Mapping private pharmacies and their characteristics in Ujjain district, Central India

Sabde, Yogesh; Diwan, Vishal; Saraf, Vivek S; Mahadik, Vijay K.; Diwan, Vinod; Costa, Ayesha De

doi:10.1186/1472-6963-11-351

Cited by 45 publications

(45 citation statements)

References 21 publications

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“…GIS is increasingly being used to describe the epidemiology of diseases and to map HCFs for strategic planning of public health measures [45–47]. We found that patients living closer to a pharmacy tended to visit facilities more frequently.…”

Section: Discussionmentioning

confidence: 96%

Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam, Tanzania

et al. 2017

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BackgroundTanzania is among the 30 countries with the highest tuberculosis (TB) burdens. Because TB has a long infectious period, early diagnosis is not only important for reducing transmission, but also for improving treatment outcomes. We assessed diagnostic delay and associated factors among infectious TB patients.MethodsWe interviewed new smear-positive adult pulmonary TB patients enrolled in an ongoing TB cohort study in Dar es Salaam, Tanzania, between November 2013 and June 2015. TB patients were interviewed to collect information on socio-demographics, socio-economic status, health-seeking behaviour, and residential geocodes. We categorized diagnostic delay into ≤ 3 or > 3 weeks. We used logistic regression models to identify risk factors for diagnostic delay, presented as crude (OR) and adjusted Odds Ratios (aOR). We also assessed association between geographical distance (incremental increase of 500 meters between household and the nearest pharmacy) with binary outcomes.ResultsWe analysed 513 patients with a median age of 34 years (interquartile range 27–41); 353 (69%) were men. Overall, 444 (87%) reported seeking care from health care providers prior to TB diagnosis, of whom 211 (48%) sought care > 2 times. Only six (1%) visited traditional healers before TB diagnosis. Diagnostic delay was positively associated with absence of chest pain (aOR = 7.97, 95% confidence intervals [CI]: 3.15–20.19; P < 0.001), and presence of hemoptysis (aOR = 25.37, 95% CI: 11.15–57.74; P < 0.001) and negatively associated with use of medication prior to TB diagnosis (aOR = 0.31, 95% CI: 0.14–0.71; P = 0.01). Age, sex, HIV status, education level, household income, and visiting health care facilities (HCFs) were not associated with diagnostic delay. Patients living far from pharmacies were less likely to visit a HCF (incremental increase of distance versus visit to any facility: OR = 0.51, 95% CI: 0.28–0.96; P = 0.037).ConclusionsTB diagnostic delay was common in Dar es Salaam, and was more likely among patients without prior use of medication and presenting with hemoptysis. Geographical distance to HCFs may have an impact on health-seeking behaviour. Increasing community awareness of TB signs and symptoms could further reduce diagnostic delays and interrupt TB transmission.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0276-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 96%

Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam, Tanzania

et al. 2017

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“…However, this proportion is expected to be low; our previous study [17] indicated the rate to be 12%. The studied pharmacies in a single city may have common dispensing patterns.…”

Section: Recommended Approach For the Dispensing Of Antibiotics And Amentioning

confidence: 89%

“…A 2012 census of private pharmacies in the Ujjain district identified 475 pharmacies, of which 387 were urban [17]. The inclusion criteria for this study, urban pharmacies with more than 30 clients per day, were identified from the previous census.…”

Section: Private Pharmaciesmentioning

confidence: 99%

“…Several studies in low-and middle-income countries have reported a lack of adherence to treatment guidelines for diarrhea as well as an overuse of antibiotics and antimotility drugs among qualified practitioners [9,13,18]. In these settings, it is possible that pharmacy staff is not even aware of such guidelines, given that 88% of staff manning pharmacies on a day-to-day basis is unqualified [17].…”

Section: Adherence To Treatment Guidelinesmentioning

confidence: 99%

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Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India

Diwan

Sabde

Byström

et al. 2015

J Infect Dev Ctries

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Introduction: In low-and middle-income countries such as India, private pharmacies play an important role in medical treatments, offering advice for common illnesses such as diarrhea and respiratory tract infections. There is a need to explore the details of the dispensing practices at the private pharmacies in low-and middle-income countries. Methodology: The present study used simulated client methodology to assess the actual dispensing practices for patients with pediatric diarrhea at private pharmacies in an urban setting of an Indian province. Results: This study identified 164 private pharmacies (84.10%) in the study setting that engaged in the practice of dispensing prescription drugs without prescriptions. Only about 40% asked clients if they had a prescription from a doctor. The average duration of consultations at the pharmacies was 1.3 minutes (range, 0.5-6 minutes). The dispensing of drugs was not in compliance with the recommended guidelines and regulations. The most commonly dispensed drugs were antibiotics (40.24%); of these, quinolones either alone or in combination with imidazoles were the most frequently dispensed. The other commonly dispensed drugs were antimotility drugs (31.10%) and Lactobacillus acidophilus (probiotics; 23.17%). The drugs were dispensed in inappropriate doses due to the absence of indications. Conclusions: Overuse and misuse of all these prescription drugs dispensed by pharmacies pose significant issues, such as resistance, dangerous side effects, and high costs. At the same time, the pharmacies did not dispense recommended drugs such as oral rehydration solution and zinc, which they are authorized to dispense without a prescription.

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“…Also, in gross violation of the law, most private pharmacies do not have a pharmacist 31. Nearly 50–60% of all clients purchase medicines without a prescription 32 33…”

Section: Global Health Problem Analysismentioning

confidence: 99%

Consequences of low birth weight, maternal illiteracy and poor access to medical care in rural India: infantile iatrogenic Cushing syndrome

Karande

2015

BMJ Case Reports

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Home delivery, low birth weight babies and maternal illiteracy among the poor in rural India are frequent. The rural poor prefer to seek healthcare from private providers, most of whom have no formal medical training and buy medicines from private pharmacies without a prescription owing to a weakly regulated environment. This report is of a 4-month-old baby from a remote village in northern India, who presented with exogenous Cushing syndrome. This baby was a full-term low birth weight home delivery. As the baby was not growing well, treatment was started at 1 month by a private doctor with betamethasone drops The mother on her own volition continued giving the betamethasone drops by buying the medicine over the counter from a private pharmacy. This case highlights the gaps in essential health services in rural India and the steps being taken to improve the situation.

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Mapping private pharmacies and their characteristics in Ujjain district, Central India

Cited by 45 publications

References 21 publications

Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam, Tanzania

Diagnostic delay and associated factors among patients with pulmonary tuberculosis in Dar es Salaam, Tanzania

Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India

Consequences of low birth weight, maternal illiteracy and poor access to medical care in rural India: infantile iatrogenic Cushing syndrome

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