Evidence map›Paper›PMID 36402956›Full record

ArticleBMC primary care2022

Non-prescribed antibiotic dispensing practices for symptoms of urinary tract infection in community pharmacies and accredited drug dispensing outlets in Tanzania: a simulated clients approach.

Pendo M Ndaki, Martha F Mushi, Joseph R Mwanga, Eveline T Konje, Stella Mugassa, Msilikale W Manyiri, Stanley M Mwita, Nyanda E Ntinginya, Blandina T Mmbaga, Katherine Keenan and 6 more

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In one paragraph

Article in BMC primary care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Pendo M NdakiDepartment of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
Martha F MushiDepartment of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
Joseph R MwangaDepartment of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania. joseph.mwanga@bugando.ac.tz.
Eveline T KonjeDepartment of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
Stella MugassaDepartment of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
Msilikale W ManyiriDepartment of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
Stanley M MwitaSchool of Pharmacy, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.
Nyanda E NtinginyaNational Institute for Medical Research, Mbeya Medical Research Centre, P.O. Box 2410, Mbeya, Tanzania.
Blandina T MmbagaKilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical University College, P.O. Box 2236, Moshi, Tanzania.
Katherine KeenanGeography and Sustainable Development, University of St Andrews, North Street, St Andrews, KY16 9AL, UK.
Wilber SabiitiDivision of Infection and Global Health, School of Medicine, University of St Andrews, North Street, St Andrews, KY16 9AL, UK.
Mike KesbyGeography and Sustainable Development, University of St Andrews, North Street, St Andrews, KY16 9AL, UK.
Fernando Benitez-PaezGeography and Sustainable Development, University of St Andrews, North Street, St Andrews, KY16 9AL, UK.
Alison SandemanDivision of Infection and Global Health, School of Medicine, University of St Andrews, North Street, St Andrews, KY16 9AL, UK.
Matthew T G HoldenDivision of Infection and Global Health, School of Medicine, University of St Andrews, North Street, St Andrews, KY16 9AL, UK.
Stephen E MshanaDepartment of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania.

Funding

Medical Research Council MR/S004785/1
6 · The paper itself

Abstract

backgroundAntibiotic dispensing without prescription is a major determinant of the emergence of Antimicrobial Resistance (AMR) which has impact on population health and cost of healthcare delivery. This study used simulated clients describing UTI like symptoms to explore compliance with regulation, variations in dispensing practices and drug recommendation, and quality of seller-client interaction on the basis of the gender of the client and the type of drug outlets in three regions in Tanzania.

methodA total of 672 Accredited Drug Dispensing Outlets (ADDOs) and community pharmacies were visited by mystery clients (MCs). The study was conducted in three regions of Tanzania namely Kilimanjaro (180, 26.79%), Mbeya (169, 25.15%) and Mwanza (323, 48.07%) in March-May 2020. During data collection, information was captured using epicollect5 software before being analyzed using Stata version 13.

resultsOverall, 89.43% (CI: 86.87-91.55%) of drug sellers recommended antibiotics to clients who described UTI like symptoms but held no prescription and 58.93% were willing to sell less than the minimum recommended course. Female clients were more likely than male to be asked if they were taking other medications (27.2% vs 9.8%), or had seen a doctor (27.8% vs 14.7%), and more likely to be advised to consult a doctor (21.6% vs 9.0%); pharmacies addressed these issues more often than ADDOs (17.7% vs 13.2, 23.9% vs 16.6%, 17.7 vs 10.9% respectively). Sellers recommended 32 different drugs to treat the same set of symptoms, only 7 appear in the Tanzanian Standard Treatment Guidelines as recommended for UTI and 30% were 2nd and 3rd line drugs. ADDO sellers recommended 31 drug types (including 2nd and 3rd line) but had permission to stock only 3 (1st line) drugs. The most commonly suggested antibiotics were Azithromycin (35.4%) and ciprofloxacin (20.5%). Azithromycin was suggested more often in pharmacies (40.8%) than in ADDOs (34.4%) and more often to male clients (36.0%) than female (33.1%).

conclusionThese findings support the need for urgent action to ensure existing regulations are adhered to and to promote the continuing professional development of drug sellers at all outlet levels to ensure compliance with regulation, high quality service and better antibiotic stewardship.

Indexed as

PharmaciesUrinary Tract InfectionsAnti-Bacterial AgentsAzithromycinCross-Sectional StudiesFemaleHumansMalePharmaceutical PreparationsTanzaniaAnti-Bacterial AgentsAzithromycinPharmaceutical PreparationsAntibioticAntibiotic resistanceDispensing practicePrescription

Identifiers

PMID36402956
PMCPMC9675131

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.