communities of Gondar, Northwest Ethiopia. Methods A community based cross-sectional survey was conducted on a total of 650 participants in Gondar town, northwest Ethiopia from December 1, 2016 to January 30, 2017. Descriptive statistics, univariate and multivariate logistic regression analysis were also performed to express different variables and to examine factors associated with inappropriate use of antibiotics. Results According to the finding of our study, 315 (48.5%) of the participants took antibiotics in the past 1 year, of which 115 (35.9%) of them used inappropriately. Amoxicillin (72%) was the most commonly utilized antibiotics and respiratory tract infection (40.9%) was the most common disease condition to which antibiotics had been sought. About 36.8% of the respondents got antibiotics from community drug retail outlets without a prescription and 67.9% of respondents had discontinued the use of antibiotics once their symptoms subside. Low educational status (AOR = 5.01, 95% CI = 2.62–9.34), being employed (AOR = 2.12, 95% CI = 1.81–7.29) and unsatisfied with health care services provided (AOR = 5.41, 95% CI = 2.71-14.21) were found to be strong predictors of inappropriate use of antibiotics use among the community. Conclusion Inappropriate use of antibiotics was found to be considerably high in the communities of Gondar, northwest Ethiopia. Taking into consideration the heightened importance of comprehensive knowledge in the rational use of antibiotics, different stakeholders working in the public health sectors should provide a comprehensive and customized education to the public so as to improve their knowledge about antibiotics. It is also essential to adopt a strong and explicit line of actions towards the accessibility of antibiotics without a valid prescription in community medicine retail outlets.
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Affiliation(s)
- Daniel Asfaw Erku
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, 16 Gondar, Ethiopia.,Department of clinical pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Abebe Basazn Mekuria
- Department of Pharmacology, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, 16 Gondar, Ethiopia
| | - Sewunet Admasu Belachew
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, 16 Gondar, Ethiopia
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20
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de Waaij DJ, Dubbink JH, Ouburg S, Peters RPH, Morré SA. Prevalence of Trichomonas vaginalis infection and protozoan load in South African women: a cross-sectional study. BMJ Open 2017; 7:e016959. [PMID: 28993385 PMCID: PMC5640031 DOI: 10.1136/bmjopen-2017-016959] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Trichomonas vaginalis is thought to be the most common non-viral sexually transmitted infection worldwide. We investigated the prevalence, risk factors and protozoan load of T. vaginalis infection in South African women. METHODS A cross-sectional study of 604 women was conducted at 25 primary healthcare facilities in rural South Africa (Mopani district). T. vaginalis DNA was detected in vaginal and rectal swabs. In univariate and multivariate analyses, the T. vaginalis infection was investigated in relation to demographic characteristics, medical history and behavioural factors. The T. vaginalis load was determined as the logarithm of DNA copies per microlitre sample solution. RESULTS Collected vaginal and rectal swabs were tested for T. vaginalis DNA. Prevalence of vaginal T. vaginalis was 20% (95% CI 17.0% to 23.4%) and rectal 1.2% (95% CI 0.6% to 2.4%). Most women (66%) with a vaginal infection were asymptomatic. Factors associated with T. vaginalis infection were a relationship status of single (OR 2.4; 95% CI 1.5 to 4.0; p<0.001) and HIV positive infection (OR 1.6; 95% CI 1.0 to 2.6; p=0.041). Women with vaginal T. vaginalis infection were more likely to have concurrent Chlamydia trachomatis rectal infection than those without vaginal infection (12%vs3%; p<0.001; OR 4.1). A higher median T. vaginalis load was observed among women with observed vaginal discharge compared with those without vaginal discharge (p=0.025). CONCLUSIONS Vaginal trichomoniasis is highly prevalent in rural South Africa, especially among single women and those with HIV infection, and often presents without symptoms.
