Challenges with accessing health care for young children presumed to have malaria in the rural district of Butaleja, Uganda: a qualitative study
Objective: A qualitative study was conducted to gain insight into challenges reported by Butaleja households during a previous household survey. Specifically, this paper discusses heads of households’ and caregivers’ perceptions of challenges they face when seeking care for their very young children with fever presumed to be malaria.
Methods: Eleven focus groups (FGs) were carried out with household members (five with heads of households and six with household caregivers) residing in five sub-counties located across the district. Purposive sampling was used to ensure the sample represented the religious diversity and geographical distance from the peri-urban center of the district. Each FG consisted of five to six participants. The FGs were conducted at a community centre by two pairs of researchers residing in the district and who were fluent in both English and the local dialect of Lunyole. The discussions were recorded, translated, and transcribed. Transcripts were reviewed and coded with the assistance of QDA Miner (version 4.0) qualitative data management software, and analyzed using thematic content analysis.
Results: The FG discussions identified four major areas of challenges when managing acute febrile illness in their child under the age of five with presumed malaria: (1) difficulties with getting to public health facilities due to long geographical distances and lack of affordable transportation; (2) poor service once at a public health facility, including denial of care, delay in treatment, and negative experiences with the staff; (3) difficulties with managing the child’s illness at home, including challenges with keeping home-stock medicines and administering medicines as prescribed; and (4) constrained to use private outlets despite their shortcomings.
Conclusions: Future interventions may need to look beyond the public health system to improve case management of childhood malaria at the community level in rural districts such as Butaleja. Given the difficulties with accessing quality private health outlets, there is a need to partner with the private sector to explore feasible models of community-based health insurance programs and expand the role of informal private providers.
World Health Organization (WHO). World malaria report 2018. Geneva, Switzerland; 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/275867/9789241565653-eng.pdf (accessed: Oct 17, 2019).
Roberts D, Matthews G. Risk factors of malaria in children under the age of five years old in Uganda. Malar J. 2016;15(246):1-11. https://doi.org/10.1186/s12936-016-1290-x
World Health Organization (WHO) [Internet]. Malaria in children under five; c2018 [cited 2019 May 28]. Malaria. Available from: https://www.who.int/malaria/areas/high_risk_groups/children/en/ (accessed: Oct 17, 2019).
World Health Organization (WHO) [Internet]. Estimated cases - Estimates by country; c2019 [cited 2019 May 28]. Global Health Observatory Data Repository. Available from: http://apps.who.int/gho/data/node.main.A1372?lang=en (accessed: Oct 17, 2019).
United States Agency for International Development (USAID). 12th annual report to congress. Washington (DC): The President’s Malaria Initiative; 2018 Apr. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/2018-pmi-twelfth-annual-report.pdf (accessed: Oct 17, 2019).
Yeka A, Gasasira A, Mpimbaza A, Achan J, Nankabirwa J, Nsobya S, Staedke SG, Donnelly MJ, Wabwire-Mangen F, Talisuna A, Dorsey G, Kamya MR, Rosenthal PJ. Malaria in Uganda: Challenges to control on the long road to elimination: I. Epidemiology and current control efforts. Acta Trop. 2012;121(3):184-195. https://doi.org/10.1016/j.actatropica.2011.03.004
World Health Organization (WHO). WHO guidelines for the treatment of malaria. 3rd ed. Geneva, Switzerland; 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/162441/9789241549127_eng.pdf?sequence=1 (accessed: Oct 17, 2019).
Idro R, Carter JA, Fegan G, Neville BGR, Newton CRJC. Risk factors for persisting neurological and cognitive impairments following cerebral malaria. Arch Dis Child. 2006;91(2):142-148. https://doi.org/10.1136/adc.2005.077784
Carter JA, Lees JA, Gona JK, Murira G, Rimba K, Neville BGR, Newton CRJC. Severe falciparum malaria and acquired childhood language disorder. Dev Med Child Neurol. 2006;48(1):51-57. https://doi.org/10.1017/S0012162206000107
United States Agency for International Development (USAID). Uganda malaria operational plan FY 2015. The President’s Malaria Initiative; 2015. Available from: https://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy-15/fy-2015-uganda-malaria-operational-plan.pdf (accessed: Oct 17, 2019).
