Drug Retail Outlets Research Articles

Quality assessment of common anti-malarial medicines marketed in Gambella, National Regional State, South Western-Ethiopia

BackgroundOver the past years, there has been a growing concern that a considerable amount of anti-malarial supply in the underdeveloped world particularly in the private sector, is of poor quality. The World Health Organization (WHO) has received about 1500 reports that mentions instances of substandard and falsified products since 2013. The majority of the reports concerned antibiotics and anti-malarials. The majority of reports (42%) originate from the WHO African region.ObjectiveThis study intends to assess the quality of the most widely used anti-malarial medications [artemether-lumefantrine tablets, chloroquine phosphate tablets, primaquine phosphate tablets, artesunate, and artemether injections] in Gambella, South-West, Ethiopia.MethodsA total of 52 samples were collected on June 2022 from Gambella National Regional State, Ethiopia. Half of the districts (six) located in the four zones of the region were chosen using simple random sampling technique. All drug retail outlets available in the selected districts (locally known as woredas) were included. The samples were subjected to visual inspection with a tool adopted from the joint WHO/FIP/ USP checklist. The pharmacopeial tests for identification, uniformity of dosage forms, assay, thickness, diameter, hardness, friability, disintegration test, dissolution, and sterility tests were carried out according to the USP 44-NF 39 and International Pharmacopoeia 11th edition, 2022 monographs.Results and DiscussionOnly 25% of the samples were registered on the Ethiopian Food and Drug Authority (EFDA’s) electronic regulatory/ registration system (ERIS). Besides, 88.8% of artemether injection products were presented in clear glass ampoules. This might expose the products to photochemical degradation that leads to in loss of anti-plasmodial activity. In addition, 50% of the artemether products assessed were not bioequivalent with the comparator product in the in vitro dissolution comparison tests. Overall, the study findings reveal a high prevalence (58.3%) of substandard anti-malarial drugs in the region. The stated percent of the samples had failed in one or more of the quality test parameters assessed in this study.ConclusionThe study findings reveal a high prevalence (58.3%) of substandard anti-malarial drugs in the region. Only a quarter were registered and 38% of the unregistered products failed the quality tests. Hence, the national, regional medicine regulatory bodies and other stake holders should perform the required roles to circumvent presence of Substandard and Falsified (SF) anti-malarial drugs in the study sites.

Assessment of factors associated with self-medication practices during the COVID-19 pandemic in southwestern Ethiopia: a community-based cross-sectional survey

BackgroundSelf-medication practices involve the use of medications without healthcare professional requests. The threat of coronavirus disease 2019 (COVID-19) caused the practice of a fittest to survive action, with the assumption that something is better than nothing. Moreover, owing to the lack of effective treatment for COVID-19, the general public has shifted toward self-medication and symptomatic treatment, with approximately 80% of people stockpiling medication for use during the pandemic. Thus, this study aimed to assess the factors associated with self-medication practices during the COVID-19 pandemic crisis in southwestern Ethiopia.MethodsA community-based cross-sectional study design was employed at selected drug retail outlets in southwestern Ethiopia for 415 community pharmacy clients from July 1, 2021, to September 1, 2021. Purposive sampling techniques were employed to select five drug retail outlets on the basis of high patient flows, and we took the study participants until the required quota allotted to each selected drug retail outlet had been filled. Bivariable and multivariable logistic regression analyses were employed to identify factors associated with self-medication. AORs with 95% CIs were used to report associations, and the level of significance was set at P < 0.05. Results: Self-medication was significantly associated with being female (AOR 3.51, 95% CI 1.04–12.41), having a college education or above (AOR 47, 95% CI 4.32–55.21), time wastage at public health facilities (AOR 2.71, 95% CI 3.47–5.21), being afraid of contracting COVID-19 (AOR 0.006, 95% CI 0.004–0.185), and having high fees at public health facility (AOR 0.006, 95% CI 0.004–0.185). The most frequently used medications to treat or prevent the COVID-19 pandemic were analgesics (42.4%) and cold medicines (29.5%). Headache (22.2%), fever (13.2%), respiratory infection (14.3%), and cold (21.4%) were the most frequently reported symptoms of the COVID-19 pandemic.ConclusionThis study revealed high self-medication practices among study area residents during the COVID-19 pandemic. The primary reasons for self-medication in the context of COVID-19 are fear of the pandemic and time wastage at public health facilities. Therefore, special attention should be given to educating public and health care providers on the types of illnesses that can be self-diagnosed and self-treated and the types of drugs to be used for self-medication.

Actual practices of community pharmacists in the management of diabetes: a comparison of simulated patient-based study with perceived role of involvement.

