Exploring the drivers of unprescribed antibiotics dispensing in community drug outlets in Dodoma Region, Central Tanzania: a cross-sectional study

Abstract

Background: Community drug outlets have primarily been associated with the unregulated sale of antibiotics, accelerating the development and spread of antibiotic resistance.  

Broad objective: This study aimed to determine the drivers and trends of unprescribed antibiotic dispensing in community drug outlets in Central Tanzania.

Methodology: This was a cross-sectional study in which 643 drug purchases were recorded in Chamba District Council (rural) and Dodoma City Council (urban) from March to June 2021. Data was collected using KoBo Collect software and analyzed by R statistical software using antibiotic dispensing as an outcome variable. Multivariate analyses were performed to determine the independent effect of variables on antibiotic dispensing.

Results: Of the 643 drug purchases recorded, 84.14 % (541/643) were in Dodoma City Council (urban), 50.3 % (324/643) were made by female clients, while only 24.88% (160/643) purchased antibiotics. Most antibiotics (75%; 120/160) were purchased and dispensed without prescriptions. Accredited Drug Dispensing Outlets (ADDO) and community pharmacies were the two types of drug stores visited in this study. Most antibiotics (86.3%; 138/160) were dispensed in ADDO beyond jurisdiction. Amoxicillin, ampicillin and cloxacillin fixed drug combination, azithromycin, Ciprofloxacin and doxycycline accounted for over 70% of the antibiotics dispensed. Compared to other diseases complaints, the odds of antibiotic dispensing for runny nose decreased by 11% (aOR=0.89;95%CI:0.81-0.98; p=0.024) and increased by 1.29 (aOR=1.29;95%CI:1.18-1.41; p<0.001), 1.31 (aOR=1.31;95%CI:1.11-1.54; p=0.001), 1.18 (aOR=1.18;95%CI:1.08-1.30; p<0.001) and 2 (aOR=2.01;95%CI: 1.75-2.31; p<0.001) times for cough, sore throat, fever and urinary tract complains respectively.

Conclusion: There are high levels of unprescribed antibiotic dispensing by accredited drug dispensers in ADDO. The majority of the antibiotics dispensed were well beyond those stipulated in the allowable ADDO medicines dispensing list. Upper respiratory and urinary tract infection symptoms accounted for most of the antibiotic dispensing in these settings.

Recommendations: Tailored community antibiotic stewardship campaigns among drug dispensers and the community at large, as well as more stringent law enforcement mechanisms, are inevitable in mitigating the overuse and/or misuse of antibiotics in community drug outlets.