Case management of malaria fever at community pharmacies in Pakistan; a threat to rational drug use
Objective: To document the case management of uncomplicated malaria fever at community pharmacies located in the two major cities of Pakistan; Islamabad (national capital) and Rawalpindi (twin city).
Method: A comparative, cross-sectional study was designed to document the management of uncomplicated malaria fever at community pharmacies in twin cities of Pakistan through simulated patient visits. Visits were conducted in 238 randomly selected pharmacies to request advice for a simulated patient case of malaria. The pharmacy’s management was scored on a checklist including history taking and provision of advice and information. Kruskal-Wallis test and Mann-Whitney U test were used to compare management of uncomplicated malaria fever by the dispensers working at community pharmacies handled by different provider types and situated at different locations in the twin cities.
Results: The simulated patients were handled by salesmen (74.8%, n=178), pharmacist (5.4%, n=13) and diploma holders (19.8 %, n=47). Medication was dispensed in 83.1 % (n=198) of the visits, but only few of the treated cases were in accordance to standard treatment guidelines for malaria. However, 14.8% (n=35) of the cases the simulated patients were directly referred to a physician. There was a significant difference observed in the process of history taking performed by different dispensers (e.g. pharmacist, pharmacy assistant, pharmacy diploma holders and salesman) while no significant differences in the provision of advice by these dispensers was observed. Pharmacists were seen more frequently involved in the process of history taking if available at the community pharmacies. On the other hand, there were no significant differences seen in the case management (history taking and provision of advice) for the treatment of malaria fever among community pharmacies situated at different locations (e.g. near hospital/super market/small market) in the twin cities
Conclusion: The results of the study revealed that the overall process of disease management of uncomplicated malaria fever at community pharmacies was not in accordance with the national standard treatment guidelines for malaria. Patients were being treated by untrained personnel’s at community pharmacies without any understanding of referral. However, pharmacists were more frequently involved in history taking, though their availability was low at community pharmacies.
2. Puspitasari HP, Aslani P, Krass I. A review of counseling practices on prescription medicines in community pharmacies. Res Social Adm Pharm. 2009;5(3):197-210. doi: 10.1016/j.sapharm.2008.08.006
3. Brugha R, Zwi A. Improving the quality of private sector delivery of public health services: challenges and strategies. Health Policy Plan. 1998;13(2):107-20.
4. Adome RO, Whyte SR, Hardon A, Popular pills: Community drug use in Uganda1996. Netherlands: Aksant Academic Publishers, 1996.
5. Azhar S, Hassali MA, Ibrahim MI, Ahmad M, Masood I, Shafie AA. The role of pharmacists in developing countries: the current scenario in Pakistan. Hum Resour Health. 2009;7:54. doi: 10.1186/1478-4491-7-54.
6. Erhun WO, Osagie A, Management of malaria by medicine retailers in a Nigerian urban community. J Health Popul Dev Ctries. 2004;8:1-6.
7. Tekobo AM, Tayo F. Knowledge and practice of drug retailers in malaria management in Lagos Nigeria: A preliminary survey. Nig Q J Hosp Med. 2004;14(1):84-7.
8. Marsh VM, Mutemi WM, Willetts A, Bayah K, Were S, Ross A, Marsh K. Improving malaria home treatment by training drug retailers in rural Kenya. Trop Med Int Health. 2004;9(4):451-60.
9. Rajakaruna RS, Weerasinghe M, Alifrangis M, Amerasinghe PH, Konradsen F. The role of private drug vendors as malaria treatment providers in selected malaria endemic areas of Sri Lanka. J Vector Borne Dis. 2006;43(2):58-65.
10. Tawfik Y, Nsungwa-Sabitii J, Greer G, Owor J, Kesande R, Prysor-Jones S. Negotiating improved case management of childhood illness with formal and informal private practitioners in Uganda. Trop Med Int Health. 2006;11(6):967-73.
11. Hetzel MW, Dillip A, Lengeler C, Obrist B, Msechu JJ, Makemba AM, Mshana C, Schulze A, Mshinda H. Malaria treatment in the retail sector: knowledge and practices of drug sellers in rural Tanzania. BMC Public Health. 2008;8:157. doi: 10.1186/1471-2458-8-157.
