ArticleBMJ public health2026
Prevalence, patterns and factors associated with over-the-counter antibiotic purchase: a cross-sectional study in private pharmacies in Montserrado County, Liberia.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Antibiotics are prescription-only medicines, but their over-the-counter (OTC) purchase is common in low-income countries such as Liberia. Private pharmacies are an important source for OTC purchases. This study investigates the prevalence, patterns and factors affecting the OTC purchase of antibiotics from private retail pharmacies in Liberia. Methods: 14 private pharmacies were selected through stratified random sampling in Montserrado County, Liberia, for the cross-sectional study conducted in 2023. Exit interviews were conducted among adult clients who consented and purchased antibiotics using a validated, semi-structured questionnaire. The demographic information, prescription availability, antibiotic use and antibiotic resistance (AR) knowledge were recorded. The Access, Watch and Reserve classifications were employed. Results: Of 600 clients approached, 584 (97%) purchased antibiotics, while 96% (562/584) purchased without-prescription. Access and Watch categories accounted for 56% (313/562) and 33% (183/562) OTC purchases, respectively. Most participants (465/584, 80%) had low awareness of AR. Previous experience with an antibiotic was the most common reason for OTC purchase (38%). Keeping antibiotics as reserve medicine (adjusted OR (aOR)=2.2, 95% CI 1.1 to 4.8), no information about AR (aOR=4.4, 95% CI 2.08 to 9.60) and affordability of purchasing antibiotics without-prescription instead of with-prescription (no doctor visit, aOR=3.2, 95% CI 1.5 to 6.6) showed a significant association with OTC purchases. Conclusion: A majority of the clients in Montserrado County purchased antibiotics without a prescription. Watch antibiotics, labelled as reserved for health facilities, accounted for one-third of total OTC purchases. Low awareness of AR and purchasing antibiotics based on prior experiences were prevalent. OTC purchases were significantly associated with antibiotic affordability, awareness level and the preservation of antibiotics for future use. Our study underlines an urgent need for implementing community-focused and pharmacy-focused antibiotic stewardship with contextual mass awareness campaigns on AR and microbial diseases and regular surveillance to rationalise antibiotic use in the community.
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