What motivates antibiotic dispensing in accredited drug dispensing outlets in Tanzania? A qualitative study
View/ Open
Author
Dillip, Angel
Embrey, Martha
Shekalaghe, Elizabeth
Kimatta, Suleiman
Liana, Jafary
Rutta, Edmund
Valimba, Richard
Chalker, John
Published Version
https://doi.org/10.1186/s13756-015-0073-4Metadata
Show full item recordCitation
Dillip, Angel, Martha Embrey, Elizabeth Shekalaghe, Dennis Ross-Degnan, Catherine Vialle-Valentin, Suleiman Kimatta, Jafary Liana, Edmund Rutta, Richard Valimba, and John Chalker. 2015. “What motivates antibiotic dispensing in accredited drug dispensing outlets in Tanzania? A qualitative study.” Antimicrobial Resistance and Infection Control 4 (1): 30. doi:10.1186/s13756-015-0073-4. http://dx.doi.org/10.1186/s13756-015-0073-4.Abstract
Background: Tanzania introduced the accredited drug dispensing outlet (ADDO) program more than a decade ago. Previous evaluations have generally shown that ADDOs meet defined standards of practice better than non-accredited outlets. However, ADDOs still face challenges with overuse of antibiotics for acute respiratory infections (ARI) and simple diarrhea, which contributes to the emergence of drug resistance. This study aimed to explore the attitudes of ADDO owners and dispensers toward antibiotic dispensing and to learn how accreditation has influenced their dispensing behavior. Methods: The study used a qualitative approach. We conducted in-depth interviews with ADDO owners and dispensers in Ruvuma and Tanga regions where the government implemented the ADDO program under centralized and decentralized approaches, respectively; a secondary aim was to compare differences between the two regions. Results: Findings indicate that the ADDO program has brought about positive changes in knowledge of dispensing practices. Respondents were able to correctly explain treatment guidelines for ARI and diarrhea. Almost all dispensers and owners indicated that unnecessary use of antibiotics contributed to antimicrobial resistance. Despite this knowledge, translating it to appropriate dispensing practice is still low. Dispensers’ behavior is driven by customer demand, habit (“mazoea”), following inappropriate health facility prescriptions, and the need to make a profit. Although the majority of dispensers reported that they had intervened in situations where customers asked for antibiotics unnecessarily, they tended to give in to clients’ requests. Small variations were noted between the two study regions; for example, some dispensers in Ruvuma reported sending clients with incorrect prescriptions back to the health facility, a practice that may reflect regional differences in ADDO implementation and in Integrated Management of Childhood Illness training. Dispensers in rural settings reported more challenges in managing ARI and diarrhea than their urban counterparts did. Conclusion: To reduce inappropriate antibiotic use, integrated interventions must include communities, health facilities, and ADDOs. Periodic refresher training with an emphasis on communication skills is crucial in helping dispensers deal with customers who demand antibiotics. Responsible authorities should ensure that ADDOs always have the necessary tools and resources available.Other Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509560/pdf/Terms of Use
This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAACitable link to this page
http://nrs.harvard.edu/urn-3:HUL.InstRepos:17820936
Collections
- HMS Scholarly Articles [17922]
Contact administrator regarding this item (to report mistakes or request changes)