Abstract
BackgroundDespite recent strides made towards reducing the emergence of artemisinin resistance, inappropriate dispensing practices for anti-malarials in both private and public sectors affect treatment outcomes negatively. In Ghana, private retail pharmacies are the most accessible health facilities for managing diseases of common occurrence. However, there is growing concern about the number of patients harmed by dispensing errors in the management of malaria in retail pharmacies. Although considerable work has been done in this area, several questions regarding dispensing practices remain unanswered. This study, therefore, sought to investigate the predictors of appropriate dispensing practices for anti-malarials in community pharmacies in the La Nkwantanang-Madina municipality of Greater Accra, Ghana.MethodsA cross-sectional analytic study was conducted in sixty-one randomly selected community pharmacies in the La Nkwantanang-Madina. Data from 230 clients and 106 dispensers were analysed. It was checked for internal consistency and completeness then entered and analysed using STATA I/C version 14.0. Frequencies, Chi square tests, and logistic regression analyses were conducted, accounting for clustering.Results and discussionOf the 106 dispensers interviewed, 71.4% were medicine counter assistants. The mean age of dispensers was 30.4 years (SD 8.8). Over 88.0% of clients were advised to complete the full course of their anti-malarials. However, the 8-h loading dose principle for artemether-lumefantrine was not explained to 88.3% of the clients. More than half of the clients (52.2%) were given appropriate dispensing information on anti-malarial use. Most clients (66.1%), were dispensed anti-malarials without malaria tests. Dispensers with more than a 10-years experience were less likely to dispense artemisinin-based combinations appropriately relative to dispensers with less than 2 years experience (AOR = 0.04, 95% CI 0.002–0.802 p-value = 0.036) while pharmacy interns were about 19 times more likely (AOR = 18.5, 95% CI 1.40–245.6 p-value = 0.03) to dispense artemisinin-based combinations appropriately compared to pharmacists.ConclusionDispensing practices for anti-malarials is unsatisfactory. There is a need to enforce existing legislation with educational programmes directed towards dispensers especially those with more than 10 years experience. Specific adherence to the World Health Organization Test, Treat and Track initiative should be encouraged to ensure effective use of anti-malarials.
Highlights
Despite recent strides made towards reducing the emergence of artemisinin resistance, inappropriate dispensing practices for anti-malarials in both private and public sectors affect treatment outcomes negatively
There is a need to enforce existing legislation with educational programmes directed towards dispensers especially those with more than 10 years experience
Their operations are regulated by the Pharmacy Council (PC) of Ghana under the Health Professions Regulatory Bodies Act 857 [8]
Summary
Despite recent strides made towards reducing the emergence of artemisinin resistance, inappropriate dispensing practices for anti-malarials in both private and public sectors affect treatment outcomes negatively. In Ghana, for example, private retail pharmacies and Licensed Chemical Shops, who are registered suppliers of specific over-the-counter medicines are the most accessible health facilities available for managing commonly occurring diseases [5]. Empirical studies have shown that the majority of families seek treatment for mild febrile diseases in retail pharmacies as compared to public health facilities [6, 7]. Their operations are regulated by the Pharmacy Council (PC) of Ghana under the Health Professions Regulatory Bodies Act 857 [8]. Community pharmacies are typically managed by pharmacists (individuals who hold a degree in pharmacy, completed the required internship programme and passed professional qualifying examination) and other pharmaceutical support staff; Medicine Counter Assistants (MCA—support staff trained to complement the role of pharmacy technicians, owing to acute shortage of the technicians) and pharmacy technicians
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