Uganda Ministry of Health. The Uganda malaria reduction strategic plan 2014-2020. Kampala, Uganda: Ministry of Health; 2014 May. Available from: https://health.go.ug/sites/default/files/The%20Uganda%20Malaria%20Reduction%20Strategic%20Plan%202014-2020.pdf (accessed: Oct 17, 201
Fink G, Dickens WT, Jordan M, Cohen JL. Access to subsidized ACT and malaria treatment - Evidence from the first year of the AMFm program in six districts in Uganda. Health Policy Plan. 2014;29(4):517-527. https://doi.org/10.1093/heapol/czt041
Affordable Medicines Facility – malaria (AMFm) Independent Evaluation Team. Independent evaluation of the Affordable Medicines Facility - malaria (AMFm) phase 1, multi-country independent evaluation report: Final report. Calverton, Maryland and London: Inner City Fund (ICF) International and London School of Hygiene and Tropical Medicine; 2012 Sep. Available from: https://unitaid.org/assets/Mid-term-evaluation-Affordable-medicines-for-malaria-facility-AMFm-Phase-1.pdf (accessed: Oct 17, 2019).
Uganda Ministry of Health, United Nations International Children's Emergency Fund (UNICEF), World Health Organization. Integrated community case management of childhood malaria, pneumonia and diarrhoea: Implementation guidelines. Kampala, Uganda: Ministry of Health; 2010 May. Available from: http://library.health.go.ug/sites/default/files/resources/ICCM%20Implementation%20Guidelines.pdf (accessed: Oct 17, 2019).
Awor P, Wamani H, Tylleskar T, Jagoe G, Peterson S. Increased access to care and appropriateness of treatment at private sector drug shops with integrated management of malaria, pneumonia and diarrhoea: A quasi-experimental study in Uganda. PLoS ONE. 2014;9(12):e115440. https://doi.org/10.1371/journal.pone.0115440
Buchner DL, Awor P. A protocol for engaging unlicensed private drug shops in rural eastern Uganda for integrated community case management (ICCM) of malaria, pneumonia and diarrhoea in children under 5 years of age. BMJ Open. 2015;5(10):e009133. https://doi.org/10.1136/bmjopen-2015-009133
Marsh DR, Hamer DH, Pagnoni F, Peterson S. Introduction to a special supplement: Evidence for the implementation, effects, and impact of the integrated community case management strategy to treat childhood infection. Am J Trop Med Hyg. 2012;87(5 Supplement):2-5. https://doi.org/10.4269/ajtmh.2012.12-0504
Kassam R, Collins JB, Liow E, Rasool N. Narrative review of current context of malaria and management strategies in Uganda (Part I). Acta Trop. 2015;152:252-268. https://doi.org/10.1016/j.actatropica.2015.07.028
Talisuna AO, Daumerie PG, Balyeku A, Egan T, Piot B, Coghlan R, Lugand M, Bwire G, Rwakimari JB. Ndyomugyenyi R, Kato F, Byangire M, Kagwa P, Sebisubi F, Nahamya D, Bonabana A, Mpanga-Mukasa S, Buyungo P, Lukwago J, Batte A, Nakanwagi G, Tibenderana J, Nayer K, Reddy K, Dokwal N, Rugumambaju S, Kidde S, Banerji J, George J. Closing the access barrier for effective anti-malarials in the private sector in rural Uganda: Consortium for ACT private sector subsidy (CAPSS) pilot study. Malar J. 2012;11(356):1-14. https://doi.org/10.1186/1475-2875-11-356
Mbonye AK, Magnussen P, Lal S, Hansen KS, Cundil B, Chandler C, Clarke SE. A cluster randomised trial introducing rapid diagnostic tests into registered drug shops in Uganda: Impact on appropriate treatment of malaria. PLoS ONE. 2015;10(7):e0129545. https://doi.org/10.1371/journal.pone.0129545
Standing H, Chowdhury AMR. Producing effective knowledge agents in a pluralistic environment: What future for community health workers? Soc Sci Med. 2008;66(10):2096-2107. https://doi.org/10.1016/j.socscimed.2008.01.046