This study evaluated the level of community pharmacy professionals' (CPPs) actual practices and contrasted it with their self-reported perceived involvement in diabetes management. A self-reported cross-sectional and simulated patient (SP)-based study were employed at community drug retail outlets (CDROs) in Northwest Ethiopia. SP-case scenarios were used to examine the actual practices of CPPs in diabetes management and were compared with self-reported perceived involvement. The data were managed and analysed using SPSS version 26. About 184 participants in the self-reported and 100 CPPs' actual practices using three SP visits were included. The overall actual practice (17.8%) was found to be significantly different compared with the perceived level of involvement (73.5%) (p-value <0.05). About 94.3% of CPPs dispensed requested medications to the SP without a prescription. Despite most participants being perceived to be involved, more than 76% of CPPs did not counsel the SP for lifestyle modifications, avoiding risky behaviours, adherence to treatment, routine blood glucose checkups, diabetic foot care techniques, or consultation with physicians for further management. A significant discrepancy between actual practices and perceived CPPs' involvement in the management of diabetes was observed. The findings may suggest that exploring possible gaps may be crucial.

Quality Assessment of Selected Essential Antimicrobial Drugs from Drug Retail Outlets of Selected Cities in Eastern Ethiopia.

The prevalence of substandard and falsified (SF) antimicrobial drugs is increasing around the globe. This poses a great concern for the healthcare system. The consumption of SF antimicrobial drugs has the potential to result in treatment failure, emergence and development of antimicrobial resistance, and ultimately a rise in mortality rate. The objective of this study was to assess the quality of four commonly used antimicrobials marketed in the cities of Dire Dawa and Jijiga and the town of Togo-Wuchale, which have high potential for illegal drug trade activities in Ethiopia because they are located near the border with Somalia. A total of 54 brands/samples of amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin, and norfloxacin formulations were collected covertly from 43 facilities using a convenience sampling strategy from March 16 to March 29, 2022. The samples were first screened using Global Pharma Health Fund (GPHF)-Minilab protocols and then analyzed using U.S. Pharmacopoeial and British Pharmacopoeia official methods. The quality evaluation detected no falsified product; however, it showed that 14.3% of the samples failed the GPHF-Minilab screening test semiquantitatively. Overall, 22.2% of the products analyzed did not meet any of pharmacopoeial specifications assessed: 13%, 12.2%, and 11.1% of the products failed in assay, dissolution, and weight variation, respectively. Additionally, 56.3% of amoxicillin samples, 60% of amoxicillin/clavulanate, 20% of ciprofloxacin, and 54.5% of norfloxacin samples were found to be pharmaceutically nonequivalent with their respective comparator products regarding dissolution profiles. The study showed the presence of substandard antimicrobial medicines in the eastern Ethiopian market.

Adherence to national malaria treatment guidelines in private drug outlets: a cross-sectional survey in the malaria-endemic Kisumu County, Kenya

BackgroundMalaria prevalence in Kenya is 6%, with a three-fold higher prevalence in western Kenya. Adherence to malaria treatment guidelines improves care for suspected malaria cases and can reduce unnecessary anti-malarial use. Data on adherence to guidelines in retail drug outlets (DOs) is limited, yet approximately 50% of people with fever access treatment first in these outlets. This study assessed adherence to the national malaria treatment guidelines among DOs in a high transmission area of Western Kenya.MethodsIn a cross-sectional survey of DOs in Kisumu Central and Seme sub-counties in 2021, DO staff were interviewed using structured questionnaires to assess outlet characteristics (location, testing services), staff demographics (age, sex, training), and health system context (supervision, inspection). Mystery shoppers (research assistants disguised as clients) observed malaria management practices and recorded observations on a standardized tool. Adherence was defined as dispensing artemether-lumefantrine (AL) to patients with a confirmed positive test, accompanied by appropriate medication counseling. Logistic regression was used to test for association between adherence to guidelines and DO-related factors.ResultsNone of the 70 DOs assessed had a copy of the guidelines, and 60 (85.7%) were in an urban setting. Staff adhered to the guidelines in 14 (20%) outlets. The odds of adherence were higher among staff who had a bachelor’s degree {odds ratio (OR) 6.0, 95% confidence interval (95% CI) 1.66–21.74}, those trained on malaria rapid diagnostic test (RDT) {OR 4.4, 95% CI 1.29–15.04}, and those who asked about patient’s symptoms {OR 3.6, 95% CI 1.08–12.25}. DOs that had higher odds of adherence included those with functional thermometers {OR 5.3, 95% CI 1.46–19.14}, those recently inspected (within three months) by Pharmacy and Poisons Board (PPB) {OR 9.4, 95% CI 2.55–34.67}, and those with all basic infrastructure {OR 3.9, 95% CI 1.01–15.00}. On logistic regression analysis, recent PPB inspection {adjusted OR (AOR) 4.6, 95% CI 1.03–20.77} and malaria RDT-trained staff (aOR 4.5, 95% CI 1.02–19.84) were independently associated with adherence.ConclusionMost outlets didn’t adhere to malaria guidelines. Regular interaction with regulatory bodies could improve adherence. Ministry of Health should enhance private sector engagement and train DOs on RDT use.

