Data from: Prescription of antibiotics at drug shops and strategies to improve quality of care and patient safety: a cross-sectional survey in the private sector in Uganda

Objectives: The main objective of this study was to assess antibiotic prescription practices 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. Methods: 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. Results: A total of 170 registered drug shops were surveyed between August–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) over-prescribed antibiotics. A third, 29.4% of drug shop providers reported that antibiotics were the first-line treatment of children with diarrhoea; yet the standard guideline is to give Oral Rehydration Salts (ORS) and zinc tablets. Only few providers, 8.2%, had training on antibiotics and 10.6% on pneumonia case management. Further to this, 7.1% drug shops had WHO- Integrated Management of Childhood Illness (IMCI) 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 pneumonia in children according to the guidelines. Conclusion: There is urgent need to regulate drug shop practices of prescribing and selling antibiotics for the safety of patients seeking care at these outlets.

研究目标：本研究旨在评估乌干达穆科诺区注册药店的抗生素处方行为，重点关注儿童上呼吸道感染病例，为改善乌干达私营医疗领域的诊疗质量与患者安全的政策研讨提供数据支撑。研究方法：2014年8月至10月，在乌干达穆科诺区的57个堂区内开展调查，采集了以下变量信息：药店基本特征、从业人员肺炎诊疗相关培训情况、诊疗指南与基础设备可及性、在售抗生素种类、针对5岁以下儿童肺炎诊疗的认知水平。本研究的主要结局指标为私营医疗机构开具抗生素处方的占比。研究结果：2014年8月至10月期间，共完成170家注册药店的调查。其中93.5%的药店均开展抗生素处方业务，常用药物为阿莫西林（Amoxicillin）与甲氧苄啶-磺胺甲恶唑（Trimethoprim-sulfamethoxazole，商品名：Septrin）。医师资质与该处方行为存在显著相关性（p=0.04），低职级从业人员（护理助理与注册护士）存在抗生素过度处方现象。29.4%的药店从业人员认为抗生素是儿童腹泻的一线治疗药物，但标准诊疗指南推荐采用口服补液盐（Oral Rehydration Salts）与锌剂进行治疗。仅8.2%的从业人员接受过抗生素相关培训，10.6%接受过肺炎病例管理培训。此外，仅有7.1%的药店配备世界卫生组织（World Health Organization）儿童疾病综合管理（Integrated Management of Childhood Illness，IMCI）指南，配备呼吸计时器与婴儿体重秤的药店占比极低（<1%）。尽管82.4%的从业人员知晓儿童肺炎的重症体征与症状，但仅17.6%的人员了解指南推荐阿莫西林为儿童肺炎的一线治疗药物。研究结论：为保障在该类药店就诊患者的安全，亟需对药店的抗生素处方与销售行为进行规范管理。