Drug Retail Outlets Research Articles

Non-Prescription Antibiotics Use and Associated Factors Among Drug Retail Outlets in Ambo, Ethiopia: A Cross-Sectional Study.

PurposeTo assess the non-prescription use of antibiotics and associated factors in Ambo Town, West Shoa, Oromia, Ethiopia.MethodsAn institutional-based cross-sectional study design supported with the qualitative study was conducted in Ambo Town from February 1 to March 1, 2020. Data were collected using a pretested semi-structured questionnaire and in-depth interview guide questions. Simple random sampling was used to select retail outlets and systematic random sampling to select study participants. The data analysis was done using SPSS and univariate and multivariate binary logistic regression analysis was performed to identify factors associated with non-prescription use of antibiotics. Thematic framework analysis was applied for the qualitative data.ResultsFrom the 421 study sample, a total of 399 participants were interviewed with a 94.8% response rate. Among the study participants, 214 (53.6) were males, 228 (57.1%) were married, 191 (47.9%) were orthodox by religion, and 343 (86%) were Oromo by ethnicity. One hundred seventy-two (43.1%; 95% CI: 38.6, 48.1) of the participants had used non-prescribed antibiotics. Being male [AOR=2.21 95% CI: 1.276, 3.835], residing in rural area [AOR=3.659, 95% CI: 1.479, 9.054], holding diploma [AOR=0.120, 95% CI: 0.025, 0.591], and hold BSC degree [AOR=0.050, 95% CI: 0.007, 0.378], and being farmer [AOR=0.034, 95% CI: 0.004, 0.285] showed significant association with the non-prescription use of antibiotics.ConclusionThis study concluded that the non-prescription use of antibiotics 172 (43.1%) was relatively high. Being male, residing in a rural area, holding a diploma, BSc degree, and being a farmer were significantly associated with non-prescription use of antibiotics. So, West Shoa Zone regulatory body should actively focus on the prevention of non-prescription use of antibiotics through health communication and public awareness on the demerits of non-prescription use of antibiotics.

Regulatory Compliance and Associated Quality of Amoxicillin in Drug Retail Outlets of Southwestern Ethiopia.

BackgroundWhile the research findings confirm the existence of private drug retail outlets that do not comply with regulatory standards in many low-income countries, there are a lack of reports that evaluate the quality of medicines obtained from these firms. Therefore, the aim of this study was to evaluate the regulatory compliance of the retails and associated quality of amoxicillin in Southwestern Ethiopia.MethodologyForty-two drug retail outlets in Jimma town were evaluated using an inspection checklist developed by the Ethiopian regulatory authority, and dispensers from these retail outlets were interviewed using the pretested structured questionnaire. The drug outlets were coded and categorized into noncompliant and compliant drug retail outlets. The physicochemical quality of amoxicillin capsules obtained from these retail outlets were evaluated following methods described in the US Pharmacopoeia.ResultsThe present study revealed that about 54.76% drug retail outlets were compliant with the regulatory standard. Factors like income of retail outlet, experience of dispenser, and training regarding good storage practice were associated with status of regulatory compliance (p-value <0.05). The identification, dissolution, and assay results indicated that all amoxicillin samples obtained from both noncompliant and compliant drug retail outlets complied with pharmacopoeial specification limit. Besides, the independent unequal variance t-test revealed that there is no significant difference between mean dissolution and assay of API of the amoxicillin samples obtained these drug retail outlets (p-value >0.05).ConclusionThe regulatory compliance of private drug retail outlets in Jimma town is not satisfactory. Moreover, the laboratory findings revealed that all samples of amoxicillin capsules compiled with pharmacopoeial specifications acceptance for packaging and labeling information, identification, assay, and dissolution. However, despite the fact that assays of the amoxicillin from retail outlets are within the required specification, the assays of amoxicillin obtained from noncompliant retail outlets appears to be slightly degraded, which may potentially demonstrate the impact of noncompliance of the drug retail outlets on the quality of medicines.

How medicines sales staff is responding to presumptive COVID-19 patients attending drug retail outlets: An exploratory qualitative study.

