Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania.
Management Sciences for Health, Arlington, VA USA.
Antimicrob Resist Infect Control. 2015 Jul 21;4:30. doi: 10.1186/s13756-015-0073-4. eCollection 2015.
Tanzania introduced the accredited drug dispensing outlet (ADDO) program more than a decade ago. Previous evaluations have generally shown that ADDOs meet defined standards of practice better than non-accredited outlets. However, ADDOs still face challenges with overuse of antibiotics for acute respiratory infections (ARI) and simple diarrhea, which contributes to the emergence of drug resistance. This study aimed to explore the attitudes of ADDO owners and dispensers toward antibiotic dispensing and to learn how accreditation has influenced their dispensing behavior.
The study used a qualitative approach. We conducted in-depth interviews with ADDO owners and dispensers in Ruvuma and Tanga regions where the government implemented the ADDO program under centralized and decentralized approaches, respectively; a secondary aim was to compare differences between the two regions.
Findings indicate that the ADDO program has brought about positive changes in knowledge of dispensing practices. Respondents were able to correctly explain treatment guidelines for ARI and diarrhea. Almost all dispensers and owners indicated that unnecessary use of antibiotics contributed to antimicrobial resistance. Despite this knowledge, translating it to appropriate dispensing practice is still low. Dispensers' behavior is driven by customer demand, habit ("mazoea"), following inappropriate health facility prescriptions, and the need to make a profit. Although the majority of dispensers reported that they had intervened in situations where customers asked for antibiotics unnecessarily, they tended to give in to clients' requests. Small variations were noted between the two study regions; for example, some dispensers in Ruvuma reported sending clients with incorrect prescriptions back to the health facility, a practice that may reflect regional differences in ADDO implementation and in Integrated Management of Childhood Illness training. Dispensers in rural settings reported more challenges in managing ARI and diarrhea than their urban counterparts did.
To reduce inappropriate antibiotic use, integrated interventions must include communities, health facilities, and ADDOs. Periodic refresher training with an emphasis on communication skills is crucial in helping dispensers deal with customers who demand antibiotics. Responsible authorities should ensure that ADDOs always have the necessary tools and resources available.
坦桑尼亚十多年前推出了认证药品销售点（ADDO）计划。以往的评估普遍表明，ADDO 比非认证销售点更符合实践标准。然而，ADDO 仍然面临着过度使用抗生素治疗急性呼吸道感染（ARI）和简单腹泻的挑战，这导致了耐药性的出现。本研究旨在探讨 ADDO 所有者和药剂师对配药的态度，并了解认证如何影响他们的配药行为。
该研究采用定性方法。我们在鲁伍马和坦噶地区分别对政府采用集中和分散方法实施 ADDO 计划的 ADDO 所有者和药剂师进行了深入访谈；次要目的是比较两个地区之间的差异。
调查结果表明，ADDO 计划使配药实践知识发生了积极变化。受访者能够正确解释 ARI 和腹泻的治疗指南。几乎所有的药剂师和所有者都表示，不必要地使用抗生素导致了抗微生物耐药性。尽管有了这些知识，但将其转化为适当的配药实践仍然很低。药剂师的行为受到客户需求、习惯（“mazoea”）、遵循不适当的医疗机构处方以及盈利需求的驱动。尽管大多数药剂师报告说，他们已经在客户不必要地要求抗生素的情况下进行了干预，但他们往往会听从客户的要求。两个研究地区之间存在一些细微差异；例如，鲁伍马的一些药剂师报告说，他们将拿着不正确处方的客户送回医疗机构，这种做法可能反映了 ADDO 实施和儿童疾病综合管理培训方面的地区差异。农村地区的药剂师报告说，与城市地区相比，他们在管理 ARI 和腹泻方面面临更多挑战。
为了减少不适当的抗生素使用，综合干预措施必须包括社区、卫生机构和 ADDO。定期进行重点强调沟通技巧的复习培训对于帮助药剂师应对要求使用抗生素的客户至关重要。责任当局应确保 ADDO 始终有必要的工具和资源可用。