Determine the perceived level of involvement and factors affecting diabetes management by community pharmacy professionals at drug retails in northwestern amhara region, Ethiopia

BackgroundPharmacists in community drug retail outlets (CDROs) have significant involvement in diabetes prevention and management by providing more direct interventions in medication education, preventive measures, and disease management. This study examined the perceived level of involvement of community pharmacy professionals (CPPs) in diabetes management at CDROs in Northwest Ethiopia. MethodsA multicenter cross-sectional study was conducted among CPPs in Northwest Ethiopia between September 1 and 30, 2022. The Statistical Package for Social Science (SPSS) version 26 was used to analyzed the data, which had been gathered using a self-administered structured questionnaire. An independent sample t-test and one-way ANOVA were used to examine the mean perceived involvement score difference between CPPs. The association between CPPs’ involvement and other sociodemographic variables was examined using linear regression analysis. At a 95% confidence interval (CI), a p-value <0.05 was considered statistically significant. ResultsThe study included 184 (94.3%) of 195 CPPs approached. The overall mean perceived involvement score of CPPs in diabetes management was 3.80 ± 0.63 out of 5. CPPs with a bachelor's degree or higher [β = 3.065, 95% CI: 2.704, 3.641; p < 0.001], CPPs with a higher monthly income (≥5000 ETB) [β = 0.242, 95% CI: 0.112, 0.596; p = 0.034], and those who provided more than 8 hours of service per day [β = 0.163, 95% CI: 0.051, 0.332; p = 0.043] had higher perceived involvement in the management of diabetes compared with their counterparts. ConclusionsThis study found that most CPPs had a high level of perceived involvement in diabetes management. Higher educational backgrounds, a higher monthly salary, and working longer hours were associated with an increased level of perceived involvement. Promoting the educational background of CPPs may be crucial to enhance their active involvement in the management of diabetes.

“Handing out non-prescribed antibiotics is storing up trouble for the next generation!” Unpacking multistakeholder views of drivers and potential solutions in Ethiopia

BackgroundAntibiotic resistance is a global health crisis, with inappropriate antibiotic use often being linked to non-prescribed antibiotic dispensing practices. This study aimed to examine the perspectives of multiple stakeholders on the drivers and potential solutions for non-prescribed antibiotic dispensing in Ethiopian community drug retail outlets (CDROs). Despite the prescription only use policies, the practice remains prevalent in Ethiopia. Many factors are thought to contribute to this issue, although little research is available for non-urban settings.MethodsA phenomenological qualitative study was conducted. Pharmacy professionals (owners or employees) working in non-urban towns CDROs were selected through a simulated client study, which identified CDROs that had dispensed antibiotics without a prescription. Some high-level decision makers in the Ethiopian health system were also purposively selected. Interviews were conducted in-person and over the phone or via Zoom. The interview data were transcribed verbatim, translated to English, and thematically analysed. NVivo 12 software was used to assist with coding.ResultsCDRO pharmacy professionals (n = 18) and five decision makers were interviewed. Most professionals (61%) were pharmacists working in drug stores, with one to 11 years of work experience. Several contributing factors were identified at the level of patients, CDRO staff, and the healthcare system. These included economic interests, inadequate knowledge and inappropriate attitudes about antibiotic use or supply, and issues within the healthcare system included inaccessibility and insufficient capacity, absence of or a weak enforcement of prescription-only regulations or service supervision. Additionally, patient-related factors included a lack of knowledge and inappropriate attitudes about antibiotics use and their supply, previous successful treatment experience and a culture of seeking out antibiotics.ConclusionsA complex set of modifiable factors related to patients, CDRO staff and healthcare system were identified that contribute to the non-prescribed supply of antibiotics. Due to this complexity, a single solution will not resolve the issues. Therefore, a range of multifaceted solutions have been suggested, including stricter regulation, increasing availability and accessibility of healthcare services, collaboration, and local consensus-building among CDROs, regular training for CDRO staff, and using community social events to educate the public about responsible use of antibiotics.

Assessment of Dispensing Malpractice in Community Drug Retail Outlets in South Gondar Zone, Northwest Ethiopia: A Simulated Patient Experience.