The objective of this qualitative study was to explore how the medicine sales staff responded to presumptive COVID‐19 patients in Pakistan. The data were obtained from the medicine sales staff working at drug retail outlets of Bahawalpur, Punjab, Pakistan, through in‐depth face‐to‐face interviews using a semi‐structured interview guide. A two‐step sampling strategy was used, including purposive and convenient sampling techniques. Sample size was determined by applying the saturation point criteria. A total of 17 interviews were audio‐recorded, transcribed verbatim and analysed using the thematic analysis. Analysis of data yielded six themes and seven sub‐themes. The themes included (1) knowledge about various aspects of COVID‐19, (2) practices of sales staff in response to COVID‐19 pandemic, (3) attitude of sales staff towards COVID‐19 pandemic, (4) services offered to presumptive COVID‐19 patients, (5) challenges encountered during pandemic and (6) suggestions to improve delivery of pharmacy services by sales staff. In Pakistan, non‐pharmacist sales staff had superficial knowledge about COVID‐19. Presumptive COVID‐19 patients were provided with only basic pharmacy services. Professional training is advised among pharmacy sales staff as a short‐term solution to improve their knowledge. As a long‐term goal, the availability of pharmacists at drug retail outlets is warranted.

Determinants of dispensing antibiotics without prescription in Eritrea: a mixed-method qualitative study on pharmacy professionals’ perspective

ObjectiveAntimicrobial resistance is a global public health challenge. Dispensing of antibiotics without prescription (DAWP), a major contributor to antibiotic resistance, is extensive in Eritrea. This study was, therefore, aimed at...

Prevalence and determinants of inappropriate antibiotic dispensing at private drug retail outlets in urban and rural areas of Indonesia: a mixed methods study

IntroductionThe aim of this mixed-method study was to determine the extent and determinants of inappropriate dispensing of antibiotics by licensed private drug retail outlets in Indonesia.MethodsStandardised patients (SPs) made a...

No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies

BackgroundNon-prescription dispensing of antibiotics, one of the main sources of antibiotic misuse or over use, is a global challenge with detrimental public health consequences including acceleration of the development of antimicrobial resistance, and is facilitated by various intrinsic and extrinsic drivers. The current review aimed to systematically summarise and synthesise the qualitative literature regarding drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries.MethodsFour electronic databases (PubMed, CINAHL, Scopus and Google Scholar) and reference lists of the relevant articles were searched. The Joanna Briggs Institute’s Critical Appraisal Checklist for qualitative studies was used to assess the quality of included studies. The enhancing transparency in reporting the synthesis of qualitative research statement was used to guide reporting of results. Data were coded using NVivo 12 software and analysed using both inductive and deductive thematic analysis.ResultsA total of 23 articles underwent full text review and 12 of these met the inclusion criteria. Four main themes were identified in relation to facilitators of non-prescribed sale of antibiotics among community drug retail outlets: i) the business orientation of community drug retail outlets and tension between professionalism and commercialism; ii) customers’ demand pressure and expectation; iii); absence of or a lax enforcement of regulations; and iv) community drug retail outlet staff’s lack of knowledge and poor attitudes about antibiotics use and scope of practice regarding provision.ConclusionsThis review identified several potentially amendable reasons in relation to over the counter dispensing of antibiotics. To contain the rise of antibiotic misuse or over use by targeting the primary drivers, this review suggests the need for strict law enforcement or enacting new strong regulation to control antibiotic dispensing, continuous and overarching refresher training for community drug retail outlet staff about antibiotic stewardship, and holding public awareness campaigns regarding rational antibiotic use.

Self-medication practice and associated factors among adults in Wolaita Soddo town, Southern Ethiopia

