Francis Wafula
Background: Specialized drug shops (SDSs) provide quick and convenient access to medicines in developing countries such as Kenya and are often the first point of call for common illnesses. Policymakers are increasingly looking for ways of including them in the provision of health services. However, concerns still linger over the quality of services SDSs offer.
Objectives: This study set out to describe the availability of antimalarials and antibiotics in rural and urban SDSs, and explore the factors that influence the dispensing practices of attendants.
Methods: The study was conducted in SDSs in 2 Kenyan districts: Bungoma South and Kakamega Central. The study had 3 data collection activities: a census to generate a list of SDSs; a provider survey to describe the availability of antimalarials and antibiotics, and characteristics of dispensers; and a mystery shopper survey to describe the dispensing practices of SDS attendants.
Results: Data were collected from 213 SDSs. The availability of most antimalarials and antibiotics was high, with TB medicines and artemisinin monotherapy treatments being the least available. Nearly all SDSs dispensed partial doses of amoxicillin without prescription, with only one quarter asking about additional symptoms, or advising against partial doses. Rural SDSs had a higher likelihood of dispensing without prescription (p<0.001), with urban pharmacies being more likely to ask about additional symptoms or advise against partial doses (p<0.001 for both). Attendants were less likely to sell ACT treatments without prescription, compared to amoxicillin, although they were also less likely to advise against buying incomplete doses. Over half of SDSs sold an ACT that had been obtained illegally from the public sector. Multivariate analysis showed recent regulatory inspection and presence of staff with pharmacy qualification to have no association with quality of dispensing practices.
Conclusions: The study highlighted the problem of inappropriate medicine use within communities. Indiscriminate dispensing habituates poor medicine use practices, which can result in the development and spread of resistance. Policy should focus on strengthening regulatory enforcement, in combination with education for dispensers, and promotion of public awareness. More research is required to describe in-depth, reasons underlying the dispensing practices observed, and how they can be improved to strengthen the role of retailers in provision of antimalarials and antibiotics within rural communities.
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