Non-prescription dispensing of antibiotic agents among community drug retail outlets in Sub-Saharan African countries: a systematic review and meta-analysis

Belachew, Sewunet Admasu; Hall, Lisa; Selvey, Linda A.

doi:10.1186/s13756-020-00880-w

Antimicrobial Resistance & Infection Control

Table 1 Characteristics of the included studies in this systematic review and meta-analysis

From: Non-prescription dispensing of antibiotic agents among community drug retail outlets in Sub-Saharan African countries: a systematic review and meta-analysis

Articles	Study locations	Data collection method	Case scenarios that resulted in antibiotics supply	Number of drug retail outlets visited	Number of visits/encounters/transactions	Encounters in which antibiotics were sold without prescriptions (%)	Main classes of antibiotics dispensed
Simulated client, acute childhood diarrhoea
Abegaz et al. [28]	Ethiopia	Simulated client	Acute childhood diarrhoea	113	113	51	Sulphonamide, Nitro-imidazole
Berih et al. [27]	Sudan	Simulated client	Acute childhood diarrhoea	63	63	67	Sulphonamide, Nitro-imidazole
Mengistu et al. [37]	Ethiopia	Simulated client	Acute childhood diarrhoea	105	105	87	Sulphonamide
Simulated client, acute childhood diarrhoea plus adult upper respiratory infections (URTIs)
Ayele et al. [29]	Ethiopia	Simulated client	Acute childhood diarrhoea and URTIs in adult	22	44	64	Sulphonamide, Nitro-imidazole, Penicillin, Macrolide Fluoroquinolone,
Erku DA et al. [33]	Ethiopia	Simulated client	Acute childhood diarrhoea and URTIs in adult	50	100	86	Sulphonamide, Nitro-imidazole, Penicillin, Macrolide, Fluoroquinolone Cephalosporin
Simulated client, acute childhood diarrhoea plus other conditions in all ages
Nyazema et al. [39]	Zimbabwe	Simulated client	Acute childhood diarrhoea, vaginal discharge and itching, urethral discharge	87	184	8	Penicillin, Sulphonamide, Tetracycline, Fluoroquinolone
Koji et al. [36]	Ethiopia	Simulated client	Common cold, acute childhood diarrhoea, childhood pneumonia, meningitis, critically sick, then each case was followed by different antibiotics request	262	262	63	Penicillin, Macrolide, Sulphonamide, Nitro-imidazole, Cephalosporin, Aminoglycoside,
Minzi et al. [38]	Tanzania	Simulated client	Cough, headache and childhood diarrhoea, left hip injury, fever and childhood diarrhoea, vomiting and diarrhoea, persistent cough, yellowish urethral discharge with a bad smell, then each case was followed by different antibiotics request	145	145	69	Penicillin, Fluoroquinolone,
Simulated client, adult acute diarrhoea plus other conditions
Bahta et al. [20]	Eritrea	Simulated Client	Acute watery diarrhoea and urinary tract infection(UTI)	84	153	88	Fluoroquinolone Sulphonamide, Penicillin, Tetracycline, Nitro-imidazole
Horumpende et al. [35]	Tanzania	Simulated client	Unspecified fever, cough, acute diarrhoea, pain during urination	39	39	92	Penicillin, Macrolide, Cephalosporin, Sulphonamide, Nitro-imidazole,, Fluoroquinolone
Damisie et al. [32]	Ethiopia	Simulated client	Acute diarrhoea, sore throat, UTI	18	54	87	Fluoroquinolone Sulphonamide, Penicillins Nitro-imidazole,, Macrolide
Simulated client, URTIs plus antibiotics product request in all ages
Erku et al. [34]	Ethiopia	Simulated client	URTIs and amox-clav request	58	116	82	Penicillin Macrolides, Cephalosporin, Fluoroquinolone
Wafula et al. [41]	Kenya	Simulated client	Acute respiratory infection followed by amoxicillin request	200	200	87	Penicillin
Chikowe et al. [31]	Malawi	Simulated client	Direct product request(amoxicillin) (if asked, clarified as flu or cold)	45	45	93	Penicillin
Chalker et al. [30]	Tanzania	Simulated client	Cough and breathing difficulty and fast breathing with harsh noise; cough and runny nose, cough and runny nose then “co-trimoxazole (septrin) request	306	306	58	Sulphonamide
Simulated client, adult sexually transmitted infections
Viberg et al. [40]	Tanzania	Simulated client	Vaginal discharge and itching, urethral discharge	94	251	53	Tetracycline, Penicillin, Sulphonamide, Macrolides, Fluoroquinolone, Nitro-imidazole,
Questionnaire based surveys, observation while pharmacy staffs are dispensing
Ahiabu et al. [47]	Ghana	Observation at the pharmacies	N/A	6	307	91	Penicillin, Nitro-imidazole, fluoroquinolone, Sulphonamide, Tetracycline, Cephalosporin, Macrolide
Abula [42]	Ethiopia	Observation at the pharmacies	N/A	12	58	31	Penicillin, Sulphonamide
Questionnaire based surveys, onsite customers interview about their antibiotic purchase
Elong Ekambi et al. [48]	Cameron	Interviewing clients at Pharmacies	N/A	7	402	47	N/A
Gebrekirstos et al. [43]	Ethiopia	Interview of clients at the pharmacies	N/A	14	780	38	NA
Questionnaire based surveys, dispensers asked about their antibiotic transaction (supplied for URTIs plus other conditions)
Mbonye et al. [46]	Uganda	Interviewing the pharmacy staff on duty about recent sale	Childhood illness (URTIs, diarrhoea)	170	170	94	Penicillin, Sulphonamide, tetracycline, aminoglycoside
Kalungia et al. [45]	Zambia	A structured Interviewer administered questionnaire using simulated case scenario	Childhood respiratory tract infection and UTI	73	146	71	Penicillins, Sulphonamide, Nitro-imidazole
Questionnaire based surveys, customers’ requested about their antibiotic purchase when they left the CDROs
Mboya et al. [44]	Tanzania	Interviewing clients at exit of the pharmacies	URTIs, UTI, diarrhoea/diarrhoea and vomiting, wound/abscess, urinary tract infection, abdominal pain, tonsillitis, asthma, fever, gastric ulcer,post-surgery, allergy, pneumonia, weeping eye, typhoid	12	152	76	Penicillin, Nitro-imidazole, Fluoroquinolone, Macrolide, Cephalosporin, Sulphonamide

NA, not available

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