Pharmacy professionals in community drug retail outlets, as the most accessible personnel for the community, are engaged in consultation and responding to health problems in addition to filling prescriptions. In doing so, different dispensing malpractices are observed and much is not known on the issue in Ethiopia. The study aimed at assessing dispensing malpractice at pharmacies, drug stores and drug vendors in South Gondar zone. A cross-sectional study design with a descriptive approach was applied from April 1 to June 30. The data was collected using the simulated patient method. Seven prescription-only medicines and a diarrheal case were requested during visit. All drug retail outlets in South Gondar zone that were in service during data collection were visited. Almost all prescription-only medications were dispensed without prescription at all community drug retail outlets. Of all the dispensaries, 19 (82.6%) provided a partial dosage regimen of amoxicillin. Presence of fever and pregnancy status were asked about by dispensers in only 8% and 20% of visits for diarrhea, respectively. Medication history was also rarely requested. Medication was dispensed in 80% of visits for diarrhea, all of which included antimicrobials. Oral rehydration salt was considered in only two (10%) dispensaries. Dispensing medications without a prescription is common in community drug retail outlets in South Gondar zone in Amhara Regional State. Our findings also showed that detailed assessments of patients' signs and symptoms are not performed properly by the dispensers to understand the diarrheal case. Training of pharmacy professionals and strict regulatory control are needed.

Pharmacists’ involvements and barriers in the provision of health promotion services towards noncommunicable diseases: Community-based cross-sectional study in Northwest Ethiopia

BackgroundCommunity drug retail outlets (CDROs) are among the initial healthcare facilities where pharmacists play a crucial role in preventing and managing noncommunicable diseases (NCDs). Therefore, this study assessed pharmacists’ level of involvement and barriers in the provision of health promotion for noncommunicable diseases at CDROs in Northwest Ethiopia.MethodsA community-based multicenter cross-sectional study was conducted among community pharmacists in Northwest Ethiopia from April to June 2022. Data was collected using a self-administered structured questionnaire, and analyzed using the Statistical Package for Social Science (SPSS) version 26. The level of involvement mean score difference among pharmacists was investigated using an independent samples t-test and a one-way ANOVA. Logistic regression analysis was used to examine the association between pharmacists’ level of involvement and other variables. A p-value < 0.05 at a 95% confidence interval (CI) was considered statistically significant.ResultsA total of 285 (94.4%) participants participated in the study out of 302 approached samples. Overall, more than half (58.9%) of the participants showed a high level of involvement in health promotion. Pharmacists who had a degree and/or above (AOR = 0.03, 95% CI: 0.01–0.63; p < 0.001) and served a lower number of clients per day (AOR = 0.19, 95% CI: 0.04–94; p = 0.042) were less likely to have low involvement in health promotion services. Pharmacists who worked fewer hours per day (AOR = 3.65, 95% CI: 1.79–7.48; p = 0.005) were more likely to have low involvement. Lack of an appropriate area in the CDROs (52.1%) and lack of coordination with other healthcare providers (43.6%) were the most reported barriers to the provision of health promotion.ConclusionMost pharmacists were found to have a high level of involvement in health promotion activities. A lack of an appropriate area in the CDROs and a lack of coordination with other healthcare providers were among the most reported barriers. Pharmacists might benefit from training to increase their educational backgrounds, and barriers could be addressed to enhance the pharmacist involvement.

Extent of cardiovascular medications dispensing practice without a prescription: Self-reported and simulated patient-based study at community pharmacies in Northwest Ethiopia

BackgroundCritical actions are required for the proper administration of medications to patients with cardiovascular diseases. However, there has been an increase in irrational use of cardiovascular drugs. The purpose of this study was to determine the extent of non-prescription cardiovascular medicine dispensing practices at community drug retail outlets (CDROs) in Gondar, Northwest Ethiopia.MethodsA cross-sectional survey and simulated patient-based visits were employed at the CDROs in Gondar City, Northwest Ethiopia between June 1 and July 20, 2022. The cross-sectional component that assessed the self-reported practices used a standardized self-reported questionnaire. A simulated patient (SP) case scenario, using different tracer prescriptions only for cardiovascular medications, allowed for the observation of real-world dispensing procedures. SPSS version 22 was used for the data entry and analysis.ResultsThe cross-sectional study approached 76 CDROs, and 71 of them agreed to take part (93.4% response rate). More than half of the respondents (53.5%) were males, with a mean (SD) age of 33.5 ± 9.1 years. Overall, the current self-reported survey showed that 59.2% of the participants provided cardiovascular drugs without a prescription. A total of 213 simulated visits were conducted. Considering all SP scenarios, the percentage of cardiovascular drugs dispensed without a prescription increased to 88.7%. Besides, more than 90% of pharmacists did not demand the SP to have a prescription, did not advise them to visit doctors or clinics, and did not inquire as to whom the medication was required.ConclusionA significant proportion of CDROs dispensed cardiovascular medications without a prescription. The findings highlight the disparity between self-reported and actual CDRO practices. Additionally, nearly all of the CDROs approached made it simple to obtain cardiovascular medications. Stakeholders could adherently follow the CDROs’ practices to improve their proper dispensing procedures.

