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

Francis N Wafula,Eric M Miriti,Catherine A Goodman

doi:10.1186/1472-6963-12-223

Abstract

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 s, 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.

Highlights

Specialized drug shops such as pharmacies and drug shops are increasingly becoming important sources of treatment
Reviews and opinion pieces were excluded, as were studies on pharmacies operating within health facilities, those looking at drug content, and those that failed to specify whether study units were specialized drug shops (SDSs) or general shops
Studies from the Eastern African region contributed more than half of all studies reviewed (Figure 2), with Tanzania alone having 17 studies

Summary

Introduction

Specialized drug shops such as pharmacies and drug shops are increasingly becoming important sources of treatment. Knowledge on their regulatory performance is scarce. No review has described regulatory practices of SDSs, despite the fact that this is the group of PMRs most often seen as an integral part of the formal health system, where strategies such as the AMFm are concerned. This is the main purpose of the review

Methods

Results

Conclusion