Practice of over-the-counter dispensary of antibiotics for childhood illnesses in Addis Ababa, Ethiopia: a simulated patient encounter study

Koji, Eyosait Mekonnen; Gebretekle, Gebremedhin Beedemariam; Tekle, Tinsae Alemayehu

doi:10.1186/s13756-019-0571-x

Cited by 41Antibiotic Use and ResistancePharmacy and Medical PracticesPharmaceutical industry and healthcare

Practice of over-the-counter dispensary of antibiotics for childhood illnesses in Addis Ababa, Ethiopia: a simulated patient encounter study

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Koji, Eyosait Mekonnen, Gebretekle, Gebremedhin Beedemariam, Tekle, Tinsae Alemayehu·2019·Antimicrobial Resistance & Infection Control

DOI 10.1186/s13756-019-0571-xPMC PMC6636089

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Abstract

Background: Dispensary and use of antibiotics without prescriptions from qualified providers is a common practice in countries with poor pharmaceutical regulations and where due focus is not given to rational use. This practice is a main factor for the spread of antimicrobial resistance due to its non-reliance on pre-treatment microbiologic work-up, improper indications and dosing errors. This study was conducted to determine the rate of over-the-counter dispensary of antibiotics for common childhood illnesses among privately owned medicine retail outlets in Addis Ababa, Ethiopia. Methods: Pre-determined simulated patient visits depicting common childhood illnesses were employed to request antibiotics without prescriptions. A simple random sampling was used to select medicine retail outlets within Addis Ababa city. Trained data collectors filled structured data forms (including antibiotic requested, reasons for denial of dispense and details enquired by pharmacist) shortly after each patient enactment. Multi-variable logistic regression analysis was employed to explore factors associated with over-the-counter sales of antibiotics. Results: A total of 262 simulated encounters were surveyed. Of the 262 verbal antibiotic requests, 63.4% were dispensed. Close to 60% of encounters were accompanied by questions about a doctor's visit or the child's symptomatology while a past history of drug allergies was enquired in only 11.1% of visits. Over-the-counter dispensary was more likely when dispenser queried about symptoms was made (AOR: 2.412, 95%CI: 1.236, 4.706), for requests for more than one antibiotics (AOR: 2.988, 95%CI: 1.258, 7.095) and for simulated patient demands for oral antibiotics for children with acute diarrhea (AOR: 3.297, 95%CI: 1.248, 8.712) and parenteral antibiotics for those reported to receive in-patient care for pneumonia (4.516, 95% CI: 1.720, 11.857). Conclusions: The prevalence of providing antibiotics over-the-counter for pediatric illnesses in Addis Ababa is markedly high. Further studies into factors encouraging this malpractice are required. Enhancing education of personnel dispensing antibiotics and strict enforcement of national regulations are needed.

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Non-prescription sale of antibiotics is profoundly common practice in LMICs, as demonstrated by the high prevalence of the practice identified in simulated clients and questionnaire-based surveys.
“The non-prescription sale of antibiotics is profoundly common practice in LMICs as demonstrated by the high prevalence of the practice identified in simulated clients and questionnaire based surveys [16, 17, 22–33].”
From 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 (2021) · cites this paper as [27]