The magnitude and predictors of self-medication amongst street dwellers in Ethiopia: a multicentre study.

Low levels of living standards amongst street dwellers worldwide limit their access to conventional healthcare services, resulting in self-medication use for the treatment of an illness. Nevertheless, self-medication use has risks, including adverse drug reactions, increased polypharmacy, drug resistance, drug dependence, drug interactions and incorrect diagnosis. Ethiopia has a large street-dwelling community; however, there are no studies conducted in Ethiopia assessing self-medication use amongst street dwellers. This study provides insight into self-medication use and predictors amongst street dwellers in Ethiopia. A community-based, multicentre cross- sectional study was conducted amongst street dwellers from 1 September 2022 to 1 February 2023 at community drug-retail outlets in the three major cities in the Amhara region of Ethiopia. The data were obtained using an interviewer-administered questionnaire. Frequencies and percentages of descriptive statistics were calculated. Bivariable and multivariable logistic regression analyses were employed to indicate predictors of self-medication use. To determine statistical significance, a 95% confidence interval with a p value below 0.05 was utilized. The prevalence of self-medication use was 67.4%. Time and financial savings were reported as the reasons for most self-medication use. The most commonly reported illnesses for which people sought self-medication were gastrointestinal diseases. Low monthly income (adjusted OR 3.72, 95% CI 2.34-5.91) and residing near sewage areas (adjusted OR 3.37, 95% CI 2.03-5.58) were significantly associated with self-medication use. Street dwellers had a high rate of self- medication use. Residing near sewage areas and having a low level of income were factors in self-medication use. Gastrointestinal diseases, respiratory ailments and dermatological conditions were the most frequently reported complaints, whereas antimicrobials and anthelmintics were the most commonly used medications. We recommend that healthcare services enhance outreach programmes to the most vulnerable people, such as street dwellers, especially those with lower monthly incomes and who live near sewage areas, to reduce self-medication rates.

Community Pharmacy Professional's Knowledge, Attitude, and Practice with Regard to Pediatric Pain Management.

Effective pain relief is an essential component of high-quality healthcare delivery, and pharmacists must be well versed in pain mechanisms, assessment, and management. This study examined community pharmacy professional's (CPPs) knowledge and attitude towards pediatric pain management in Community pharmacies (CPs) and Drug Retail Outlets (DRO) of Ambo and Ginchi towns, west central Ethiopia. A cross sectional study was conducted in Ambo and Ginchi towns, the western part of the nation's capital. All voluntary CPPs working by CPs and DRSs in the towns of Ambo and Ginchi were included in the current study. SPSS version 25 was then used to process, analyze, and interpret the data. Among the 131 CPPs who were approached for the study, 104 agreed to participate and returned the questionnaire. CPPs mean knowledge score on pediatric pain management was 6.69 ±1.92, with a minimum score of 2 and a maximum score of 17. The majority of CPPs 82 (87.2%) in the study did not correctly answer half of the questions. Most of CPPs, 98 (94.3%), admitted they had no training in pain management, and 102 (98.2%) of the respondents said the same about pediatric pain management. The finding indicated that CPPs work experience in CP or DROs had impact on their knowledge about pediatric pain management and similarly, the mean knowledge score of pharmacists was higher than that of pharmacy technicians. This study revealed that CPPs have inadequate knowledge and attitude to provide effective pediatric pain management service. To bridge the knowledge gap and effectively control pediatric pain, pharmacists who are actively practicing their profession are advised to continue their medical education and training.

Medication counselling practices amid COVID -19 pandemic and associated factors in drug retail outlets of Jimma town, Southwest Ethiopia: cross-sectional study.

Patients' good understanding and awareness of drug information received at the drug retail outlet is paramount to gaining expected outcomes. In the COVID-19 pandemic, the routine counselling practice faced multifactorial challenges. The study aimed to assess medication counseling practice and associated factors in drug retail outlets of Jimma town, southwest Ethiopia. A facility-based cross-sectional study was conducted using an interviewer administered questionnaire. The data were analysed by using SPSS version 23. A multivariable logistic regression model was used to identify factors associated with medication counselling practice. A total of 180 pharmacy professionals were enrolled in the study, about half (51.1%) of the participants reported good medication counselling provision for their patients. In A multivariable logistic regression analysis, reduced pharmacist's level of communication (AOR=0.008; CI: 0.001-0.292; p= 0.009) and shortage of personal protective equipment (AOR=0.021; CI: 0.002-0.226; p=0.002) due Covid-19 were factors associated with poor medication counselling practice. Reduced level of communication and shortage of personal protective equipment due to Covid-19 were factors associated with poor medication counselling practice. In general, Jimma town health offices and Oromia Region Health bureau should struggle in association with other stakeholders to improve the identified bottleneck of pharmacist's counselling practice.