Bennett S, George A, Rodriguez D, Shearer J, Diallo B, Konate M, Dalglish S, Juma P, Namakhoma I, Banda H, Chilundo B, Mariano A, Cliff J. Policy challenges facing integrated community case management in Sub-Saharan Africa. Trop Med Int Health. 2014;19(7):872-882. https://doi.org/10.1111/tmi.12319
Kassam R, Sekiwunga R, Collins JB, Tembe J, Liow E. Caregivers’ treatment-seeking behaviors and predictors of whether a child received an appropriate antimalarial treatment: A household survey in rural Uganda. BMC Infect Dis. 2016;16:478. https://doi.org/10.1186/s12879-016-1815-5
Kassam R, Collins J, Sekiwunga R. Assets and challenges facing caregivers when managing malaria in young children in rural Uganda. Malar J. 2016;15(467):1-14. https://doi.org/10.1186/s12936-016-1521-1
Kassam R, Sekiwunga R, MacLeod D, Tembe J, Liow E. Patterns of treatment-seeking behaviors among caregivers of febrile young children: A Ugandan multiple case study. BMC Public Health. 2016;16:160. https://doi.org/10.1186/s12889-016-2813-7
Liow E, Kassam R, Sekiwunga R. Investigating unlicensed retail drug vendors’ preparedness and knowledge about malaria: An exploratory study in rural Uganda. Acta Trop. 2017;174:9-18. https://doi.org/10.1016/j.actatropica.2017.06.008
Liow E, Kassam R, Sekiwunga R. Understanding unlicensed drug vendor practices related to childhood malaria in one rural district of Uganda: An exploratory study. J Trop Med. 2018;2018(6987435):6987435. https://doi.org/10.1155/2018/6987435
Liow E, Kassam R, Sekiwunga R. How unlicensed drug vendors in rural Uganda perceive their role in the management of childhood malaria. Acta Trop. 2016;164:455-462. https://doi.org/10.1016/j.actatropica.2016.10.012
Konde-Lule J, Okuonzi S, Matsiko CW, Mukanga D, Onama V Gitta SN. The potential of the private sector to improve health outcomes in Uganda. Makerere University Institute of Public Health; 2006 July:1-93. Available from: https://www.researchgate.net/publication/255570875_The_Potential_of_the_Private_sector_to_improve_health_outcomes_in_Uganda (accessed: Oct 17, 2019).
Uganda Ministry of Health, Health Systems 20/20, Makerere University School of Public Health, United States Agency for International Development (USAID). Uganda health system assessment 2011. Kampala, Uganda and Bethesda (MD): Health Systems 20/20 project, Abt Associates Inc, Ministry of Health; 2011 Apr. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/hsa.pdf (accessed: Oct 17, 2019).
Uganda Ministry of Health. National policy on public private partnership in health. Kampala, Uganda: Ministry of Health; 2005 Jul. Available from: http://library.health.go.ug/sites/default/files/resources/National%20Policy%20on%20Public%20Private%20Partnerships%20in%20Health%20Final%20Print_0.pdf (accessed: Oct 17, 2019).
Jones CL, Jensen JD, Scherr CL, Brown NR, Christy K, Weaver J. The health belief model as an explanatory framework in communication research: Exploring parallel, serial, and moderated mediation. Health Commun. 2015;30(6):566-576. https://doi.org/10.1080/10410236.2013.873363
Uganda Bureau of Statistics (UBOS). 2017 statistical abstract. Kampala, Uganda: Uganda Bureau of Statistics; 2017 Oct. Available from: https://www.ubos.org/wp-content/uploads/publications/03_20182017_Statistical_Abstract.pdf (accessed: Oct 17, 2019).
Wikipedia.org [Internet]. Butaleja district; c2018 [cited 2019 June 29]. Available from: https://en.wikipedia.org/wiki/Butaleja_District (accessed: Oct 17, 2019).