Background: Self-medication is the selection and use of medicines by individuals to treat their self-recognized illnesses or symptoms. Self-medication can decrease costs and enable health professionals to concentrate on more serious health problems.&#x0D; Aim: To assess self-medication practice and associated factors among adults in Wolaita Soddo town, Southern Ethiopia, 2017.&#x0D; Methods: An institution-based cross-sectional study was conducted from September 30 to October 30, 2017. A multi-stage sampling technique of drug retail outlets in Wolaita Soddo town was employed to identify 623 individuals that came to buy drugs in the past three months. Data was collected using a structured questionnaire.&#x0D; Results: About 33.7% of the respondents had practiced self-medication in the past 3 months. Multivariate analysis revealed that female sex (adjusted odds ratio (AOR) = 2.22, 95% confidence interval (CI): 1.47–3.36), low income (AOR = 3.95, 95% CI: 2.32–6.73) and higher educational level (AOR = 5.79, 95% CI: 2.47–13.58) were the independent factors significantly affecting the practice of self-medication with drugs. Headache/fever (32.4%), respiratory tract infections (31.4%) and gastrointestinal diseases (16.2%) were the most frequently reported illnesses or symptoms of illnesses that prompted self-medication of study participants.&#x0D; Conclusion: Health education campaigns, strict legislations on dispensing drugs from private pharmacies, and improving accessibility and affordability of health care are among the important interventions required to change people’s health-seeking behavior and prevent the potential risks of self-medication.

History taking and response to an adult diarrheal case among community drug retail outlets in Gondar town, north-west Ethiopia: a simulated-client survey

BackgroundSelf-care is one of the growing tasks of community pharmacy professionals. They are highly engaged in consultations in response to specific drug request (product-based presentation) or symptoms clients describe (symptom-based presentation).PurposeThis study was aimed at assessing the appropriateness of patient assessment and response to an adult diarrheal case among community drug retail outlets in Gondar town, north-west Ethiopia.MethodsA descriptive cross-sectional study design based on simulated-client method of visit was conducted from 03 August to 21 September, 2020. An adult female diarrheal case scenario was developed and used to guide data collectors to interact with professionals in a standardized and consistent way. All 60 dispensaries in the town during the data collection were included in the study. A pretested data collection tool was used to record the conversation between simulated clients and providers. The data were analyzed using SPSS version 20.ResultsWith regard to patient history, age of the patient, whether diarrhea is watery or bloody and onset and duration of diarrhea were the three most commonly requested questions with 59 (98.3%), 55 (91.7%) and 46 (76.7%), respectively. Past-medical and medication history are enquired in none of the visits. Medication was dispensed in 57 (95%) of the visits and no referral to a health facility was recommended in majority (90%) of cases. The most commonly recommended medications were ciprofloxacin 30 (52.6%) and metronidazole 20 (35.1%). ORS was considered in only 6 (10.5%) dispensaries.ConclusionPatient assessment, final decisions and treatment recommendations for an adult diarrheal case are inadequate, irrational and illegal. Educational interventions coupled with incentive mechanisms for cognitive pharmaceutical service and strict regulatory enforcement are needed to reduce the problem.

National Health Insurance Fund\u2019s relationship to retail drug outlets: a Tanzania case study

BackgroundAchieving universal health coverage will require robust private sector engagement; however, as many low- and middle-income countries launch prepayment schemes to achieve universal health coverage, few are covering products from retail drug outlets (pharmacies and drug shops). This case study aims to characterize barriers and facilitators related to incorporating retail drug outlets into national prepayment schemes based on the experience of the Tanzanian National Health Insurance Fund’s (NHIF) certification of pharmacies and accredited drug dispensing outlets.MethodsWe reviewed government documents and interviewed 26 key informants including retail outlet owners and dispensers and central and district government authorities representing eight districts overall. Topics included awareness of NHIF in the community, access to medicines, claims processing, reimbursement prices, and how the NHIF/retail outlet linkage could be improved.ResultsImportant enablers for NHIF/retail outlet engagement include widespread awareness of NHIF in the community, NHIF’s straightforward certification process, and their reimbursement speed. All of the retail respondents felt that NHIF helps their business and their clients to some degree. As for barriers, retailers thought that NHIF needed to provide more information to them and to its members, particularly regarding coverage changes. Some retailers and government officials thought that the product reimbursement prices were below market and not adjusted often enough, and pharmacy respondents were unhappy about claim rejections for what they felt were insignificant issues. All interviewees agreed that one of the biggest problems is poor prescribing practices in public health facilities. They reiterated that prescribers need more supervision to improve their practices, particularly to ensure adherence to standard treatment guidelines, which NHIF requires for approving a claim. In addition, if a prescription has any problem, including a wrong date or no signature, the client must return to the health facility to get it corrected or pay out-of-pocket, which is burdensome.ConclusionsLittle published information is available on the relationship between health insurance plans and retail providers in low- and middle-income countries. This case study provides insights that countries can use when designing ways to include retail outlets in their health insurance schemes.

