Request for Antimalarial Medicines and Their Dispensing Without a Prescription in Community Pharmacies in Rwanda

Figures & data

Table 1 Demographic Characteristics of Community Pharmacists and Pharmacies (n=235)

Variables	Number	Percent
Gender
Male	171	72.8
Female	64	27.2
Age
20–30 years	126	53.6
31–40 years	77	32.8
41–50 years	10	4.3
Prefer not to say	22	9.4
Education
Bachelor’s degree	217	92.8
Master’s degree	18	7.7
Marital status
Single	138	58.7
Married	97	41.3
Year of graduation
2005–2010	8	3.4
2011–2015	48	20.4
2016–2021	179	76.2
Ownership of pharmacy
Owner	47	20
Employee	188	80
Location of pharmacy
Kigali city	129	54.9
Southern Province	34	14.5
Northern Province	25	10.6
Western Province	21	8.9
Eastern Province	26	11
Professional experience in community pharmacy
1–5 years	169	71.9
6–10 years	53	22.6
11–15 years	9	3.8
16 years and above	4	1.7
Availability of Nurse in the pharmacy
Yes	213	90.6
No	22	9.4

Table 2 Request and Dispensing of Antimalarial Medicines Without a Prescription (n=235)

Variables	Number	Percent
Availability of ACTs during the day of the visit
Yes	228	97
No	7	3
Request for dispensing ACTs without a prescription
Yes	208	88.5
No	27	11.5
Dispensing of ACTs without a prescription
Yes	127	54
No	108	46
Frequency of request for dispensing ACTs without a prescription per week
Less than once a week	17	7.2
Once or twice a week	71	30.2
Three or more times a week	120	51.1
Not requested during last week	27	11.5
Frequency of dispensing antimalarial without a prescription per week
1 time	27	21.1
2–3 times	61	47.2
4–5 times	24	17.9
More than 5 times	15	13.1
Never dispensed antimalarials without prescription	108	46
Type of antimalarial medicine requested without a prescription
Artemether + Lumefantrine	208	88.5
None requested without prescription	27	11.5

Abbreviation: ACTs, Artemisinin-based combination therapy.

Table 3 Symptoms of Malaria (n=235)

Symptom	Yes		No
	Number	Percent	Number	Percent
Fever	225	95.7	10	4.3
Headache	176	74.9	59	25.1
Body weakness	150	63.8	85	36.2
Vomiting	83	35.3	152	64.7
Chills	69	29.4	166	70.6
Loss of appetite	62	26.4	173	73.6
Nausea	63	26.8	172	73.2
Muscle/joint Pain	55	23.4	180	76.6
Night Sweat	23	9.8	212	90.2
Dizziness	14	6.0	221	94.0
Diarrhoea	7	3.0	228	97.0
Anorexia	7	3.0	228	97.0

Table 4 Perceptions of Community Pharmacists on Prescription Status of Antimalarial Medicines (n=235)

Prescription Status of Antimalarial Medicines in Rwanda	Number	Percent
Prefer not to say	20	8.5
Over-the-counter medicine	17	7.2
A prescription medicine but often dispensed without a prescription	149	63.4
A prescription medicine and always dispensed on a prescription	49	20.9
Level of problem to dispense antimalarial without malaria confirmation
Not a problem	11	4.7
Minor problem	20	8.5
Moderate problem	48	20.4
Serious problem	156	66.4
Should antimalarial be dispensed only after a positive diagnostic test?
Yes	204	86.8
No	31	13.2

Table 5 Bivariate Logistic for Associated Factors of Dispensing Antimalarial Without Prescription (n=127)

Variables	Dispensing of Antimalarial Medicine Without a Prescription		95% Confidence Intervals
	Yes		OR	Lower	Upper	p-value
Gender	Number	Percent
Male	90	70.9	1
Female	37	29.1	1.03	0.57	1.86	0.919
Age
20–30 years	126	53.6	1			0.8
31–40 years	77	32.8	1.01	0.41	2.51	0.985
41–50 years	10	4.3	0.86	0.33	2.21	0.747
Education level
Bachelor	117	921.1	1
Master	10	7.9	0.89	0.34	2.33	0.805
Academic year for graduation
2005-2010	3	2.4	1			0.49
2011-2015	23	18.1	0.49	0.11	2.09	0.332
2016-2021	101	79.5	0.68	0.36	1.3	0.244
Pharmacy owner
No	103	81.1	1
Yes	24	18.9	1.21	0.64	2.3	0.557
Location of pharmacy
Kigali	69	54.3	1			0.561
East	15	11.8	1.26	0.54	2.96	0.592
West	11	8.7	1.02	0.4	2.56	0.97
North	10	7.9	0.62	0.26	1.48	0.277
South	22	17.3	1.5	0.69	3.24	0.308
Experience
1–5 years	96	75.6	1			0.289
6–10 years	25	19.7	0.66	0.36	1.23	0.19
11–15 years	3	2.4	0.4	0.1	1.65	0.204
16 years and above	3	2.4	2.39	0.24	23.48	0.454
Availability of nurse in the pharmacy
No	13	10.2	1
Yes	114	89.8	0.75	0.31	1.84	0.534
Availability of antimalarials
No	3	2.4	1
Yes	124	97.6	1.51	0.33	6.89	0.596
Knowledge on prescription status
Prefer not to say	15	11.8	1			<0.001*
Over-the-counter medicine	12	9.4	9.25	2.78	30.82	<0.001*
A prescription medicine but often dispensed without a prescription	88	69.3	5.65	1.72	18.56	0.004*
A prescription medicine and always dispensed on a prescription	12	9.4	4.21	2.03	8.71	<0.001*
Availability of m-RDTs in pharmacy
No	85	66.9	1
Yes	42	33.1	1.89	1.06	3.37	0.03*
Aware of negative effects of dispensing antimalarial without prescription
Not a problem	6	4.7				0.031*
Minor problem	16	12.6	1.64	0.5	5.38	0.417
Moderate problem	30	23.6	1.95	1	3.79	0.049*
Serious problem	75	59.1	3.74	1.31	10.72	0.014*

Note: *p<0.05.

Abbreviations: OR: Odds ratio, m-RDTs, malaria rapid diagnostic tests malaria.

Table 6 Multivariate Logistic for Associated Factors of Dispensing Antimalarial Without a Prescription (n=127)

Variables	Dispensing of Antimalarial Medicine Without a Prescription		95% Confidence Intervals
Knowledge on prescription status	Yes		OR	Lower	Upper	p-value
	Number	Percent
Prefer not to say	15	11.8	1			<0.001***
Over-the-counter medicine	12	9.4	7.03	2.01	24.56	0.002**
A prescription medicine but often dispensed without a prescription	88	69.3	5.71	1.65	19.78	0.006**
A prescription medicine and always dispensed on a prescription	12	9.4	4.17	1.95	8.91	<0.001***
Availability of m-RDTs in pharmacy
No	85	66.9	1
Yes	42	33.1	2.08	1.1	3.94	0.024*
Aware of negative effects of dispensing antimalarial without a prescription
Not a problem	6	4.7	1			0.362
Minor problem	16	12.6	1.14	0.33	3.93	0.836
Moderate problem	30	23.6	1.53	0.76	3.09	0.239
Serious problem	75	59.1	2.36	0.78	7.18	0.131

Notes: *p<0.05, **p<0.01, ***p<0.001.

Abbreviations: OR: Odds ratio; m-RDTs, malaria rapid diagnostic tests.