Uganda Bureau of Statistics (UBOS). Higher local government statistical abstract 2008/2009: Butaleja district. Butaleja, Uganda: Uganda Bureau of Statistics; 2009 Jun. Available from: https://www.ubos.org/onlinefiles/uploads/ubos/2009_HLG_%20Abstract_printed/Butaleja%20DLG%20Abstract-Final.pdf (accessed: Oct 17, 2019).
Hennink MM, Kaiser BN, Weber MB. What influences saturation? Estimating sample sizes in focus group research. Qual Health Res. 2019;29(10):1483-1496. https://doi.org/10.1177/1049732318821692
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Heal Care. 2007;19(6):349-357. https://doi.org/10.1093/intqhc/mzm042
Smith CP, editor. Motivation and personality: Handbook of thematic content analysis. Cambridge: Cambridge University Press; 1992. https://doi.org/10.1017/CBO9780511527937 (accessed: Oct 17, 2019).
Amuge B, Wabwire-Mangen F, Puta C, Pariyo GW, Bakyaita N, Staedke S, Kamya M, Okui O. Health-seeking behavior for malaria among child and adult headed households in Rakai district, Uganda. Afr Health Sci. 2004;4(2):119-124.
Castellani J, Nsungwa-Sabiiti J, Mihaylova B, Ajayi IO, Siribié M, Afonne C, Balyeku A, Sermé L, Sanou AK, Sombié BS, Tiono AB, Sirima SB, Kabarungi V, Falade CO, Kyaligonza J, Evers SMAA, Paulus ATG, Petzold M, Singlovic J, Gomes M. Impact of improving community-based access to malaria diagnosis and treatment on household costs. Clin Infect Dis. 2016;63(Supplement 5):S256-S263. https://doi.org/10.1093/cid/ciw623
Artemisinin-based Combination Therapy watch (ACTwatch) Group, Program for Accessible Health, Communication & Education (PACE)/Uganda. Household survey Uganda: 2012 survey report. Washington (DC): Population Services International; 2012. Available from: http://www.actwatch.info/sites/default/files/content/publications/attachments/ACTwatch%20HH%20Report%20Uganda%202012.pdf (accessed: Oct 17, 2019).
Artemisinin-based Combination Therapy watch (ACTwatch) Group, Program for Accessible Health, Communication & Education (PACE)/Uganda. Household survey report (baseline) Republic of Uganda 03/09 - 04/09. Washington (DC): Population Services International; 2009. Available from: http://www.actwatch.info/sites/default/files/content/publications/attachments/Uganda%20Household%20Baseline%2C%20ACTwatch%202009.pdf (accessed: Oct 17, 2019).
Kiwanuka SN, Ekirapa EK, Peterson S, Okui O, Hafizur-Rahman M, Peters D, Pariyo GW. Access to and utilisation of health services for the poor in Uganda: A systematic review of available evidence. Trans R Soc Trop Med Hyg. 2008;102(11):1067-1074. https://doi.org/10.1016/j.trstmh.2008.04.023
Mbonye AK. Prevalence of childhood illnesses and care-seeking practices in rural Uganda. Sci World J. 2003;3:721-730. https://doi.org/10.1100/tsw.2003.52
Peterson S, Nsungwa-sabiiti J, Were W, Nsabagasani X, Magumba G, Nambooze J, Mukasa G. Coping with paediatric referral - Ugandan parents’ experience. Lancet. 2004;363(9425):1955-1956. https://doi.org/10.1016/S0140-6736(04)16411-8
Uganda Bureau of Statistics (UBOS), Inner City Fund (ICF) International. Uganda malaria indicator survey (MIS) 2014-15. Kampala, Uganda and Rockville (MD): Uganda Bureau of Statistics, National Malaria Control Programme, Uganda Malaria Surveillance Project Molecular Laboratory, ICF International; 2015 Oct. Available from: https://dhsprogram.com/pubs/pdf/MIS21/MIS21.pdf (accessed: Oct 17, 2019).