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Affiliation(s)
- Dewi J de Waaij
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Genetics and Cell Biology, Faculty of Health, Medicine & Life Sciences, Institute for Public Health Genomics, Research School GROW (School for Oncology & Developmental Biology), University of Maastricht, Maastricht, The Netherlands
| | - Jan Henk Dubbink
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Genetics and Cell Biology, Faculty of Health, Medicine & Life Sciences, Institute for Public Health Genomics, Research School GROW (School for Oncology & Developmental Biology), University of Maastricht, Maastricht, The Netherlands
| | - Sander Ouburg
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Remco P H Peters
- Anova Health Institute, Johannesburg and Tzaneen, South Africa
- Department of Medical Microbiology, University of Maastricht, Maastricht, The Netherlands
| | - Servaas A Morré
- Department of Medical Microbiology and Infection Control, Laboratory of Immunogenetics, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Genetics and Cell Biology, Faculty of Health, Medicine & Life Sciences, Institute for Public Health Genomics, Research School GROW (School for Oncology & Developmental Biology), University of Maastricht, Maastricht, The Netherlands
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Kabunga LN, Mujasi P. Does access to credit services influence availability of essential child medicines and licensing status among private medicine retail outlets in Uganda? J Pharm Policy Pract 2017; 10:30. [PMID: 28948025 PMCID: PMC5609064 DOI: 10.1186/s40545-017-0116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite making great progress in reducing under five mortality in the last three decades. Uganda still ranks high among countries with the highest under five mortality rates. More than a third (36%) of these deaths are caused by pneumonia (15%), malaria (12%), or diarrhea (9%). For many mothers and caregivers, private drug shops are a point of care seeking for these illnesses. However, many drug-shops, are unlicensed and do not stock essential commodities due to insufficient capital and operational funds. This study set out to understand the relationship, between access to credit services through financial loans or stock and i) availability of essential child medicines and ii) licensing status among medicine retail outlet including drug shops and pharmacies. METHODS This was a cross-sectional study conducted between April and March 2016. The country was divided into 168 enumeration areas based on the geographical regions and household population distribution within the region; these served as the primary sampling units. Within each enumeration area, all private medicine retail outlets (drug-shops and pharmacies) that provide consultation for childhood illnesses were identified and surveyed. Data on access to credit services was collected through interviews and data on stock, through observations of shelves for Oral rehydration salts, amoxicillin dispersible tablets, amoxicillin syrup, Artemether combined therapies, and Zinc dispersible tablets. Android tablets were used for data collection and results were analyzed using STATA12. A total of 586 outlets were visited during the study, 96% were drug shops and 4% were pharmacies. RESULTS For all five essential child medicines assessed, access to credit through financial loans or through obtaining stock on credit did not influence stock availability. Access to credit services through loans or through stock on credit was seen to influence licensing status. The odds increased by more than 50% (1.53, CI: 1.27-2) among outlets who accessed loans compared to those who hadn't and by 2 fold (2, CI: 1.03-3.8) among those who accessed stock on credit than in those who had not. CONCLUSIONS Access to credit does not influence stock availability of essential child medicines among private medicine outlets, however, it has an effect on licensing status. In addition to further research, the provision of financing mechanisms to support the licensing processes could increase the proportion of unlicensed outlets.
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Affiliation(s)
- Lorraine Nabbanja Kabunga
- Universitat Pompeu Fabra, International Master in Health Economics & Pharmacoeconomics, Barcelona School of Management, Balmes 132, 08001 Barcelona, Spain
| | - Paschal Mujasi
- International Masters in Health & Pharmacoeconomics; Universitat Pompeu Fabra, Barcelona School of Management, Balmes 132, 08001 Barcelona, Spain
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Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control 2017; 6:47. [PMID: 28515903 PMCID: PMC5433038 DOI: 10.1186/s13756-017-0208-x&token2=exp=1496969815~acl=/static/pdf/676/art%253a10.1186%252fs1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 05/10/2017] [Indexed: 04/09/2024] Open
Abstract
The causes of antimicrobial resistance (AMR) in developing countries are complex and may be rooted in practices of health care professionals and patients' behavior towards the use of antimicrobials as well as supply chains of antimicrobials in the population. Some of these factors may include inappropriate prescription practices, inadequate patient education, limited diagnostic facilities, unauthorized sale of antimicrobials, lack of appropriate functioning drug regulatory mechanisms, and non-human use of antimicrobials such as in animal production. Considering that these factors in developing countries may vary from those in developed countries, intervention efforts in developing countries need to address the context and focus on the root causes specific to this part of the world. Here, we describe these health-seeking behaviors that lead to the threat of AMR and healthcare practices that drive the development of AMR in developing countries and we discuss alternatives for disease prevention as well as other treatment options worth exploring.
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Affiliation(s)
- James A. Ayukekbong
- Section for Clinical Microbiology, Redeem Biomedical, P.O. Box 16, Buea, Cameroon
- Metabiota Inc., Nanaimo, BC Canada
| | - Michel Ntemgwa
- Human Safety Division, Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON Canada
| | - Andrew N. Atabe
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control 2017; 6:47. [PMID: 28515903 PMCID: PMC5433038 DOI: 10.1186/s13756-017-0208-x] [Citation(s) in RCA: 599] [Impact Index Per Article: 85.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 05/10/2017] [Indexed: 12/29/2022] Open
Abstract
The causes of antimicrobial resistance (AMR) in developing countries are complex and may be rooted in practices of health care professionals and patients’ behavior towards the use of antimicrobials as well as supply chains of antimicrobials in the population. Some of these factors may include inappropriate prescription practices, inadequate patient education, limited diagnostic facilities, unauthorized sale of antimicrobials, lack of appropriate functioning drug regulatory mechanisms, and non-human use of antimicrobials such as in animal production. Considering that these factors in developing countries may vary from those in developed countries, intervention efforts in developing countries need to address the context and focus on the root causes specific to this part of the world. Here, we describe these health-seeking behaviors that lead to the threat of AMR and healthcare practices that drive the development of AMR in developing countries and we discuss alternatives for disease prevention as well as other treatment options worth exploring.
