Selling antibiotics without prescriptions among community pharmacies and drug outlets: a simulated client study from Ghana

ABSTRACT

Background

Selling antibiotics without prescriptions is mostly illegal worldwide, including in Ghana, and promotes antimicrobial resistance. We evaluated the prevalence and practice of selling antibiotics without prescriptions among community pharmacies (CPs) and drug outlets, for the first time, in Ghana to quantify and characterize this issue to inform future interventions.

Research design and methods

Two scenarios utilizing the Simulated Client Methodology were enacted: an upper respiratory tract infection of viral origin (scenario one); and pediatric diarrhea (scenario two). CPs/Outlets were selected by stratified proportional random sampling from four metropolitan cities (~14% of the total Ghanaian population). Selling of antibiotics was assessed at three demand levels and its overall prevalence was estimated, then stratified by the study variables.

Results

Out of the 265 sampled CPs/outlets, the prevalence of selling antibiotic without prescription was 88.3% (n = 234/265), with variations not only across the four regions [92.5% (n = 123/133) in Kumasi, 87.5% (n = 14/16) in Cape Coast, 84.1% (n = 69/82) in Accra, and 82.4% (n = 28/34) in Tamale] but also across CPs [90% (n = 121/134)] and drug outlets [86% (n = 113/131)].

Conclusions

A very high prevalence/sub-optimal practice of selling antibiotics without prescriptions was found. This highlights the need to increase compliance with antibiotic dispensing legislation through evidence-based interventions including education of key stakeholders.

KEYWORDS:

• Antimicrobial resistance; antibiotic self-purchasing
• OTC antibiotic sale-
• community drug outlets
• Ghana
• illegal antibiotic sales
• health policy
• simulated client

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors wish to thank the simulated clients, Pharm Theresa Acolatse, and Pharm Joseph Gyewu for their roles in the study. We also wish to thank the management of the Cape Coast Teaching Hospital for their support in implementing this project and the Pharmacy Council of Ghana for providing the necessary support to conduct this study. This work has not been previously presented as an abstract at a conference or similar forum.

Author contribution statement

Study conception and design: all authors; data collection and management: JA (Joseph Acolatse), GA (George Akafity), RI (Robert Incoom), AR (Audu Rauf); data analysis and interpretation: AK (Amanj Kurdi), JA, AS (Andrew Seaton), JS (Jacqueline Sneddon), EC (Elaine Cameron), MW (Margaret Watson), MWat (Marta Wanat), BG (Brian Godman); manuscript writing and drafting: JA, EN (Eric Kofi Ngyedu); manuscript reviewing and revising as well as providing constructive criticism and final approval: all authors. All authors have substantially contributed to the conception and design of the article and interpreting the relevant literature, and have been involved in writing the article or revised it for intellectual content.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2023.2283037

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This manuscript was funded by the International Society of Antimicrobial Chemotherapy Small Project Grant.