Patient-Centered Communication Among Pharmacy Professionals Working in Hospitals and Drug Retail Outlets in Asmara, Eritrea: Knowledge, Attitude, Self-Efficacy and Barriers.

BackgroundGlobally, preventable medication-related problems are increasing constantly. Patient-centered communication (PCC) is essential to identify and reduce the occurrence of drug-related problems such as inappropriate use of medications, adverse drug reactions and non-adherence. In Eritrea, personal observations and anecdotal reports showed that pharmacy professionals’ practice towards PCC was unsatisfactory. This study was conducted to assess pharmacy professionals' knowledge, attitude, self-efficacy and barriers towards the practice of PCC.MethodsAn analytical cross-sectional study design was employed among all pharmacy professionals who were employees of the drug retail outlets and hospital out-patient pharmacies of Asmara, Eritrea. A census approach was employed and data were collected from May to June 2021 using a face to face interview-based data collection tool. Descriptive and analytical statistics including independent samples t-test and multiple linear regression were employed using IBM SPSS (version-26).ResultsA total of 79 pharmacy professionals with a median age of 36 (IQR: 20) years were included in the study. The mean (SD) knowledge score of PCC was found to be 11.91 (2.0) out of 17. Moreover, the mean (SD) attitude score was 39.55 (4.0) out of 60 and the overall mean (SD) self-efficacy score was 52.51 (12.0) out of 96. Self-efficacy was significantly correlated with attitude (p=0.015). Work setting (p=0.002) and training (p=0.045) were predictors for the sub-scales of self-efficacy ‘exploring patient’s perspectives’ and ‘dealing with communicative challenges’, respectively. Workload/shortage of pharmacy professionals and time constraint were found to be the main barriers of the pharmacy professionals for not practicing PCC.ConclusionGenerally the pharmacy professionals’ fairly encouraging knowledge and attitude score on PCC, it was not supported with their self-efficacy. This necessitates further attention from policy makers and health facility managers in creating an ideal working environment for the pharmacy professionals to practice PCC at their best.

Herbal Medicine (HM) among pharmacy professionals working in drug retail outlets in Asmara, Eritrea: knowledge, attitude and prevalence of use

BackgroundGlobally, the usage of herbal medicines (HMs) is increasingly growing in treating and preventing various ailments. Although, HMs play a vital role in healthcare, concerns have been raised over their safety. Since pharmacy professionals are at the right position to provide patients with evidence-based information on herbals, they should be knowledgeable enough on the subject matter. Thus, the aim of the study was to assess the knowledge, attitude and prevalence of HMs use and its associated factors among pharmacy professionals.MethodAn analytical cross-sectional study was conducted among pharmacy professionals working in drug retail outlets in Asmara (the capital city of Eritrea). A census design was employed and data were collected through face-to-face interview. Data were entered and analyzed using Census and Survey Processing System (version-7.2) and IBM Statistical Package for Social Sciences (version 26), respectively. Descriptive and analytical statistics including Mann-Whitney U test/Kruskal-Wallis test and logistic regression were employed. P-values less than 0.05 were considered as significant.ResultsA total of 50 pharmacy professionals (90.9% response rate) were enrolled in the study. Majority of them (62%) were males and two-thirds had a bachelor’s degree. The overall median (Interquartile range, IQR) knowledge score was found to be 24 (12.16) out of 100 with a minimum score of 8 and maximum score of 53. Generally, the median (IQR) attitude score was 70.4 (4.2) out of 100. Majority (78%) of them had used HM for self-treatment. Only religion was found to be a significant determinant of knowledge on indication of HMs (p = 0.015), while attitude score was independent of the potential determining factors. Moreover, prevalence of use was significantly associated with pharmacy ownership (Adjusted Odds Ratio (AOR) =14.44, 95%Confidence Interval (CI): 1.67, 124.52) as well as with the percentage attitude score (AOR = 0.632, 95%CI: 0.41, 0.96) at multivariable level.ConclusionGenerally, the overall knowledge score of pharmacy professionals was low. However, they possessed positive attitude towards herbal medicines. Besides, there was prevalent usage of herbal medicine for self-treatment. This outcome triggers the need for educational courses and workshops centered on herbal medicine.

Assessment of Pharmaceutical Service Quality Provided in Community Drug Retail Outlets in Selected Towns, South West Ethiopia.