Assessment of awareness and attitude towards counterfeit medicines among pharmacy professionals working in community drug retail outlets in Harar town, Ethiopia

Background: Counterfeit medicines are drugs which are deliberately and fraudulently mislabeled with respect to identity and/or source. According to the WHO 2017 report, about 1% of prescribed medicines in the developed world and about 10-50% in parts of the developing world are estimated to be counterfeits. Objective: The objective of this study was to assess the knowledge and attitude of pharmacy profes-sionals towards counterfeit medicines in Harar town. Method: A cross sectional study was conducted among pharmacy professionals found in Harar town, East Ethiopia. All pharmacy professionals working in community drug retail outlets of Harar town was included in the study. Accordingly, 92 pharmacy professionals were included in the study. The data was collected by using self-administered questionnaire. The questionnaire was prepared in English language. Data was coded, entered and analyzed by using Statistical Package for Social Sci-ence version 22. Then chi-square(x2) test was performed to determine there exists association of so-cio-demographic characters, profession and year of service towards awareness and attitude about counterfeit medicines was investigated using. Result: A total of 92 respondents were included in the study. The majority, 76 (82.6%), of the study participants had information about counterfeit medicine. The 26(28.3%), 42(45.7%) and 24(26%) of the respondents replied that counterfeit medicines have problem of efficacy, safety and cause eco-nomic problem on sellers of genuine drugs respectively. Majority of the study of the study partici-pants were not aware of a way of identification of counterfeit medicines, with only 18(19.6%), 47(51.1%) and 27(29.3%), replied that counterfeit medicines can be identified by its effect, inspec-tion and cost respectively. Majority of the respondents, 60(65.2%), responded that pharmacy profes-sional that knowingly dispense counterfeit medicine are business man /women. Most of the re-spondents, 66(71.7%), replied that pharmacy professionals carry out the business of counterfeit medicines transaction because of big profit obtained from such an activity. gender, profession and year of service in serving as pharmacy professional was found to be significantly associated with awareness towards counterfeit medicines, (p&lt;0.05). Conclusion: Significant proportion of the study participants were not aware of the problems associ-ated with counterfeit medicines as efficacy, safety and economic problems. Majority of the respond-ents still are unaware about ways of identification of counterfeit medicines as inspection, by effica-cy and cost. Keywords: Counterfeit medicines; Awareness; Attitude; Professionals; Drug retail outlets

Comparative In Vitro Evaluation Of Different Brands Of Metformin Hydrochloride Film Coated Tablets Marketed In Addis Ababa, Ethiopia

Metformin hydrochloride is a biguanide class of drug widely used to treat Type 2 diabetes mellitus. Its oral bioavailability is about 50 to 60 % with a half-life of about 3 h. This study focused on evaluation and comparison of the physicochemical properties of different brands of metformin hydrochloride (500mg) film coated tablets available in drug retail outlets in Addis Ababa, Ethiopia. Some different in vitro tests including hardness, weight variation, disintegration time, dissolution study, and assay were conducted as per United States Pharmacopeia. To compare dissolution profiles of the generic products against the innovator product (product A), a model independent method, similarity factor (f2), was also used. Weight variation result showed that all brand fall within the 5% limit from the average which is acceptable. Disintegration time of less than 15 minutes was observed for all brands. The in vitro drug release study results for the products ranged between 82 and 93% release within 30 minutes which is above 80% limit as per the United States Pharmacopeia requirement. The similarity f2 values for generic products ranged from 53 to 75%. Furthermore, assay value of the studied brands varied from 95.60 to 104.37% which was within standard limit (95-105%). It can be concluded that all brands of metformin hydrochloride tablets met pharmacopoeial specification for the tested parameters of physicochemical properties like weight variation, hardness of tablets, disintegration time, drug release study and assay.&#x0D;

Factors influencing non-prescription sales of antibiotics among patent and proprietary medicine vendors in Kano, Nigeria: a cross-sectional study.

