Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia

Kalungia, Aubrey; Burger, Johanita; Godman, Brian; Costa, Juliana de Oliveira; Simuwelu, Chimwemwe

doi:10.1080/14787210.2016.1227702

Cited by 119 publications

(119 citation statements)

References 40 publications

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“…However, it is higher than the findings reported from southwestern Ethiopia (39%) [20], South Ethiopia (14.5%) [19], in a systematic and meta-analysis study in low and middle income countries, the overall estimate of antimicrobial use is 38.8% [11] and Saudi Arabia (35.4%) [26]. The finding of this study is lower than findings documented in several studies; in northern Uganda (75.7%) [16], in Zambia (97%) [17], in Bangalore, India (66.7%) [12] and in Riyadh, Saudi Arabia (77.6%) [14]. The possible explanation could be due to these studies varying in the nature of definitions used; the present study used non-prescribed antimicrobial (both self and caregiver medication practices) whereas these studies included as comparison with the current finding applied only self-medication as outcome variable.…”

Section: Discussionmentioning

confidence: 74%

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Non-prescribed antimicrobial use and associated factors among customers in drug retail outlet in Central Zone of Tigray, northern Ethiopia: a cross-sectional study

Gebrekirstos

Workneh

Gebregiorgis

et al. 2017

Antimicrob Resist Infect Control

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BackgroundNon-prescribed antimicrobial use and their resistance are among the main public health problems, worldwide. In Ethiopia, particularly in the northern part, the magnitude of non-prescribed antimicrobial use and its major determinants is not yet well known. Thus, this study was done to assess the magnitude of non-prescribed anti-microbial use and associated factors among customers in drug retail outlet in Central Zone, Tigray, Ethiopia.MethodsA drug retail outlet based cross-sectional study was conducted among adults aged 18 years and above. A multistage sampling procedure was used to select study participants. Data were collected using a structured questionnaire by druggists under the supervision of pharmacists. Data were entered into EpiInfo software version 3.5.4. Binary logistic regression was used to identify independently associated variables in bivariate and multivariable analyses using SPSS version 21. Odds Ratios with 95% confidence intervals were estimated.ResultsFrom 829 study samples, a total of 780 respondents participated in this study with a response rate of 94.1%. Of 367 respondents who received non-prescribed antimicrobial, 249 (67.8%), 121 (33%), and 94 (25.6%) of them were males, secondary school and paid employed respectively. The magnitude of non-prescribed antimicrobial use was 47.1% (95% CI: 43.8, 50.5). The factors which were independently associated with non-prescribed antimicrobial use were male sex [AOR = 1.72, 95% CI = 1.21, 2.44], seeking modern health care in private/Non-Governmental Organization (NGO) [AOR =0.47, 95% CI; 0.23, 0.98], moderate waiting time in health care facilities [AOR = 1.92, 95% CI; 1.20, 3.09], delayed waiting time in health care facilities [AOR = 1.56, 95% CI; 1.03, 2.38], ever received antimicrobial [AOR = 3.51, 95% CI; 2.45, 5.02], and frequency of purchasing non-prescribed antimicrobial (1–3 times and 4 times, [AOR = 2.04, 95% CI; 1.36, 3.06] and [AOR = 2.66, 95% CI; 1.24, 5.68] respectively).ConclusionThe magnitude of non-prescribed antimicrobial use was high. Familiarizing with health care utilization and delayed waiting time in health care facilities were the very important factors independently associated with non-prescribed antimicrobial use. Emphasis should be given to community education through involvement of the private health sector and health care providers. Regulation and policy enforcement are also necessary to promote the rational use of antimicrobial.

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Section: Discussionmentioning

confidence: 74%

“…Other similar studies from various countries support this irrational use of medicine, in India (50%–66.7%) [12, 13], Saudi Arabia (48%–77.6%) [14, 15], Uganda (75.7%) [16], Zambia (97%) [17] and in Ethiopia ranges from (14.5% - 43.24%) [18–20]. …”

Section: Introductionmentioning

confidence: 72%

Non-prescribed antimicrobial use and associated factors among customers in drug retail outlet in Central Zone of Tigray, northern Ethiopia: a cross-sectional study

