Medicines dispensers' knowledge on the implementation of an artemisinin-based combination therapy policy for the treatment of uncomplicated malaria in Tanzania

Abstract

Objectives In 2005, Tanzania changed its policy for uncomplicated malaria treatment from sulphadoxine–pyrimethamine (SP) to artemisinin‐based combination therapy (ACT), specifically artemether–lumefantrine (ALU). SP remains the medicine of choice for intermittent preventive treatment in pregnancy (IPTp). There is a need to assess dispensers' knowledge regarding the treatment of uncomplicated malaria and IPTp in Tanzania given appreciable self‐purchasing to improve future care. Methods Descriptive cross‐sectional design with structured questionnaires to capture quantitative data, with qualitative data captured using focus groups. The study was performed at 32 private pharmacies and 33 Accredited Drug Dispensing Outlets in the Nyamagana and Sengerema Districts in Tanzania, with 20 dispensers included in the qualitative discussions. Key findings The knowledge level of dispensers in the private medicine outlets was variable. Most dispensers knew ALU was first‐line treatment in uncomplicated malaria, however variable knowledge about taking ALU with fatty meals. Generally, dispensers had poor knowledge about dosing intervals for SP in IPTp and variable knowledge regarding treatments in the first trimester. Overall, 49% had good knowledge and 48% had moderate knowledge of ACT in uncomplicated malaria. There was a significant relationship between dispenser type and knowledge of ACT but no statistical relationship between the level of knowledge on IPTp and the dispenser. Conclusions The majority of dispensers in private medicines outlets have good knowledge on ACT policy in the treatment of uncomplicated malaria; however, few dispensers had good knowledge on IPTp, which may contribute to irrational dispensing of SP. This needs addressing given the extent of self‐purchasing in Tanzania.

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…Act where necessary to ensure education and CPD activities fully equip pharmacists for their extended roles as custodians and managers of antibiotics in ambulatory care. This can include instigating prescribing licenses for rural pharmacies building on examples in countries where pharmacists are allowed to dispense antimicrobials under guidance 49,123,133 .…”

“…Ensuring that only qualified personnel sell antibiotics to patients in pharmacies where such activities are essentialespecially in rural LMICs. For example in Tanzania, different levels of pharmacies can dispense different treatments for malaria based on their knowledge level and skills 133 .…”

“…whether patients can afford to see both a physician and purchase their medicines) and economic benefits. In some situations, pharmacists are the only healthcare professionals available to patients 47,[128][129][130][131][132][133][134][135][136][137][138][139][140][141] . Self-purchasing of antimicrobials is particularly problematic in LMICs compared with high income countries 49,52,120,121,123,142,143 .…”

Dispensing of antimicrobials in Kenya: A cross-sectional pilot study and its implications

“…This compares with Tanzania were the variable training of personnel in private pharmacies and medicine outlets resulted in concerns with irrational dispensing of self-medicated treatments for uncomplicated malaria. [ 25 ] All the prescribed antibiotics were given as per the prescription, and no substitution was performed, largely because prescriptions were sourced from qualified medical personnel. The prescription and dispensing processes were carried out in the suggested way, and patients were typically given clear instructions on how to take their antibiotics [ Table 1 ].…”

Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications

“…The data collection form was adapted to include HIV, TB, malaria, and malnutrition as key modifiers of antimicrobial use given the wide prevalence of these conditions in sub-Sahara Africa [20,57,66,67]. A set of instructions were produced to undertake the PPS in hospitals including information on diagnoses and antibiotic history, data to assess current microbiology services and capacity, as well as the extent of any ongoing programs to enhance the appropriateness of antibiotic use [20].…”