Abstract:
Background: Studies indicate that antibiotics are sold against regulation and without prescription in private
drugstores in rural Tanzania. The objective of the study was to explore and describe antibiotics sale and dispensing
practices and link it to drugseller knowledge and perceptions of antibiotics and antibiotic resistance.
Methods: Exit customers of private drugstores in eight districts were interviewed about the drugstore encounter
and drugs bought. Drugsellers filled in a questionnaire with closed- and open-ended questions about antibiotics
and resistance. Data were analyzed using mixed quantitative and qualitative methods.
Results: Of 350 interviewed exit customers, 24% had bought antibiotics. Thirty percent had seen a health worker
before coming and almost all of these had a prescription. Antibiotics were dispensed mainly for cough,
stomachache, genital complaints and diarrhea but not for malaria or headache. Dispensed drugs were assessed as
relevant for the symptoms or disease presented in 83% of all cases and 51% for antibiotics specifically. Nonprescribed
drugs were assessed as more relevant than the prescribed. The knowledge level of the drugseller was
ranked as high or very high by 75% of the respondents. Seventy-five drugsellers from three districts participated.
Seventy-nine percent stated that diseases caused by bacteria can be treated with antibiotics but 24% of these also
said that antibiotics can be used for treating viral disease. Most (85%) said that STI can be treated with antibiotics
while 1% said the same about headache, 4% general weakness and 3% ‘all diseases’. Seventy-two percent had
heard of antibiotic resistance. When describing what an antibiotic is, the respondents used six different kinds of
keywords. Descriptions of what antibiotic resistance is and how it occurs were quite rational from a biomedical
point of view with some exceptions. They gave rise to five categories and one theme: Perceiving antibiotic
resistance based on practical experience.
Conclusions: The drugsellers have considerable “practical knowledge” of antibiotics and a perception of antibiotic
resistance based on practical experience. In the process of upgrading private drugstores and formalizing the sale of
antibiotics from these outlets in resource-constrained settings, their “practical knowledge” as well as their
perceptions must be taken into account in order to attain rational dispensing practices.
