Antimicrobial Use and Management of Childhood Diarrhea at Community Drug Retail Outlets in Eastern Ethiopia: A Matched Questionnaire-Based and Simulated Patient-Case Study

Abstract

Introduction

Antimicrobial agents have saved millions of lives worldwide. However, inappropriate use has become a global concern leading to the emergence and spread of antimicrobial resistance (AMR). In this regard, the dispensing practices of pharmacy professionals in the community drug retail outlets (CDROs) plays a central role. Therefore, this study was aimed to assess the knowledge and dispensing practices of pharmacy professionals in the management of childhood diarrhea in CDROs of Eastern Ethiopia.

Methods

A community based cross-sectional study was conducted in 100 randomly selected CDROs in Eastern Ethiopia from 1 August to 30 September 2020. Data were collected with a structured questionnaire matched with a simulated patient case. Descriptive statistics were employed to summarize variables. Cohen’s Kappa was analyzed to measure the degree of agreement between questionnaire-based and simulated patient-based methods. Binary logistic regression analysis was conducted to determine factors associated with inappropriate dispensing practice.

Results

Majority of the participants were aged 25–34 years (median: 29 years). High proportion of them were male (65%) and had work experiences of two or more years. Majority (61%) of the professionals were knowledgeable about AMR. Out of 2886 scores, 745 scores were agreed on Cohen’s Kappa interrater agreement scale with the overall percent agreement between the two methods being 26.0%. Besides, about 67% of dispensing practices to the simulated patient case was found inappropriate. On the multivariate analysis, insufficient knowledge of retailers on AMR was significantly associated with the inappropriate dispensing of antimicrobial agents.

Conclusion

A considerable proportion of retailers had insufficient knowledge regarding the emergence and spread of AMR. Only a quarter of their questionnaire-based knowledge response agreed with simulated-patient-based actual practice, indicating weak agreement between the two methods and high level of inappropriate practice. Besides, insufficient knowledge of retailers was significantly associated with their inappropriate dispensing of antimicrobials.

Keywords:

• diarrhea
• pediatrics
• antimicrobial use
• CDROs
• Ethiopia

Data Sharing Statement

All the data used for the study are contained within the paper.

Ethics Approval and Consent to Participate

This study was conducted following the Declaration of Helsinki. Before starting data collection and preliminary study, the investigating team obtained a formal letter of ethical approval from the Institutional Health Research Ethics Review Committee of College of Health and Medical Sciences, Haramaya University (letter’s reference number: IHRERC/100/2019). A letter of support, written from the College of Health and Medical Sciences to Regional Health Bureaus and health facilities, was delivered to the study settings prior to initiation of the study. Relevant information about the study was highlighted to the respondents about the purposes and procedures, potential risk and benefits of the study. In this respect, participation in the study was ensured voluntary and participants were told to have the right to withdraw from the study without giving justification, and all responses were kept confidential. Verbal informed consent was approved by the Institutional Health Research Ethics Review Committee of College of Health and Medical Sciences, Haramaya University.

Acknowledgment

The authors thank data collectors and staff of all healthcare settings for their substantial help to realize this research work. The authors also extend their thank to Haramaya University for granting this research work.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors have declared that no competing interests exist.

Additional information

Funding

The authors disclosed reception of financial support from Haramaya University for conducting this research work.