Buregyeya E, Rutebemberwa E, LaRussa P, Lal S, Clarke SE, Hansen KS, Magnussen P, Mbonye AK. Comparison of the capacity between public and private health facilities to manage under-five children with febrile illnesses in Uganda. Malar J. 2017;16(1):183. https://doi.org/10.1186/s12936-017-1842-8
James CD, Hanson K, McPake B, Balabanova D, Gwatkin D, Hopwood I, Kirunga C, Knippenberg R, Meessen B, Morris SS, Preker A, Souteyr Y, Tibouti A, Villeneuve P, Xu K. To retain or remove user fees?: Reflections on the current debate in low- and middle-income countries. Appl Health Econ Health Policy. 2006;5(3):137-153. https://doi.org/10.2165/00148365-200605030-00001
McPake B, Asiimwe D, Mwesigye F, Ofumbi M, Ortenblad L, Streefland P, Turinde A. Informal economic activities of public health workers in Uganda: Implications for quality and accessibility of care. Soc Sci Med. 1999;49(7):849-865. https://doi.org/10.1016/S0277-9536(99)00144-6
Rutebemberwa E, Pariyo G, Peterson S, Tomson G, Kallander K. Utilization of public or private health care providers by febrile children after user fee removal in Uganda. Malar J. 2009;8:45. https://doi.org/10.1186/1475-2875-8-45
Xu K, Evans DB, Kadama P, Nabyonga J, Ogwal PO, Nabukhonzo P, Aguilar AM. Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda. Soc Sci Med. 2006;62(4):866-876. https://doi.org/10.1016/j.socscimed.2005.07.004
Kakyo TA, Xiao LD. Challenges faced in rural hospitals : The experiences of nurse managers in Uganda. Int Nurs Rev. 2018;66(1):70-77. https://doi.org/10.1111/inr.12459
Littrell M, Gatakaa H, Evance I, Poyer S, Njogu J, Solomon T, Munroe E, Chapman S, Goodman C, Hanson K, Zinsou C, Akulayi L, Raharinjatovo J, Arogundade E, Buyungo P, Mpasela F, Adjibabi CB, Agbango JA, Ramarosandratana BF, Coker B, Rubahika D, Hamainza B, Shewchuk T, Chavasse D, O'Connell KA. Monitoring fever treatment behaviour and equitable access to effective medicines in the context of initiatives to improve ACT access: Baseline results and implications for programming in six African countries. Malar J. 2011;10:327. https://doi.org/10.1186/1475-2875-10-327
Mudaly P, Nkosi ZZ. Factors influencing nurse absenteeism in a general hospital in Durban, South Africa. J Nurs Manag. 2015;23(5):623-631. https://doi.org/10.1111/jonm.12189
Ojakaa D, Olango S, Jarvis J. Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya. Hum Resour Health. 2014;12:33. https://doi.org/10.1186/1478-4491-12-33
Rowe AK, De Savigny D, Lanata CF, Victora CG. How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet. 2005;366(9490):1026-1035. https://doi.org/10.1016/S0140-6736(05)67028-6
Wurie HR, Samai M, Witter S. Retention of health workers in rural Sierra Leone: Findings from life histories. Hum Resour Health. 2016;14:3. https://doi.org/10.1186/s12960-016-0099-6
Awor P, Wamani H, Bwire G, Jagoe G, Peterson S. Private sector drug shops in integrated community case management of malaria, pneumonia, and diarrhea in children in Uganda. Am J Trop Med Hyg. 2012;87(5 Supplement):92-96. https://doi.org/10.4269/ajtmh.2012.11-0791
Zurovac D, Tibenderana JK, Nankabirwa J, Ssekitooleko J, Njogu JN, Rwakimari JB, Meek S, Talisuna A, Snow RW. Malaria case-management under artemether-lumefantrine treatment policy in Uganda. Malar J. 2008;7:181. https://doi.org/10.1186/1475-2875-7-181
Artemisinin-based Combination Therapy watch (ACTwatch) Group; Kaula H, Buyungo P, Opigo J. Private sector role, readiness and performance for malaria case management in Uganda, 2015. Malar J. 2017;16:219. https://doi.org/10.1186/s12936-017-1824-x
