Abstract:
BACKGROUND: Provision of pharmaceutical services in accredited drug-dispensing
outlets (ADDOs) in Tanzania has not been reported. This study compared the
antibiotics dispensing practice between ADDOs and part II shops, or duka la dawa
baridi (DLDBs), in Tanzania.
METHODOLOGY: This was a cross-sectional study that was conducted in ADDOs and
DLDBs. A simulated client method for data collection was used, and a total of 85
ADDOs, located in Mvomero, Kilombero, and Morogoro rural districts, were compared
with 60 DLDBs located in Kibaha district. The research assistants posed as
simulated clients and requested to buy antibiotics from ADDOs and DLDBs after
presenting a case scenario or disease condition. Among the diseases presented
were those requiring antibiotics and those usually managed only by oral
rehydration salt or analgesics. The simulated clients wanted to know the
antibiotics that were available at the shop. The posed questions set a convincing
ground to the dispenser either to dispense the antibiotic directly, request a
prescription, or refer the patient to a health facility. Proportions were used to
summarize categorical variables between ADDOs and DLDBs, and the chi-square test
was used to test for statistical difference between the two drug-outlet types in
terms of antibiotic-dispensing practice.
RESULTS: As many as 40% of trained ADDO dispensers no longer worked at the ADDO
shops, so some of the shops employed untrained staff. A larger proportion of
ADDOs than DLDBs dispensed antibiotics without prescriptions (P = 0.004). The
overall results indicate that there was no difference between the two types of
shops in terms of adhering to regulations for dispensing antibiotics. However, in
some circumstances, eg, antibiotic sale without prescription and no referral
made, for complicated cases, ADDOs performed worse than DLDBs. As many as 30% of
DLDBs and 35% of ADDOs dispensed incomplete doses of antibiotics. In both ADDOs
and DLDBs, fortified procaine penicillin powder was dispensed as topical
application for injuries.
CONCLUSION: There was no statistical difference between ADDOs and DLDBs in the
violation of dispensing practice and both ADDOs and DLDBs expressed poor
knowledge of the basic pharmacology of antibiotics.
