Impact of a face-to-face educational intervention on improving the management of acute respiratory infections in private pharmacies and drug shops in Uganda
BACKGROUND: In Uganda, although private retail pharmacies and drug shops are the most common sources of drugs for the majority of the population, the quality of care received from these outlets has been reported as suboptimal. It is believed that lack of adequate knowledge is an important underlying factor to such practices.
OBJECTIVES: In this study, we investigated the impact of a face-to-face educational intervention on counter attendants' dispensing behaviour for mild and severe acute respiratory infections (ARI) in children at private pharmacies and drug shops.
STUDY DESIGN AND SETTING: We used a quasi-experimental research design with comparison groups to analyse counter attendants' management of ARI before and after an intervention. The study was conducted in Kampala District, and used a sample of 191 registered drug outlets (27 pharmacies and 164 drug shops), stratified into two groups: 1) An experimental group that received training; 2) A control group unexposed to training. Data on the practices in the drug outlets from both groups were collected at two time-points: seven months before the intervention, and at one-month after the intervention.
OUTCOME MEASURES: Two main outcome measures were considered: a) Assessment of the child's condition. b) The dispensing practices of counter attendants.
RESULTS: The study found that despite the training, the assessment of the child's condition remained inadequate in both groups, where the child's age was the only question asked in more than 90% of cases. High levels of inappropriate dispensing practices for both mild and severe ARI were still persistent in both groups after the intervention. Antibiotic prescribing for both conditions was very common, and barely any advice or instruction was given with dispensed drugs. Client demand for particular drugs, competition among drug outlets, and inability of most clients to afford the recommended treatments were the main reported barriers that emerged from the focus group discussions with the counter attendants.
CONCLUSIONS: The evaluation of the practices one month after the face-to-face educational intervention showed that the management of ARI did not improve in the drug outlets. While study design issues may have contributed to such findings, there are many other factors not related to knowledge and education that may indirectly hamper the promotion of appropriate dispensing in the private pharmacies and drug shops in Uganda. It is possible that a combination of interventions may contribute to improved management of ARI by counter attendants in the private drug shops and pharmacies in Uganda.