STI management in Tanzanian private drugstores: practices and roles of drug sellers

Viberg, Nina; Mujinja, Phare; Kalala, Willbrord; Kumaranayake, Lilani; Vyas, Seema; Tomson, Göran; Lundborg, Cecilia Stålsby

doi:10.1136/sti.2008.032888

Cited by 28 publications

(25 citation statements)

References 23 publications

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“…The predominance of nurse aides staffing SDSs is likely to reflect their low marketability in the formal health sector. Similar patterns have been observed in Tanzania, where the majority of staff in private drug stores were found to be nurse assistants [36]. …”

Section: Discussionsupporting

confidence: 80%

The policy-practice gap: describing discordances between regulation on paper and real-life practices among specialized drug shops in Kenya

Wafula

Abuya

Amin³

et al. 2014

BMC Health Serv Res

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BackgroundSpecialized 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.MethodsThe 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.ResultsThe 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.ConclusionWhile 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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Section: Discussionsupporting

confidence: 80%

The policy-practice gap: describing discordances between regulation on paper and real-life practices among specialized drug shops in Kenya

Wafula

Abuya

Amin³

et al. 2014

BMC Health Serv Res

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“…Majority of staff knew what drugs to give for tracer conditions, but had less knowledge on appropriate dosing. This was seen in Tanzania [7,26,27,42-44], Uganda [25,45], Eritrea [21], and Nigeria [31,46]. Misconceptions were also reported: for instance, most South African pharmacists erroneously believed that emergency contraceptive pills (ECPs) posed health risks if used repeatedly [47], majority of Nigerian PMVs believed fever medicines could cure malaria on their own [48], and that white colored medicines were less efficacious overall [49], and nearly one-fifth of Tanzanian drug sellers thought that antibiotics could cure viral infections [50].…”

Section: Resultsmentioning

confidence: 93%

“…Although staff qualification varied substantially, those working in pharmacies and part II drug shops generally held higher qualifications compared to those working in PMVs. In Kenyan pharmacies for instance, nearly all staff were found to have tertiary health-related training [24]; similarly, nearly all staff working in Tanzanian part II drug stores and Ugandan drug shops were reported to have some health-related training [11,26,27]. The majority of staff were nurse aides.…”

Section: Resultsmentioning

confidence: 99%

Examining characteristics, knowledge and regulatory practices of specialized drug shops in Sub-Saharan Africa: a systematic review of the literature

Wafula

Miriti

Goodman

2012

BMC Health Serv Res

111

117

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BackgroundSpecialized 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.MethodsWe 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.ResultsWe 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.ConclusionsEvidence 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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“…Viberg and colleagues (2009) in a study from Tanzania found that private pharmacies often gave incorrect drug regimens and failed to provide complete drug combinations for syndromic management of sexually transmitted infections. The data from the quantitative part of this study indicated that 33.8% of the men “never”, and 29.3% “sometimes”, used a condom during anal sex with their partner (Anonymous, 2014b).…”

Section: Discussionmentioning

confidence: 99%

Being Forced to Become Your Own Doctor: Men Who Have Sex with Men's Experiences of Stigma in the Tanzanian Healthcare System

Larsson

Ross

Månsson

et al. 2016

International Journal of Sexual Health

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Objective To acquire a deepened understanding of how stigma in healthcare affects health-seeking behaviours of same-sex practising men in Tanzania. Methods In-depth interviews with twelve men were conducted in Dar es Salaam, 2012. Data were interpreted through qualitative content analysis. Results Narratives revealed that men’s healthcare perceptions were shaped by previous encounters, rumours in gay community, norms and legislation around homosexuality. Fears of exposure aggravated men’s possibilities of giving full anamnesis and detached them from formal healthcare services. Conclusions Stigma in healthcare might lead to severe public health problems due to perceived exclusion from the health system by sexual minorities.

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STI management in Tanzanian private drugstores: practices and roles of drug sellers

Cited by 28 publications

References 23 publications

The policy-practice gap: describing discordances between regulation on paper and real-life practices among specialized drug shops in Kenya

The policy-practice gap: describing discordances between regulation on paper and real-life practices among specialized drug shops in Kenya

Examining characteristics, knowledge and regulatory practices of specialized drug shops in Sub-Saharan Africa: a systematic review of the literature

Being Forced to Become Your Own Doctor: Men Who Have Sex with Men's Experiences of Stigma in the Tanzanian Healthcare System

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