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Additional file 1 of Non-prescription dispensing of antibiotic agents among community drug retail outlets in Sub-Saharan African countries: a systematic review and meta-analysis
Belachew, S. A., Hall, L., & Selvey, L. A. (2021) · Figshare · doi:10.6084/m9.figshare.13578729
Additional file 1 of 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
Belachew, S. A., Hall, L., Erku, D., & Selvey, L. A. (2021) · Figshare · doi:10.6084/m9.figshare.14728678
Additional file 2 of Non-prescription dispensing of antibiotic agents among community drug retail outlets in Sub-Saharan African countries: a systematic review and meta-analysis
Belachew, S. A., Hall, L., & Selvey, L. A. (2021) · Figshare · doi:10.6084/m9.figshare.13578732
Additional file 1 of Community drug retail outlet staff’s knowledge, attitudes and practices towards non-prescription antibiotics use and antibiotic resistance in the Amhara region, Ethiopia with a focus on non-urban towns
Belachew, S. A., Hall, L., & Selvey, L. A. (2022) · Figshare · doi:10.6084/m9.figshare.19687387
Additional file 2 of Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis
Edessa, D., Assefa, N., Dessie, Y., Asefa, F., Dinsa, G., & Oljira, L. (2022) · Figshare · doi:10.6084/m9.figshare.21256636
Additional file 2 of Community drug retail outlet staff’s knowledge, attitudes and practices towards non-prescription antibiotics use and antibiotic resistance in the Amhara region, Ethiopia with a focus on non-urban towns
Belachew, S. A., Hall, L., & Selvey, L. A. (2022) · Figshare · doi:10.6084/m9.figshare.19687390
Additional file 4 of Non-prescription dispensing of antibiotic agents among community drug retail outlets in Sub-Saharan African countries: a systematic review and meta-analysis
Belachew, S. A., Hall, L., & Selvey, L. A. (2021) · Figshare · doi:10.6084/m9.figshare.13578738
Additional file 3 of Non-prescription dispensing of antibiotic agents among community drug retail outlets in Sub-Saharan African countries: a systematic review and meta-analysis
Belachew, S. A., Hall, L., & Selvey, L. A. (2021) · Figshare · doi:10.6084/m9.figshare.13578735
Additional file 3 of Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis
Edessa, D., Assefa, N., Dessie, Y., Asefa, F., Dinsa, G. D., & Oljira, L. (2022) · Figshare · doi:10.6084/m9.figshare.21256639
Additional file 1 of Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis
Edessa, D., Assefa, N., Dessie, Y., Asefa, F., Dinsa, G., & Oljira, L. (2022) · Figshare · doi:10.6084/m9.figshare.21256633
Additional file 2 of 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
Belachew, S. A., Hall, L., Erku, D., & Selvey, L. A. (2021) · Figshare · doi:10.6084/m9.figshare.14728681
Additional file 1 of “Handing out non-prescribed antibiotics is storing up trouble for the next generation!” Unpacking multistakeholder views of drivers and potential solutions in Ethiopia
Belachew, S. A., Hall, L., & Selvey, L. A. (2023) · Figshare · doi:10.6084/m9.figshare.23902936
Additional file 1 of Antimicrobial dispensing process in community pharmacies: a scoping review
de Souza, E. V., Vieira, L. J. S. C., dos Santos, S. N. P., Cerqueira‐Santos, S., Rocha, K. S. S., & de Lyra, D. P. (2022) · Figshare · doi:10.6084/m9.figshare.21152945
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Additional file 1: of Practice of over-the-counter dispensary of antibiotics for childhood illnesses in Addis Ababa, Ethiopia: a simulated patient encounter study
Koji, E. M., Gebretekle, G. B., & Tekle, T. A. (2019) · Figshare · doi:10.6084/m9.figshare.8940866
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Authors: Koji, E. M., Gebretekle, G. B., & Tekle, T. A.
Affiliations: Addis Ababa University (ET)
Corresponding author: Tekle, Tinsae Alemayehu
ORCID: Gebretekle, Gebremedhin Beedemariam
Venue: Antimicrobial Resistance & Infection Control
Publisher: Springer Science and Business Media LLC
Published: 2019-07-16
Volume: 8
Issue: 1
Pages: 119-119
ISSN: 2047-2994 (ISSN-L)
DOI: 10.1186/s13756-019-0571-x
PMC: PMC6636089
OpenAlex: W2958714699
Cited by: 41
References: 13
Citations by year: 2026: 2 · 2025: 3 · 2024: 3 · 2023: 6 · 2022: 12 · 2021: 10 · 2020: 5
FWCI: 4.39
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (tdm)
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Antimicrobial Resistance and Infection Control (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Addis Ababa University
Topics: Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmaceutical industry and healthcare
Keywords: antibiotics, childhood diseases, antibiotic misuse, antimicrobial resistance, simulated patient encounters, pharmacist dispensing, acute diarrhea, pneumonia, rational antibiotic use, Addis Ababa
MeSH terms: Anti-Bacterial Agents, Child, Computer Simulation, Cross-Sectional Studies, Diarrhea, Nonprescription Drugs, Ethiopia, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Pharmacies, Pharmacists, Prospective Studies, Private Sector, Prescriptions

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Practice of over-the-counter dispensary of antibiotics for childhood illnesses in Addis Ababa, Ethiopia: a simulated patient encounter study

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