Patent and proprietary medicine vendors (PPMVs) increase access to antibiotics through non-prescription sales in their drug retail outlets. This fosters irrational antibiotic use among people, thus contributing to the growing burden of resistance. Although training programmes on antibiotic use and resistance exist, they have disproportionately targeted health workers in hospital settings. It's unclear if there is a relationship between such trainings and non-prescription sales of antibiotics among PPMVs which are more embedded in communities. Therefore, a cross-sectional study was conducted to elicit the determinants of non-prescription antibiotic sales among PPMVs in Kano metropolis, Nigeria. Through brainstorming, causal loop diagrams (CLDs) were used to illustrate the dynamics of factors that are responsible for non-prescription antibiotic sales. Multilevel logistic regression model was used to determine the relationship between training on antibiotic use and resistance and non-prescription antibiotic sales, after controlling for potential confounders. We found that two-third (66.70%) of the PPMVs reported that they have sold non-prescribed antibiotics. A total of three CLDs were constructed to illustrate the complex dynamics of the factors that are related to non-prescription antibiotic sales. After controlling for all factors, PPMVs who reported that they had never received any training on antibiotic use and resistance were twice as more likely to sell antibiotic without prescription compared with those who reported that they have ever received such training (OR = 2.07, 95% CI: 1.27-3.37). This finding suggests that there is an association between training on antibiotic use and resistance and non-prescription sales of antibiotics. However, the complex dynamics of the factors should not be ignored as it can have implications for the development of intervention programmes. Multifaceted and multicomponent intervention packages (incorporating trainings on antibiotic use and resistance) that account for the inherent complexity within the system are likely to be more effective for this setting.

No Prescription, No Problem! A Mixed-Methods Study of Antimicrobial Stewardship Relating to Working Equines in Drug Retail Outlets of Northern India.

Multidrug resistance (MDR) is already occurring among some equids in India. Donkeys and mules are a mobile species moving between regions and international borders, often populating areas of India where private community pharmacies, or medical stores, are the primary healthcare provider for both humans and animals. This article highlights how the capacities of drug retail outlet workers might affect their antibiotic dispensing practices, particularly in relation to donkeys and mules, in order to consider how this might impact the development of antimicrobial resistance (AMR) on a wider scale. A mixed-methods approach was implemented using patient simulation method (n = 28), semi-structured interviews (SSIs) (n = 23), focus group discussions (FGDs) with veterinary practitioners and non-governmental organisation animal health workers (n = 2 FGDs), and participant observation. Fewer than 48 per cent of drug retail outlet workers admitted to having had any formal training in pharmaceuticals at all, while 78 per cent reported having no formal training in animal-related pharmaceuticals. Moreover, 35 per cent of all participants sold antibiotics without a prescription, unprompted and without specifically being asked for antibiotics. Of the antibiotics dispensed, only 21 per cent were correctly dispensed for the symptoms presented, and all dosages dispensed were incorrect (underdosed). Furthermore, 43 per cent of drug retail outlet workers interviewed believe that some antibiotics can be legally dispensed without a prescription. Equine owners in northern India are frequently being sold antibiotics without a prescription and, in most cases, with incorrect diagnoses, treatment choice, and dosage. A substantial gap in capacities exists amongst Drug Retail Outlet (DRO) workers, with few being sufficiently qualified or trained to dispense antibiotics to animal owners. The study highlights the need for further training of private DRO workers as well as knowledge extension and awareness training for both DRO workers and animal owners regarding antimicrobial resistance and its potential impact upon livelihoods. It also illustrates the need to identify a balance whereby greater enforcement of regulation at all levels is implemented, while at the same time maintaining sufficient access to medicine for rural populations.

Availability and prices of medicines for non-communicable diseases at health facilities and retail drug outlets in Kenya: a cross-sectional survey in eight counties

ObjectivesThe objective of this study was to determine the availability and prices of medicines for non-communicable diseases (NCDs) in health facilities and private for-profit drug outlets in Kenya.DesignCross-sectional study.MethodsAll public...