12. Rusk A, Smith N, Menya D, Obala A, Simiyu C, Khwa-Otsyula B, O'Meara W. Does anti-malarial drug knowledge predict anti-malarial dispensing practice in drug outlets? A survey of medicine retailers in western Kenya. Malar J. 2012;11:263. doi: 10.1186/1475-2875-11-263.
13. Buabeng KO, Matowe LK, Smith F, Duwiejua M, Enlund H. Knowledge of medicine outlets’ staff and their practices for prevention and management of malaria in Ghana. Pharm World Sci. 2010;32(4):424-31. doi: 10.1007/s11096-010-9397-6.
14. Marsh VM, Mutemi WM, Muturi J, Haaland A, Watkins WM, Otieno G, Marsh K. Changing home treatment of childhood fevers by training shop keepers in rural Kenya. Trop Med Int Health. 1999;4(5):383-9.
15. Babar Z. Medicalising Pakistan. 2007. Available from: http://www.chowk.com/articles/11520 (Accessed 2009 20th November)
16. Hussain A, Ibrahim MI, Baber ZU. Compliance with Legal Requirements by Community Pharmacies in Pakistan: a cross sectional survey. Int J Pharm Pract. 2012;20(3):183-90. doi: 10.1111/j.2042-7174.2011.00178.x
17. Hussain A, Ibrahim MI, Baber ZU. Compliance with legal requirements at community pharmacies:A cross sectional study from Pakistan. Int J Pharm Pract. 2012;20(3):183-90. doi: 10.1111/j.2042-7174.2011.00178.x.
18. Hussain A, Ibrahim MI. Qualification, knowledge and experience of dispensers working at community pharmacies in Pakistan. Pharm Pract. 2011; 9(2):93-100.
19. Hussain A, Ibrahim MI. Medication counselling and dispensing practices at community pharmacies: A comparative cross sectional study from Pakistan. Int J Clin Pharm. 2011;33(5):859-67. doi: 10.1007/s11096-011-9554-6.
20. Butt ZA, Gilani AH, Nanan D, Sheikh AL, White F. Quality of pharmacies in Pakistan: a cross-sectional survey. Int J Qual Health Care. 2005;17(4):307-13.
21. Rabbani F, Cheema FH, Talati N, Siddiqui S, Syed S, Bashir S, Zuberi LZ, Shamim A, Mumtaz Q. Behind the counter:pharmacies and dispensing patterns of pharmacy attendants in Karachi. J Pak Med Assoc. 2001;51(4):149-53.
22. Malik M, Hassali MA, Shafie AA, Hussain A. Prescribing practices for the treatment of malaria among public and private facilities: A comparative cross sectional study from Pakistan. Health Med. 2012. 6(4):1147-54.
23. World Health Organization. World Malaria Report 2012. 2012; Available from: http://www.who.int/malaria/publications/world_malaria_report_2012/wmr2012_full_report.pdf (Accessed 2013 15th January)
24. Brieger WR, Osamor PE, Salami KK, Oladepo O, Otusanya SA. Interactions between patent medicine vendors and customers in urban and rural Nigeria. Health Policy Plan. 2004;19(3):177-82.
25. McCombie SC. Self-treatment for malaria: the evidence and methodological issues. Health Policy Plan. 2002;17(4):333-44.
26. Goodman C, Brieger W, Unwin A, Mills A, Meek S, Greer G. Medicine sellers and malaria treatment in sub-Saharan Africa: what do they do and how can their practice be improved? Am J Trop Med Hyg. 2007;77(6 Suppl):203-18.
27. Goodman C, Kachur SP, Abdulla S, Bloland P, Mills A. Drug shop regulation and malaria treatment in Tanzania—why do shops break the rules, and does it matter? Health Policy Plan. 2007;22(6):393-403.
28. Greer G, Akinpelumi A, Madueke L, Plowman B, Fapohunda B, Tawfik Y, Holmes R, Owor J, Gilpin U, Clarence C, Bob Lenno B. Improving management of childhood malaria in Nigeria and Uganda by improving practices of patent medicine vendors. Arlington, Va: USAID, 2004.