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Affiliation(s)
- James A Ayukekbong
- Section for Clinical Microbiology, Redeem Biomedical, P.O. Box 16, Buea, Cameroon.,Metabiota Inc., Nanaimo, BC Canada
| | - Michel Ntemgwa
- Human Safety Division, Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON Canada
| | - Andrew N Atabe
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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The policy-practice gap: describing discordances between regulation on paper and real-life practices among specialized drug shops in Kenya. BMC Health Serv Res 2014; 14:394. [PMID: 25227916 PMCID: PMC4175572 DOI: 10.1186/1472-6963-14-394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 09/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Specialized drug shops (SDSs) are popular in Sub-Saharan Africa because they provide convenient access to medicines. There is increasing interest in how policymakers can work with them, but little knowledge on how their operation relates to regulatory frameworks. This study sought to describe characteristics and predictors of regulatory practices among SDSs in Kenya. METHODS The regulatory framework governing the Kenya pharmaceutical sector was mapped, and a list of regulations selected for inclusion in a survey questionnaire. An SDS census was conducted, and survey data collected from 213 SDSs from two districts in Western Kenya. RESULTS The majority of SDSs did not comply with regulations, with only 12% having a refrigerator and 22% having a separate dispensing area for instance. Additionally, less than half had at least one staff with pharmacy qualification (46%), with less than a third of all interviewed operators knowing the name of the law governing pharmacy.Regulatory infringement was more common among SDSs in rural locations; those that did not have staff with pharmacy qualifications; and those whose operator did not know the name of the pharmacy law. Compliance was not significantly associated with the frequency of inspections, with over 80% of both rural and urban SDSs reporting an inspection in the past year. CONCLUSION While compliance was low overall, it was particularly poor among SDSs operating in rural locations, and those that did not have staff with pharmacy qualification. This suggested the need for policy to introduce levels of practice in recognition of the variations in resource availability. Under such a system, rural SDSs operating in low-resource setting, and selling a limited range of medicines, may be exempted from certain regulatory requirements, as long as their scope of practice is limited to certain essential services only. Future research should also explore why regulatory compliance is poor despite regular inspections.
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Kariuki S, Dougan G. Antibacterial resistance in sub-Saharan Africa: an underestimated emergency. Ann N Y Acad Sci 2014; 1323:43-55. [PMID: 24628272 PMCID: PMC4159419 DOI: 10.1111/nyas.12380] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Antibacterial resistance-associated infections are known to increase morbidity, mortality, and cost of treatment, and to potentially put others in the community at higher risk of infections. In high-income countries, where the burden of infectious diseases is relatively modest, resistance to first-line antibacterial agents is usually overcome by use of second- and third-line agents. However, in developing countries where the burden of infectious diseases is high, patients with antibacterial-resistant infections may be unable to obtain or afford effective second-line treatments. In sub-Saharan Africa (SSA), the situation is aggravated by poor hygiene, unreliable water supplies, civil conflicts, and increasing numbers of immunocompromised people, such as those with HIV, which facilitate both the evolution of resistant pathogens and their rapid spread in the community. Because of limited capacity for disease detection and surveillance, the burden of illnesses due to treatable bacterial infections, their specific etiologies, and the awareness of antibacterial resistance are less well established in most of SSA, and therefore the ability to mitigate their consequences is significantly limited.