Assessment of Self- Medication Practice and Contribution Factor in Arada Sub City Addis Ababa, Ethiopia

Background : - a number of individuals in developing countries do not attend physicians for their illnesses; instead they commonly use self-medication. Self-medication could be using drugs existing in home like over the counter (OCT) drugs, traditional medicine or non- pharmacological action. Aim of this study was to assess the practice of self-medication in Arada Sub city town, Addis Ababa, Ethiopia Methods : - a community based cross sectional study was carried out in Arada sub City from Feb 20 to Feb 27, 2019. Data was collected by Semi-structured and pre-tested questionnaire, consisting questions on general demographic, socio-economic as well as on perceived illness /symptoms in two weeks recall period and actions taken for it; and administered to respondents of the 412 systematically selected households. The data was analyzed and presented using tables and chi-square calculation. Result: - Out of the 386 individuals with perceived illness, 142 (39.9%) were self-medicated and females 82 (58.27%) were more self-medicated than males. The most frequent illness/symptom reported for self-medication was fever (40.6%). Most of the drugs (41.95%) used for self-medication were obtained from drug retail outlets, and previous experience for the perceived low severity of illness/symptoms (41.1%) was the main reason for self-medication. Conclusion &amp; Recommendation:- S elf-medication is widely practiced for a wide range of illnesses/symptoms and by using OTC drugs, prescription only drugs and also traditional medicine/non-pharmacological action. The public as well as the health care providers have to be educated on the scope of self-medication; i.e., the type of illnesses to be self-diagnosed and self-treated, and the type of drug products to be used in order to promote responsible self-medication. Keywords: Self-medication; Arada subcity, OTC drug DOI: 10.7176/JHMN/74-02 Publication date: May 31 st 2020

&lt;p&gt;Physicochemical Quality Assessment of Antimalarial Medicines: Chloroquine Phosphate and Quinine Sulfate Tablets from Drug Retail Outlets of South-West Ethiopia&lt;/p&gt;

BackgroundMalaria is a complex disease and main community health problem in Africa and the top leading cause of outpatient visits, admissions, and deaths in Ethiopia. Its effective management is possible through early diagnosis and immediate treatment employing antimalarials. The quality of these drugs has to be good enough to attain their intended purpose. However, there are treatment failures resulted from the consumption of falsified and substandard antimalarials. Therefore, the current study was undertaken to evaluate the quality of two commonly used antimalarial drugs [chloroquine phosphate and quinine sulfate tablets] and to determine whether the quality of these drugs was affected by the origin, brand and sample collection sites in South-West Ethiopia.MethodsRandom sampling based on Ethiopian malaria eco-epidemiological strata map, with different levels of medicines outlets, was applied to select sampling sites.ResultsSixty samples were bought from 43 drug retails (pharmacy, drug store, and drug vendor) in twelve different geographical locations of South-West Ethiopia between June and July 2016. Visual inspection was done for all samples before the lab experiment. A 28.3%, 31.7%, and 6.8% of samples failed to comply with the Pharmacopoeial quality standards for visual inspection, hardness and weight variation tests, respectively. Statistical analysis revealed that origin and geography from which samples were collected significantly affects the active pharmaceutical content of both drugs at P < 0.05 level. Significant variation was observed for chloroquine samples within batches of the same manufacturing and between origins.ConclusionThis study indicated that all the chloroquine and quinine tablets met the quality specification concerning friability, dissolution and assay. Out-of-specification results for weight variation, hardness and visual inspection tests for the chloroquine tablets are signs of substandard/spurious/falsely labeled/falsified/counterfeit actions that may compromise the quality of these drugs. Besides, within the acceptance limit, the origin of drugs and collection sites have found to determine the quality which raises good manufacturing practice and storage (drug supply chain system) issues to be evaluated.

Dispensing of antibiotics without prescription and associated factors in drug retail outlets of Eritrea: A simulated client method

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.

Assessment of Pharmaceuticals Waste Practices Among Private Drug Retail Outlets in Ethiopia.

