Abstract
Dispensing antibiotics without prescription is irrational and can hasten the emergence and spread of antibiotic resistance. This study aims at determining the extent of this practice and its determinants in all drug retail outlets of Eritrea. A cross-sectional simulated client method was used to conduct the study. Data was collected between July and August 2019, entered and analyzed using Statistical Package for Social Science version 22. Descriptive analysis was performed using mean (standard deviation), median (interquartile range), frequency, percentage, as appropriate, for independent variables. Logistic regression, at bivariate and multivariate levels, along with odds ratio (95% confidence interval) was used to determine the association between the dispensing of antibiotics without prescription and independent variables. P-values less than 0.05 were considered as statistically significant. The extent of dispensing antibiotics without prescription was found to be 87.6% with the most frequently dispensed antibiotics being ciprofloxacin (47.8%) and co-trimoxazole (37.5%). Furthermore, 12.4% of the drug retail outlet attendants did not dispense antibiotics because they preferred a referral to health facilities (52.6%), were following administrative restrictions not to sell antibiotics (42.1%), or did not have the necessary antibiotics (31.6%). Private community pharmacies (AOR = 7.68, 95% CI: 1.67, 35.37; p = 0.009) and private drug shops (AOR = 10.65, 95% CI: 1.96, 57.93; p = 0.006) were more likely to dispense antibiotics compared to the governmental community pharmacies. Dispensing antibiotics without prescription was more likely to occur in the Maekel (central) region (AOR = 3.76, 95% CI: 1.19, 11.92; p = 0.024) compared to the remaining regions combined. In conclusion, the sales of antibiotics without prescription in the drug retail outlets of Eritrea is alarming which requires immediate attention from policymakers.
Highlights
Antibiotic resistance is a global public health threat that warrants immediate global intervention [1, 2]
This study aims at determining the extent of this practice and its determinants in all drug retail outlets of Eritrea
Dispensing of antibiotics without prescription was found to be less frequent in studies conducted in Gipuzkoa, a Spanish province (17.5%) [11], Republic of Srpska (18.5%) [22], northwestern Spain (18.83%) [23], Beirut and its suburbs, Lebanon (32%) [24], Sri Lanka (41%) [25], Catalonia, Spain (45.2%) [26], and urban cities of China (66.8%) [10]
Summary
Antibiotic resistance is a global public health threat that warrants immediate global intervention [1, 2]. To tackle this problem, the WHO, in its 68th world health assembly, passed a resolution, based on the global action plan, that instructs all member states to develop a national strategic plan on combating antimicrobial resistance [3]. In line with the WHO resolution, Eritrea developed a national action plan to combat antimicrobial resistance. The National Medicines and Food Administration in collaboration with stakeholders developed medicines schedule guide in June 2019. On top of the above initiatives, Eritrea has been conducting annual campaigns on awareness of antibiotic resistance using a one-health approach since 2017
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