29. Idowu OA, Mafiana CF, Luwoye IJ, Adehanloye O. Perceptions and home management practices of malaria in some rural communities in Abeokuta, Nigeria. Travel Med Infect Dis. 2008;6(4):210-4. doi: 10.1016/j.tmaid.2007.10.007.
30. Malik M, Hassali MA, Shafie AA, Hussain A, Aljadhey H. Availability of different strengths of anti-malarial preparations in Pakistan: Implication for patient safety. J Pharmacol Biomed Anal. 2012, 1:1.
31. Nishtar, S. Drug Regulatory Authority: A Case for Hope? . 2012; Available from: http://www.huffingtonpost.co.uk/dr-sania-nishtar/drug-regulatory-authority_b_2270449.html (Accessed 2012 25 December)
32. Nishtar S. Devolving health-Part - II 2011; Available from: http://www.thenews.com.pk/Todays-News-9-65635-Devolving-health-Part---II (Accessed 2012 15th March)
33. Hussain A, Ibrahim MI. Medication counseling and dispensing practices at community pharmacies: a comparative cross sectional study from Pakistan. Int J Clin Pharm. 2011;33(5):859-67. doi: 10.1007/s11096-011-9554-6.
34. World Health Organization and Malaria Control Program Directorate, National treatment guidelines for malaria, 2005, Pakistan; Ministry of Health Pakistan: 2005.
35. Gomes M, Wayling S, Pang L. Pang, Interventions to improve the use of antimalarials in south-east Asia: an overview. Bull World Health Organ. 1998;76(Suppl 1):9-19.
36. Israel GD, Determining sample size. Retrieved February. Vol. 10. 2003. 2007.
37. INRUD, How to investigate drug use in health facilities, WHO, Editor 2002.
38. Field A, Discovering statistics using SPSS, T. Oaks, Editor, California: SAGE: 2009.
39. Malik M, Hussain A, Hassali MA, Shafie AA. Standard treatment guidelines for malaria: Challenges in its implementation in Islamabad (federal capital) and Rawalpindi (twin city), Pakistan. Saudi Pharm J. 2013;21(1):123-124.
40. Hussain A, Ibrahim MI, Malik M. Assessment of disease management of acute respiratory tract infection at community pharmacies through simulated visits in Pakistan. Latin Am J Pharm. 2012; 31(10):1435-40.
41. Hussain A, Ibrahim MI. Management of diarrhea cases by community pharmacies in 3 cities of Pakistan. East Mediterr Health J. 2012;18(6):635-40.
42. World Health Organization. How to investigate drug use in health facilities:Selected drug use indicators; Available from: http://apps.who.int/medicinedocs/pdf/s2289e/s2289e.pdf (Accessed 2002 20th April)
43. Rajeswari R, Balasubramanian R, Bose MS, Sekar L, Rahman F. Private pharmacies in tuberculosis control—a neglected link. Int J Tuberc Lung Dis. 2002;6(2):171-3.
44. Turner AN, Ellertson C, Thomas S, García S. Diagnosis and treatment of presumed STIs at Mexican pharmacies: survey results from a random sample of Mexico City pharmacy attendants. Sex Transm Infect. 2003;79(3):224-8.
45. Tumwikirize WA, Ekwaru PJ, Mohammed K, Ogwal-Okeng JW, Aupont O. Management of acute respiratory infections in drug shops and private pharmacies in Uganda a study of counter attendants' knowledge and reported behaviour. East Afr Med J. 2004;(Suppl):S33-40.
46. Minzi OM, Haule AF. Poor Knowledge On New Malaria Treatment Guidelines Among Drug Dispensers In Private Pharmacies In Tanzania: The Need For Involving The Private Sector In Policy Preparations And Implementation. East Afr J Public Health. 2008;5(2):117-21.
47. Smith LA, Jones C, Meek S, Webster J. Review: Provider practice and user behavior interventions to improve prompt and effective treatment of malaria: do we know what works? Am J Trop Med Hyg. 2009;80(3):326-35.