Determinants of dispensing antibiotics without prescription in Eritrea: a mixed-method qualitative study on pharmacy professionals’ perspective

Abstract

ObjectiveAntimicrobial resistance is a global public health challenge. Dispensing of antibiotics without prescription (DAWP), a major contributor to antibiotic resistance, is extensive in Eritrea. This study was, therefore, aimed at deeply understanding, qualitatively, the pharmacy professionals’ perspective on the factors that trigger DAWP and how this practice could be mitigated.DesignA qualitative exploratory study design was employed.SettingDrug retail outlets of Asmara, capital of Eritrea, and pharmaceutical services of Eritrea.ParticipantsThirty pharmacy professionals who were owners and employees of the drug retail outlets stationed in Asmara and six key informants from the pharmaceutical services of all administrative regions of Eritrea, selected purposively, were the study participants.Data collection and analysisThe data were collected using focus group discussions and key informant interviews between March and September 2020. The collected data were transcribed verbatim, translated to English and finally thematically analysed using an inductive approach.ResultsThe main triggering factors were related to the drug retail outlet owners, dispensers, healthcare system and patients. Knowledge and attitude-based motivation, economic interest, inadequate services in health facilities, weak regulatory enforcement, inadequate training, trust and satisfaction of patients, previous successful experience, seriousness of a condition and saving time and money were reported among others as determinants of DAWP.ConclusionsThe triggering factors to DAWP were found to be very complex and some of them were important that might require immediate attention from policymakers. Ensuring readily available and accessible healthcare services, empowering medicines regulation and continuing sensitisation of dispensers are highly recommended to minimise DAWP.

Knowledge, Attitude and Practice of Pharmacy Professionals Against Dispensing Antibiotics Without Prescription in Ethiopia

“…The most common reasons given for DAWP were a lack of willingness to consult a physician unless the infection appeared to be too serious, a lack of control mechanisms from regulatory agencies, and the consumers' economic status; this finding was consistent with other studies. 28,35,36 To effectively address the issue of DAWP in Ethiopia, a multidimensional approach is required, and national regulations governing the sale of antibiotics must be strictly enforced.…”

“…Participants in the study with a master's degree or higher, pharmacy professionals working in government health facilities, and professionals with 2-5 years of work experience had a lower rate of DAWP compared to their counterparts, these findings were supported by Eritrean and Saudi Arabian studies. 28,36 This study is the first of its type to evaluate pharmacy professionals' knowledge, attitudes, and practices about DAWP in Ethiopia, and the study could be used as an input for future study. There were a few limitations to this study, 1; most of participants were drawn from the country's capital city, which had a better demographic and socioeconomic profile.…”

“Handing out non-prescribed antibiotics is storing up trouble for the next generation!” Unpacking multistakeholder views of drivers and potential solutions in Ethiopia

“…Many professionals acknowledged that the lack or inadequacy of healthcare facilities leads to community members relying on CDROs as their primary source of treatment. This factor has been consistently reported in many studies across SSA [ 34 , 37 , 41 , 42 ]. The reasons for this could be that the unavailability or unaffordability of healthcare facilities that leads people to rely on CDROs as their primary and sometimes only point of contact with the healthcare system.…”

The Extent of Antibiotic Dispensing in Self-Medication Encounters in Sudan: A Simulated Patient Study Focusing on Cefixime Sale

“… 22 In addition, an exploratory study from Africa has found many factors that affect antibiotic dispensing without prescription including weak regulation, poor inspection and training, community pharmacy owners’ economic interest, inadequate patient knowledge, and the inability of patients to access health facilities. 50 …”