ArticleAntimicrobial resistance and infection control2023
Antibiotic dispensing practices during COVID-19 and implications for antimicrobial resistance (AMR): parallel mystery client studies in Uganda and Tanzania.
Article in Antimicrobial resistance and infection control, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 26 citations in OpenAlex.
- Engaging communities in addressing antimicrobial resistance: Co-producing locally relevant public health messages.PLOS global public health · 2026Article
- Article
- Mortality burden of bacterial antimicrobial resistance in East Africa: pooled analysis of modelled estimates.Tropical medicine and health · 2025Article
- Patterns of antibiotic resistance in urinary tract infections before and during the COVID-19 pandemic in Uganda and Tanzania.JAC-antimicrobial resistance · 2025Article
- National consumption of antimicrobials in Tanzania: 2020-2022.JAC-antimicrobial resistance · 2025Article
- How does the medicines retail sector ensure continued access to medicines during public health emergencies? Lessons from the COVID-19 pandemic in Uganda.Journal of pharmaceutical policy and practice · 2025Article
- Intersecting social and environmental determinants of multidrug-resistant urinary tract infections in East Africa beyond antibiotic use.Nature communications · 2024Article
- Epidemiology and antimicrobial resistance trends of pathogens causing urinary tract infections in Mwanza, Tanzania: A comparative study during and after the implementation of the National Action Plan on Antimicrobial Resistance (2017-2022).International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2024Article
- Etiology and antimicrobial susceptibility patterns of bacteria causing pneumonia among adult patients with signs and symptoms of lower respiratory tract infections during the COVID-19 pandemic in Mwanza, Tanzania: a cross-sectional study.Pneumonia (Nathan Qld.) · 2024Article
- Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications.JAC-antimicrobial resistance · 2024Article
- Treatment seeking and antibiotic use for urinary tract infection symptoms in the time of COVID-19 in Tanzania and Uganda.Journal of global health · 2024Article
- Vaccine uptake, associated factors and reasons for vaccination status among the South African elderly; findings and next steps.PloS one · 2024Article
- Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya.PLOS global public health · 2024Article
- A Narrative Review of Recent Antibiotic Prescribing Practices in Ambulatory Care in Tanzania: Findings and Implications.Medicina (Kaunas, Lithuania) · 2023Review
- Antimicrobial stewardship in private pharmacies in Wakiso district, Uganda: a qualitative study.Journal of pharmaceutical policy and practice · 2023Article
- Leveraging the COVID-19 pandemic as a natural experiment to assess changes in antibiotic use and antibiotic-resistant E. coli carriage in semi-rural Ecuador.Scientific reports · 2023Observational
- Practices and challenges related to antibiotic use in paediatric treatment in hospitals and health centres in Niger and Uganda: a mixed methods study.Antimicrobial resistance and infection control · 2023Article
- Unravelling patient pathways in the context of antibacterial resistance in East Africa.BMC infectious diseases · 2023Article
- Is it possible for drug shops to abide by the formal rules? The structural determinants of community medicine sales in Uganda.BMJ global health · 2023Article
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Authors and funding
18 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundOver-the-counter antibiotic access is common in low-and-middle-income countries and this may accelerate antimicrobial resistance. Our study explores critical aspects of the drug seller-client interaction and antibiotic dispensing patterns for simulated COVID-19 symptoms during the pandemic in two study sites in Tanzania and Uganda, countries with different government responses to the pandemic.
methodsResearch assistants posing as clients approached different types of drug sellers such as pharmacies (Pharms), drug shops (DSs), and accredited drug dispensing outlets (ADDOs) in Mwanza, Tanzania (nPharms = 415, nADDOs = 116) and Mbarara, Uganda (nPharms = 440, nDSs = 67), from June 10 to July 30, 2021. The mystery clients held no prescription and sought advice for simulated COVID-19 symptoms from the drug sellers. They documented the quality of their interaction with sellers and the type of drugs dispensed.
resultsAdherence to COVID-19 preventive measures and vigilance to COVID-19 symptoms was low in both sites but significantly higher in Uganda than in Tanzania. A higher percentage of drug sellers in Mbarara (Pharms = 36%, DSs = 35%, P-value = 0.947) compared to Mwanza (Pharms = 9%, ADDOs = 4%, P-value = 0.112) identified the client's symptoms as possibly COVID-19. More than three-quarters of drug sellers that sold prescription-only medicines in both Mbarara (Pharms = 86%, DSs = 89%) and Mwanza (Pharms = 93%, ADDOs = 97%) did not ask the MCs for a prescription. A relatively high percentage of drug sellers that sold prescription-only medicines in Mwanza (Pharms = 51%, ADDOs = 67%) compared to Mbarara (Pharms = 31%, DSs = 42%) sold a partial course without any hesitation. Of those who sold antibiotics, a higher proportion of drug sellers in Mbarara (Pharms = 73%, DSs = 78%, P-value = 0.580) compared to Mwanza (Pharms = 40% ADDOs = 46%, P-value = 0.537) sold antibiotics relevant for treating secondary bacterial infections in COVID-19 patients.
conclusionOur study highlights low vigilance towards COVID-19 symptoms, widespread propensity to dispense prescription-only antibiotics without a prescription, and to dispense partial doses of antibiotics. This implies that drug dispensing related to COVID-19 may further drive AMR. Our study also highlights the need for more efforts to improve antibiotic stewardship among drug sellers in response to COVID-19 and to prepare them for future health emergencies.
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