Dispensing Antibiotics without Prescription at Community Pharmacies and Accredited Drug Dispensing Outlets in Tanzania: A Cross-Sectional Study
Pendo M. Ndaki,
Martha F. Mushi,
Joseph R. Mwanga,
Eveline T. Konje,
Nyanda E. Ntinginya,
Blandina T. Mmbaga,
Katherine Keenan,
Wilber Sabiiti,
Mike Kesby,
Fernando Benitez-Paez,
Alison Sandeman,
Matthew T. G. Holden,
Stephen E. Mshana,
HATUA Consortium
Affiliations
Pendo M. Ndaki
Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
Martha F. Mushi
Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
Joseph R. Mwanga
Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
Eveline T. Konje
Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
Nyanda E. Ntinginya
Mbeya Centre, National Medical Research Institute, Mbeya P.O. Box 2410, Tanzania
Blandina T. Mmbaga
Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi P.O. Box 2236, Tanzania
Katherine Keenan
Geography and Sustainable Development Department, University of St. Andrews, St. Andrews KY16 9AL, UK
Wilber Sabiiti
Division of Infection and Global Health, School of Medicine, University of St. Andrews, St. Andrews KY16 9AL, UK
Mike Kesby
Geography and Sustainable Development Department, University of St. Andrews, St. Andrews KY16 9AL, UK
Fernando Benitez-Paez
Geography and Sustainable Development Department, University of St. Andrews, St. Andrews KY16 9AL, UK
Alison Sandeman
Division of Infection and Global Health, School of Medicine, University of St. Andrews, St. Andrews KY16 9AL, UK
Matthew T. G. Holden
Division of Infection and Global Health, School of Medicine, University of St. Andrews, St. Andrews KY16 9AL, UK
Stephen E. Mshana
Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania
Worldwide, antimicrobial resistance is increasing rapidly and is associated with misuse of antimicrobials. The HATUA study (a broader 3-country study) investigated the antibiotic dispensing practices of pharmaceutical providers to clients, particularly the propensity to dispense without prescription. A cross-sectional study using a ‘mystery client’ method was conducted in 1148 community pharmacies and accredited drugs dispensing outlets (ADDO) in Mwanza (n = 612), Mbeya (n = 304) and Kilimanjaro (n = 232) in Tanzania. Mystery clients asked directly for amoxicillin, had no prescription to present, did not discuss symptoms unless asked [when asked reported UTI-like symptoms] and attempted to buy a half course. Dispensing of amoxicillin without prescription was common [88.2, 95%CI 86.3–89.9%], across all three regions. Furthermore, the majority of outlets sold a half course of amoxicillin without prescription: Mwanza (98%), Mbeya (99%) and Kilimanjaro (98%). Generally, most providers in all three regions dispensed amoxicillin on demand, without asking the client any questions, with significant variations among regions [p-value = 0.003]. In Mbeya and Kilimanjaro, providers in ADDOs were more likely to do this than those in pharmacies but no difference was observed in Mwanza. While the Tanzanian government has laws, regulations and guidelines that prohibit antibiotic dispensing without prescription, our study suggests non-compliance by drug providers. Enforcement, surveillance, and the provision of continuing education on dispensing practices is recommended, particularly for ADDO providers.
