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. 2023 Feb 11;12(1):10.
doi: 10.1186/s13756-022-01199-4.

Antibiotic dispensing practices during COVID-19 and implications for antimicrobial resistance (AMR): parallel mystery client studies in Uganda and Tanzania

Emmanuel Olamijuwon #  1 , Eveline Konje #  2 , Catherine Kansiime #  3 , Mike Kesby  4 , Katherine Keenan  4 , Stella Neema  5 , Benon Asiimwe  6 , Stephen E Mshana  7 , Martha F Mushi  7 , Olga Loza  4 , Benjamin Sunday  8 , Alison Sandeman  9 , Derek J Sloan  9 , Fernando Benitez-Paez  4 , Joseph R Mwanga  2 , Wilber Sabiiti  9 , Matthew T G Holden  9 ; CARE Consortium
Collaborators, Affiliations

Antibiotic dispensing practices during COVID-19 and implications for antimicrobial resistance (AMR): parallel mystery client studies in Uganda and Tanzania

Emmanuel Olamijuwon et al. Antimicrob Resist Infect Control. .

Abstract

Background: Over-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.

Methods: Research 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.

Results: Adherence 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.

Conclusion: Our 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.

Keywords: Antimicrobial resistance; COVID-19; Drug sale; Mystery client; Pharmacy; Tanzania; Uganda.

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Conflict of interest statement

The authors and MCs declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Geographic distribution of drug sellers sampled in the survey
Fig. 2
Fig. 2
Explicit and implicit vigilance to COVID-19 and recommendations for managing COVID-19-like symptoms between drug seller types in Mbarara, Uganda and Mwanza, Tanzania
Fig. 3
Fig. 3
Patterns and quality of drug seller-client interaction by the quality of assessment, drug dispensing practices and advice. Note: No.Obj. = drug seller sold a partial course without any objection, Hes. = drug seller hesitated in selling half-course but still sold it
Fig. 4
Fig. 4
Comparison of drug-dispensing practices between pharmacies and drug shops/ADDOs in Tanzania and Uganda. Note: ««—implies that the percentage distribution is based on the total number of drug sellers who sold antibiotics; **—implies that the percentage distribution is based on the total number of drug sellers who suspected COVID-19 and sold antibiotics
See this image and copyright information in PMC

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