BackgroundInappropriate pharmaceutical services may result in unsafe, ineffective, and poor-quality treatment. This practice ultimately will lead to prolonged illness, suffering and damage to the patient and an increase in the cost of treatment. This study aims to assess the activities of pharmacy professionals and the pharmaceutical service quality given in community drug retail outlets of selected towns, Southern Ethiopia.MethodsA cross-sectional study was conducted on all drug retail outlets working in Adola, Bule Hora, Dilla, and Yabelo towns, southern Ethiopia from October 1 to November 30, 2021, by interview through self- structured questionnaires and participant observations of the dispensing process.ResultsA total of 46 (100%) dispensers participated. Out of which 18 (39.13%) respondents were from Dilla town, 11 (23.91%) were from Adola, 8 (17.39%) were from Bule Hora and 9 (19.57%) were from Yabelo town. Standard Reference Books 21 (45.7%) and Internet 20 (43.5%) were used as drug information sources by pharmacy professionals to get the latest facts about medicines. The leading causes of a dispensing error were incomplete prescription (54.34%) and illegible prescription (30.43%) from the prescriber. The errors were managed by communicating with patients (23, 50%), and prescribers (18, 39.13%). There was a high frequency of dispensing prescription drugs without prescription paper.ConclusionThe study revealed that less than half of the respondents use standard reference books and the internet as their drug information sources. Incomplete prescriptions from the prescribers were found to be the leading cause of dispensing errors. Dispensing of prescription drugs without receiving an order from a prescriber remains a common problem. Therefore, extensive work from regulatory authorities and pharmacy professionals is required to improve the quality of pharmaceutical services provided in drug retail outlets.

Generic substitution for prescribed brand medicines in Ethiopia: knowledge, attitude and practice among pharmacy professionals in community drug retail outlets

BackgroundGeneric substitution is a good approach to reduce pharmaceutical expenses without compromising healthcare quality. Yet, the practice of generic substitution has been contentious due to concerns on quality and efficacy.ObjectiveThis study was aimed to assess knowledge, attitude and practice among pharmacy professionals toward generic substitution in community drug retail outlets in Jimma town, Southwest Ethiopia.MethodsA descriptive cross-sectional study was conducted among pharmacy professionals working in community drug retail outlets. Data was collected using a self-administered questionnaire. Knowledge was tested using a 3-point response format consisting of “Yes,” “No” and “I am not sure.” Attitude was evaluated using the 5-point Likert scale ranging from 1(strong agreement) to 5 (strong disagreement). The practice was examined as never, seldom, sometimes, often, and always with scores ranging from 0 to 4. The influences of socio-demographic factors on knowledge, attitude, and practice were tested using the Mann–Whitney U and Kruskal–Wallis tests as appropriate. P ≤ 0.05 was considered statistically significant.ResultsThe mean knowledge score of participants regarding generic medicines was 5.75 ± 1.79. Only 32 respondents (30.2%) of the participants were knowledgeable about the generic substitution. 54 (50.9%) of respondents had positive attitude toward generic substitution and 52 (49.1%) had practiced generic substitution. The year of experience had a significant effect on knowledge (X2 = 9.14, p = 0.01) and practice (X2 = 4.71, p = 0.03) of generic substitution.ConclusionsOur study found that pharmacy professionals working in community drug retail outlets in Jimma town had lack of knowledge about generic substitution. Conversely, an enormous amount of participants had positive attitude toward generic substitution and nearly half of them had practiced generic substitution. The year of experience had a significant effect on knowledge and practice of generic substitution.

Community drug retail outlet staff\u2019s knowledge, attitudes and practices towards non-prescription antibiotics use and antibiotic resistance in the Amhara region, Ethiopia with a focus on non-urban towns

IntroductionSome evidence suggests that knowledge and attitudes towards rational antibiotic use influences dispensing practice in community drug retail outlets. However, there is limited evidence in resource limited countries, including Ethiopia. We aimed to assess the knowledge and attitudes surrounding antibiotic use or supply and antibiotic resistance, and the non-prescribed antibiotic dispensing practices in community drug retail outlets in non-urban Ethiopia.MethodsWe conducted a cross-sectional survey of community drug retail outlet staff in the Amhara region, Ethiopia with a focus on non-urban towns. An expert validated self-administered questionnaire was used. Following exploratory factor analysis and best items selection, we summarised our findings and assessed factors associated with non-prescribed antibiotic dispensing. The data were analysed using Stata Statistical Software version 17. P-values < 0.05 were considered significant.ResultsA total of 276 participants from 270 drug outlets completed the questionnaire. The participants median age was 30 (Interquartile range (IQR) = 25–35) years and 79.7% were pharmacy assistants. The majority demonstrated good levels of knowledge about antibiotic use or supply and antibiotic resistance (77.9% and 76% of the participants responded correctly to more than half of the items, respectively). We identified four attitude domains: the role of antibiotics in recovering from diseases regardless of their cause (median score = 2 (IQR = 2–4), beliefs inconsistent with good practice); professional competency to supply non-prescribed antibiotics, and the non-prescribed antibiotics supply (median score for each domain = 4 (IQR = 4–5), attitudes consistent with good practice); and positive attitudes towards actions to prevent antibiotic resistance and promote appropriate antibiotic use (median score = 4 (IQR = 4–5). Fifty eight percent of the participants reported that they had dispensed antibiotics without a prescription. Participants who did not perceive that they were competent to supply non-prescribed antibiotics (adjusted odds ratio = 0.86, 95% confidence interval = 0.78–0.93) were less likely to report non-prescribed antibiotics dispensing.ConclusionWhile most of the participants had appropriate knowledge about and attitudes to antibiotic use and antibiotic resistance, basic knowledge and attitude gaps remain. Despite Ethiopia’s regulatory restrictions, the non-prescribed antibiotic provision continues to be a common practice. Our study highlights the need for multifaceted interventions that may include a strict regulatory system, staff training and public education.