Rutebemberwa E, Nsabagasani X, Pariyo G, Tomson G, Peterson S, Kallander K. Use of drugs, perceived drug efficacy and preferred providers for febrile children: Implications for home management of fever. Malar J. 2009;8:131. https://doi.org/10.1186/1475-2875-8-131
O’Connell KA, Gatakaa H, Poyer S, Njogu J, Evance I, Munroe E, Solomon T, Goodman C, Hanson K, Zinsou C, Akulayi L, Raharinjatovo J, Arogundade E, Buyungo P, Mpasela F, Adjibabi CB, Agbango JA, Ramarosandratana BF, Coker B, Rubahika D, Hamainza B, Chapman S, Shewchuk T, Chavasse D. Got ACTs? Availability, price, market share and provider knowledge of anti-malarial medicines in public and private sector outlets in six malaria-endemic countries. Malar J. 2011;10:326. https://doi.org/10.1186/1475-2875-10-326
Nabyonga-Orem J, Mugisha F, Okui AP, Musango L, Kirigia JM. Health care seeking patterns and determinants of out-of-pocket expenditure for malaria for the children under-five in Uganda. Malar J. 2013;12:175. https://doi.org/10.1186/1475-2875-12-175
Cattamanchi A, Miller CR, Tapley A, Haguma P, Ochom E, Ackerman S, Davis JL, Katamba A, Handley MA. Health worker perspectives on barriers to delivery of routine tuberculosis diagnostic evaluation services in Uganda: A qualitative study to guide clinic-based interventions. BMC Health Serv Res. 2015;15:10. https://doi.org/10.1186/s12913-014-0668-0
Konde-Lule J, Gitta SN, Lindfors A, Okuonzi S, Onama VON, Forsberg BC. Private and public health care in rural areas of Uganda. BMC Int Health Hum Rights. 2010;10:29. https://doi.org/10.1186/1472-698X-10-29
Donfouet HPP, Mahieu PA. Community-based health insurance and social capital: A review. Health Econ Rev. 2012;2(5):1-5. https://doi.org/10.1186/2191-1991-2-5
Haven N, Dobson AE, Yusuf K, Kellermann S, Mutahunga B, Stewart AG, Wilkinson E. Community-based health insurance increased health care utilization and reduced mortality in children under-5, around Bwindi Community Hospital, Uganda between 2015 and 2017. Front Public Heal. 2018;6:281. https://doi.org/10.3389/fpubh.2018.00281
Jegede AS, Oshiname FO, Sanou AK, Nsungwa-Sabiiti J, Ajayi IO, Siribié M, Afonne C, Sermé L, Falade CO. Assessing acceptability of a diagnostic and malaria treatment package delivered by community health workers in malaria-endemic settings of Burkina Faso, Nigeria, and Uganda. Clin Infect Dis. 2016;63(Supplement 5):S306-S311. https://doi.org/10.1093/cid/ciw630
Malimbo M, Mugisha E, Kato F, Karamagi C, Talisuna AO. Caregivers’ perceived treatment failure in home-based management of fever among Ugandan children aged less than five years. Malar J. 2006;5:124. https://doi.org/10.1186/1475-2875-5-124
Nanyonjo A, Nakirunda M, Makumbi F, Tomson G, Källander K, The inSCALE Study Group. Community acceptability and adoption of integrated community case management in Uganda. Am J Trop Med Hyg. 2012;87(5 Supplement):97-104. https://doi.org/10.4269/ajtmh.2012.11-0763
Kalyango JN, Alfven T, Peterson S, Mugenyi K, Karamagi C, Rutebemberwa E. Integrated community case management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms in children under five years in eastern Uganda. Malar J. 2013;12:340. https://doi.org/10.1186/1475-2875-12-340
Morse JM. The significance of saturation. Qual Health Res. 1995;5(2):147-149. https://doi.org/10.1177/104973239500500201
The authors hereby transfer, assign or otherwise convey to Pharmacy Practice (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print or epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final PDFs of their respective articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.