Mbonye Anthony K, Buregyeya Esther, Rutebemberwa Elizeus, Clarke Siân E, Lal Sham, Hansen Kristian S, Magnussen Pascal, LaRussa Philip
Ministry of Health, Directorate of Clinical and Community Services, Kampala, Uganda Department of Community & Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda.
Department of Disease Control & Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
BMJ Open. 2016 Mar 15;6(3):e010632. doi: 10.1136/bmjopen-2015-010632.
The main objective of this study was to assess practices of antibiotic prescription at registered drug shops with a focus on upper respiratory tract infections among children in order to provide data for policy discussions aimed at improving quality of care and patient safety in the private health sector in Uganda.
A survey was conducted within 57 parishes from August to October 2014 in Mukono District, Uganda. Data was captured on the following variables: drug shop characteristics, training of staff in management of pneumonia, availability of guidelines and basic equipment, available antibiotics, knowledge on treatment of pneumonia in children aged <5 years. The main study outcome was the proportion of private health facilities prescribing an antibiotic.
A total of 170 registered drug shops were surveyed between August and October 2014. The majority of drug shops, 93.5% were prescribing antibiotics, especially amoxicillin and trimethoprim-sulfamethoxazole (septrin). The professional qualification of a provider was significantly associated with this practice, p=0.04; where lower cadre staff (nursing assistants and enrolled nurses) overprescribed antibiotics. A third, 29.4% of drug shop providers reported that antibiotics were the first-line treatment for children with diarrhoea; yet the standard guideline is to give oral rehydration salts and zinc tablets. Only few providers, 8.2%, had training on antibiotics, with 10.6% on pneumonia case management. Further to this, 7.1% drug shops had WHO-Integrated Management of Childhood Illness guidelines, and a negligible proportion (<1%) had respiratory timers and baby weighing scales. Although the majority of providers, 82.4%, knew severe signs and symptoms of pneumonia, few, 17.6%, knew that amoxicillin was the first-line drug for treatment of pneumonia in children according to the guidelines.
There is urgent need to regulate drug shop practices of prescribing and selling antibiotics, for the safety of patients seeking care at these outlets.
本研究的主要目的是评估注册药店的抗生素处方行为，重点关注儿童上呼吸道感染情况，以便为旨在提高乌干达私营卫生部门医疗质量和患者安全的政策讨论提供数据。
2014年8月至10月在乌干达穆科诺区的57个教区进行了一项调查。收集了以下变量的数据：药店特征、员工肺炎管理培训情况、指南和基本设备的可获得性、可用抗生素、对5岁以下儿童肺炎治疗的知识。主要研究结果是开具抗生素的私营卫生机构的比例。
2014年8月至10月期间共调查了170家注册药店。大多数药店（93.5%）开具抗生素，尤其是阿莫西林和复方新诺明（百炎净）。提供者的专业资格与这种行为显著相关，p = 0.04；低级别工作人员（护理助理和注册护士）抗生素处方过量。三分之一（29.4%）的药店提供者报告称抗生素是腹泻儿童的一线治疗药物；然而标准指南是给予口服补液盐和锌片。只有少数提供者（8.2%）接受过抗生素培训，10.6%接受过肺炎病例管理培训。此外，7.1%的药店有世界卫生组织的《儿童疾病综合管理》指南，比例可忽略不计的药店（<1%）有呼吸定时器和婴儿体重秤。尽管大多数提供者（82.4%）知道肺炎的严重体征和症状，但只有少数（17.6%）知道根据指南阿莫西林是儿童肺炎治疗的一线药物。
为了在这些机构就诊患者的安全，迫切需要规范药店开具和销售抗生素的行为。