The response to COVID-19 among drug retail outlets in Indonesia: A cross-sectional survey of knowledge, attitudes, and practices

SummaryBackgroundPharmacists have been at the frontline of the COVID-19 response in Indonesia, providing medicines, advice, and referral services often in areas with limited healthcare access. This study aimed to explore their knowledge, attitudes, and practices during the pandemic, so that we can be better prepared for future emergencies.MethodsA cross-sectional online survey of community pharmacists and pharmacy technicians in Indonesia was conducted between July and August 2020. The dataset was analysed descriptively, and logistic regression was used to explore willingness to participate in COVID-19 interventions.Findings4716 respondents participated in the survey. Two-thirds (66·7%) reported knowing only “a little” about COVID-19 and around a quarter (26·6%) said they had not received any COVID-19 guidelines. Almost all were concerned about being infected (97·2%) and regularly took steps to protect themselves and their clients (87·2%). Stock-outs of Personal Protective Equipment (PPE) and other products (32·3%) was the main reason for not taking any precautions. Around a third (37·7%) mentioned having dispensed antibiotics to clients suspected of having COVID-19. To support COVID-19 response efforts, most respondents were willing to provide verbal advice to clients (97·8%), distribute leaflets to clients (97·7%), and participate in surveillance activities (88·8%). Older respondents, those identifying as male, and those working in smaller outlets were more willing to provide information leaflets. Those working in smaller outlets were also more willing to engage in outbreak surveillance.InterpretationDrug retail outlets continue to operate at the frontline of disease outbreaks and pandemics around the world. These providers have an important role to play by helping to reduce the burden on facilities and providing advice and treatment. To fulfil this role, drug retail outlets require regular access to accurate guidelines and steady supplies of PPE. Calls for drug retail outlet staff to plat in response efforts including the provision of information to clients and surveillance could ease escalating pressures on the health system during future outbreaks.FundingThis study was funded by a grant from the Department of Foreign Affairs and Trade, Australia, under the Stronger Health Systems for Health Security Scheme.

Antimicrobial Use and Management of Childhood Diarrhea at Community Drug Retail Outlets in Eastern Ethiopia: A Matched Questionnaire-Based and Simulated Patient-Case Study.

IntroductionAntimicrobial agents have saved millions of lives worldwide. However, inappropriate use has become a global concern leading to the emergence and spread of antimicrobial resistance (AMR). In this regard, the dispensing practices of pharmacy professionals in the community drug retail outlets (CDROs) plays a central role. Therefore, this study was aimed to assess the knowledge and dispensing practices of pharmacy professionals in the management of childhood diarrhea in CDROs of Eastern Ethiopia.MethodsA community based cross-sectional study was conducted in 100 randomly selected CDROs in Eastern Ethiopia from 1 August to 30 September 2020. Data were collected with a structured questionnaire matched with a simulated patient case. Descriptive statistics were employed to summarize variables. Cohen’s Kappa was analyzed to measure the degree of agreement between questionnaire-based and simulated patient-based methods. Binary logistic regression analysis was conducted to determine factors associated with inappropriate dispensing practice.ResultsMajority of the participants were aged 25–34 years (median: 29 years). High proportion of them were male (65%) and had work experiences of two or more years. Majority (61%) of the professionals were knowledgeable about AMR. Out of 2886 scores, 745 scores were agreed on Cohen’s Kappa interrater agreement scale with the overall percent agreement between the two methods being 26.0%. Besides, about 67% of dispensing practices to the simulated patient case was found inappropriate. On the multivariate analysis, insufficient knowledge of retailers on AMR was significantly associated with the inappropriate dispensing of antimicrobial agents.ConclusionA considerable proportion of retailers had insufficient knowledge regarding the emergence and spread of AMR. Only a quarter of their questionnaire-based knowledge response agreed with simulated-patient-based actual practice, indicating weak agreement between the two methods and high level of inappropriate practice. Besides, insufficient knowledge of retailers was significantly associated with their inappropriate dispensing of antimicrobials.