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Affiliation(s)
- Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Gordon Dougan
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
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Wafula FN, Miriti EM, Goodman CA. Examining characteristics, knowledge and regulatory practices of specialized drug shops in Sub-Saharan Africa: a systematic review of the literature. BMC Health Serv Res 2012; 12:223. [PMID: 22838649 PMCID: PMC3520114 DOI: 10.1186/1472-6963-12-223] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 07/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Specialized drug shops such as pharmacies and drug shops are increasingly becoming important sources of treatment. However, knowledge on their regulatory performance is scarce. We set out to systematically review literature on the characteristics, knowledge and practices of specialized drug shops in Sub-Saharan Africa. METHODS We searched PubMed, EMBASE, WEB of Science, CAB Abstracts, PsycINFO and websites for organizations that support medicine policies and usage. We also conducted open searches using Google Scholar, and searched manually through references of retrieved articles. Our search included studies of all designs that described characteristics, knowledge and practices of specialized drug shops. Information was abstracted on authors, publication year, country and location, study design, sample size, outcomes investigated, and primary findings using a uniform checklist. Finally, we conducted a structured narrative synthesis of the main findings. RESULTS We obtained 61 studies, mostly from Eastern Africa, majority of which were conducted between 2006 and 2011. Outcome measures were heterogeneous and included knowledge, characteristics, and dispensing and regulatory practices. Shop location and client demand were found to strongly influence dispensing practices. Whereas shops located in urban and affluent areas were more likely to provide correct treatments, those in rural areas provided credit facilities more readily. However, the latter also charged higher prices for medicines. A vast majority of shops simply sold whatever medicines clients requested, with little history taking and counseling. Most shops also stocked popular medicines at the expense of policy recommended treatments. Treatment policies were poorly communicated overall, which partly explained why staff had poor knowledge on key aspects of treatment such as medicine dosage and side effects. Overall, very little is known on the link between regulatory enforcement and practices of specialized drug shops. CONCLUSIONS Evidence suggests that characteristics and practices of specialized drug shops differ across rural and urban locations, and that these providers are highly responsive to client demand. However, there is a dearth in knowledge on how regulatory enforcement influences their characteristics and practices, and what strategies can be employed to strengthen the governance of the retail pharmaceutical sector.
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Affiliation(s)
- Francis N Wafula
- Health Systems and Social Science Research Group, KEMRI-Wellcome Trust Research Programme, Box 43640-00100, Nairobi, Kenya
| | - Eric M Miriti
- Health Systems and Social Science Research Group, KEMRI-Wellcome Trust Research Programme, Box 43640-00100, Nairobi, Kenya
| | - Catherine A Goodman
- Health Systems and Social Science Research Group, KEMRI-Wellcome Trust Research Programme, Box 43640-00100, Nairobi, Kenya
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Hussain A, Ibrahim MIM. Qualification, knowledge and experience of dispensers working at community pharmacies in Pakistan. Pharm Pract (Granada) 2011; 9:93-100. [PMID: 24688615 PMCID: PMC3969832 DOI: 10.4321/s1886-36552011000200006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 05/19/2011] [Indexed: 11/17/2022] Open
Abstract
Pharmacies are managed by a variety of dispensers in terms of qualification,
knowledge and experience in Pakistan. Objective The study aimed to document the state of knowledge, experience and
qualification of dispensers working at community pharmacies in Pakistan. Methods A comparative cross sectional study was conducted at a randomly selected
sample of 371 pharmacies in the three cities of Pakistan. A structured
questionnaire for data collection was developed and finalized by focused
group discussions and pilot testing. The data was coded, entered and
analyzed by using SPSS Version 16. Kruskal-Wallis and Mann-Whitney tests
(p≤0.05) were performed to find out differences. Results Out of total sample of 371 pharmacies, 31.8 % (118) were in Islamabad, 32.4 %
(120) in Peshawar and 35.8 % (133) were in Lahore. Fifty percent of the
respondents had correct knowledge of range of room temperature at which
medicines should be stored. Only 11.1% (41) of the respondents knew about
OTC (over the counter drugs) which can be sold without prescription while
5.9 % (22) of the respondents were aware of POM (prescription only
medicines) which can be only sold on a valid prescription. While 87.6%
(325), 88.1% (327), 58.7% (318) and 95.7 % (355) of the respondents did not
know the meaning of the dispensing abbreviations such as ‘h.s’, ‘q.d’, ‘sos’
and ‘p.r.n’. The respondents did not know correctly the status of
Deltacortil® (Prednisolone), Septran® (Sulfamethoxazole) and
Fansidar® (Pyrimethamine and Sulfadoxine) either as OTC or POM in
26.7% (99), 64.2% (238), and 44.5 % (165) of the cases, respectively. There
was a significant difference (p≤0.05) in knowledge of dispensers
regarding storage temperature, prescription terminologies and status of
medicines having different level of qualification and experience. Conclusions The overall knowledge and training of dispensers working at community
pharmacies is inadequate in Pakistan. However, pharmacists had relatively
better knowledge regarding storage temperature, prescription terminologies
and status of medicines as compared to pharmacy assistants, diploma holders
and salesperson.
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Affiliation(s)
- Azhar Hussain
- Discipline of Social and Administrative Pharmacy, University Sains Malaysia . Penang ( Malaysia ) and Associate Professor. Hamdard Institute of Pharmaceutical Sciences Hamdard University , Islamabad ( Pakistan )
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