Background: Pharmaceuticals waste is a public safety concern, resulting in a possible accidental poisoning, misuse, and environmental pollution. Thus, appropriate disposal of the damaged and expired medicines would save lives and protect the ecological system. Objective: The study was aimed to assess knowledge, attitudes, and disposal practices of pharmaceuticals waste among practitioners in private retail outlets. Method: A facility-based descriptive cross-sectional study was conducted among private practitioners in retail outlets of Jimma city from November 20 to December 19, 2018. All private drug retail outlets and the respective staffs that fulfilled the eligibility criteria were included in the study. The data were collected using self-administrated questionnaires. Results: Of 106 questionnaires distributed to practitioners, 87 completed questionnaires returned, making a response rate of 82.1%. Fifty-nine (67.8%) of the participants reported that at least one type of damaged or expired medicines was present in their store. The main reasons for the damage or expiration include inappropriate storage practices, 32 (29.1%), and receiving medicines with a near expiration date, 42 (38.2%). Concerning knowledge about disposal practices, 70 (41.7%) and 47 (38.2%) of the participants, respectively, reported that safe disposal of damaged or expired medicines would prevent environmental pollution and illegal use. Regarding disposal practice, 47 (38.2%) of the respondents reported burning separately, and 24 (19.5%) of them reported burying underground. Fifty-two (59.8%) of the total participants strongly agreed that they had a responsibility to protect environmental pollution. Conclusions: The majority of the participants knew that the appropriate disposal of pharmaceuticals waste could protect human beings and ecological systems. However, a majority of the respondents disposed of the pharmaceuticals waste at the retail pharmacy.

Community pharmacists as antibiotic stewards: A qualitative study exploring the current status of Antibiotic Stewardship Program in Bahawalpur, Pakistan

BackgroundThe World Health Organization released a Global Action Plan to overcome the threatening concerns of antibacterial resistance. One of the cornerstones of this plan is the Antibiotic Stewardship Program (ASP). The study aimed to assess the community pharmacists’ knowledge, perceptions and current practices regarding ASP. MethodsA qualitative study was conducted in Bahawalpur, Pakistan, in which data were collected from the community pharmacists through in-depth, semi-structured interviews. The convenience sampling technique was used to recruit the study participants. Interview protocol was pilot tested and the sample size was limited by applying the saturation point criteria. All interviews were audio recorded and transcribed verbatim. The thematic analysis approach was used to analyze the data and draw conclusions based on study objectives. ResultsA total of fifteen community pharmacists were interviewed. Analysis of the data yielded five themes and 16 subthemes. All of the respondents had sound knowledge about the irrational use of antibiotics; however, they were oblivious about the ASP. After explaining the term, the respondents were of the opinion that these strategies could not be implemented in the current healthcare system of the country. According to the findings of the study, prescribing and dispensing practices were not followed. Only a few patients were educated about the antibiotics they were purchasing. ConclusionMost of the study participants were unaware of any ASP being offered in the community pharmacy settings. The study participants agreed to be the antibiotic stewards, but a number of obstacles were reported. The training of pharmacists, medication reconciliation, the implementation of the good pharmacy practice guidelines and assurance of pharmacist availability at drug retail outlets were few suggestions given by the study participants to incorporate the ASP in the community settings.

Awareness of Veterinary Drug Retail Outlets on Antimicrobial Resistance and its Containment Strategy in Ethiopia

A cross-sectional study was conducted from January to March 2018 to assess the awareness of veterinary drug retail outlets on Antimicrobial Resistance (AMR) and the availability of veterinary antimicrobials in these facilities. Qualitative and quantitative data were collected using a structured questionnaire from a total of 108 retail outlets. The study revealed that there is a difficulty to treat infectious diseases of animals because of AMR which is reported by 70 (64.8%) of the respondents. 80.6% of the respondents believe that use of wrong antimicrobial is the possible cause of AMR and 79.6% use of counterfeit or poor quality antimicrobials, and 70.4% owners self-prescription of medicines for their animals. 59 (54.6%) of them also answered poor husbandry practices such as overcrowding, poor hygiene and sanitation, and poor feeding practice are the possible causes of AMR while 8 (7.4%) and 9 (8.3%) of the respondents do not know the reason for the AMR development and possible solutions for AMR containment, respectively. Only 24 (22.2%) of the dispensers have taken training on antimicrobial selection, use, resistance and resistance containment. Even though antimicrobials such as Oxytetracycline are available in around 90% of the retail outlets, only 70 (64.8%) of the retail outlets receive an average of 14 prescriptions (ranging from one to 200) per week from public and private clinics which shows a practice of antimicrobials dispensing without prescription. Therefore, strong mainstreaming strategies to prevent and control AMR should be developed and implemented. Antimicrobials prescription and dispensing practice should also be well regulated to avoid irrational prescription and dispensing practices.