Gebrekirstos

Workneh

Gebregiorgis

et al. 2017

Antimicrob Resist Infect Control

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“…Sometimes, pharmacists are free to change prescriptions, even though there are no specific policies in place to promote this change ( “no other policies in place but freedom of pharmacists to change prescription”) . In many low and lower middle-income countries in Africa, Asia, and Latin America, patients can purchase medicines directly from the pharmacist; this also applies for some developed countries (e.g., Greece) [47, 48]. In other cases, there is indicative substitution at substance level, which is often combined with soft incentives to substitute cheaper products ( “incentives in place for substitution”) .…”

Section: Resultsmentioning

confidence: 99%

Comprehensive taxonomy and worldwide trends in pharmaceutical policies in relation to country income status

Maniadakis

Kourlaba²,

Shen

et al. 2017

BMC Health Serv Res

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BackgroundRapidly evolving socioeconomic and technological trends make it challenging to improve access, effectiveness and efficiency in the use of pharmaceuticals. This paper identifies and systematically classifies the prevailing pharmaceutical policies worldwide in relation to a country’s income status.MethodsA literature search was undertaken to identify and taxonomize prevailing policies worldwide. Countries that apply those policies and those that do not were then grouped by income status.ResultsPharmaceutical policies are linked to a country’s socioeconomics. Developed countries have universal coverage and control pharmaceuticals with external and internal price referencing systems, and indirect price–cost controls; they carry out health technology assessments and demand utilization controls. Price-volume and risk-sharing agreements are also evolving. Developing countries are underperforming in terms of coverage and they rely mostly on restrictive state controls to regulate prices and expenditure.ConclusionsThere are significant disparities worldwide in the access to pharmaceuticals, their use, and the reimbursement of costs. The challenge in high-income countries is to maintain access to care whilst dealing with trends in technology and aging. Essential drugs should be available to all; however, many low- and middle-income countries still provide most of their population with only poor access to medicines. As economies grow, there should be greater investment in pharmaceutical care, looking to the policies of high-income countries to increase efficiency. Pharmaceutical companies could also develop special access schemes with low prices to facilitate coverage in low-income countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2304-2) contains supplementary material, which is available to authorized users.

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“…In Kenya, antibiotics were prescribed in two thirds of patients seeing a physician for diarrhoea (Brooks et al 2006). Self-purchasing of antibiotics is also common in many other countries despite being illegal in most (Chatterjee and Fleck 2011; Godman et al 2014;WHO Europe 2014;Massele et al 2015;WHO 2015;Kalungia et al 2016) and is strongly correlated with increasing AMR rates in low-income and middle-income countries (LMICs) (Alsan et al 2015). Self-purchasing of antibiotics is also common in many other countries despite being illegal in most (Chatterjee and Fleck 2011; Godman et al 2014;WHO Europe 2014;Massele et al 2015;WHO 2015;Kalungia et al 2016) and is strongly correlated with increasing AMR rates in low-income and middle-income countries (LMICs) (Alsan et al 2015).…”

Section: Extent and Threat Of Antimicrobial Resistance And Its Impactmentioning

confidence: 99%

“…This means addressing issues such as physicians' lack of adherence to treatment guidelines and their lack of knowledge and training regarding antibiotics, the lack of diagnostic facilities as well as uncertainty over the diagnosis, pressures from patients and the pharmaceutical industry and finally fear of clinical failure (Little et al 2013; Van Nguyen et al 2013;Hassali et al 2015;Md Rezal et al 2015;Riaz et al 2015). In LMIC countries and others, this also includes implementing and enforcing regulations surrounding the dispensing of antibiotics including self-purchasing where this is a concern (Radyowijati and Haak 2003;Kotwani et al 2010;; Van Nguyen et al 2013;Holloway and Henry 2014;Holloway et al 2015;Kalungia et al 2016).…”

Section: Extent and Threat Of Antimicrobial Resistance And Its Impactmentioning

confidence: 99%

Drug Resistance in Bacteria, Fungi, Malaria, and Cancer

Godman

Fadare

Kibuule

et al. 2017

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Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia

Abstract: Non-prescription sale and dispensing of antibiotics is widespread in Zambia. Concerted public and professional interventions are needed coupled with stronger regulatory enforcement to reduce this.

Cited by 119 publications

References 40 publications

Non-prescribed antimicrobial use and associated factors among customers in drug retail outlet in Central Zone of Tigray, northern Ethiopia: a cross-sectional study

Non-prescribed antimicrobial use and associated factors among customers in drug retail outlet in Central Zone of Tigray, northern Ethiopia: a cross-sectional study

Comprehensive taxonomy and worldwide trends in pharmaceutical policies in relation to country income status

Drug Resistance in Bacteria, Fungi, Malaria, and Cancer

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