Transcript Role of private pharmacies in TB control in Egypt

Role of private pharmacies in TB
control in Egypt, 2009
Principal investigators
Dr.Sherry Victor / NTP Logistic and DR-TB officer
Dr. Magdy Fawzy/ Research & PAL coordinator, DR-TB consultant
Technical assisstance: Dr Amal Bassili, TB Surveillance officer, STB/WHO/EMRO
Focal point, Tropical Disease Research.
Egypt is a country in North Africa
Area:1,010,000 square kilometers
Population : 79,000,000
Objectives of the study:
General objective:
• To describe the current pattern of TB treatment
regimens used in the private pharmacies in
Egypt
Specific objectives
• To determine the proportion of private pharmacies that have
anti-TB treatment, ATT, in different geographical
governorates;
• To evaluate the prescribing practices of the physicians
referring cases to the private pharmacies for purchasing the
drugs;
• To evaluate knowledge, attitudes and practices, KAP, of the
private pharmacists towards TB;
• To evaluate the feasibility of engaging the private
pharmacists in identifying TB suspects and their referral to
the nearest TBMU for diagnosis.
Study area/Govenorates
• The study was carried out in a representative
sample of all Egyptian governorates.
• Inclusion criteria
- Pharmacies that have been working for at least
3 months whether registered or not
- Consent to participate in the study
Study type
• Cross-sectional survey conducted in one quarter
where pharmacists/pharmacists assistants in a
representative sample of private pharmacies were
interviewed using a questionnaire inquiring the
following information:
• The presence of ATT,
• Their KAP regarding TB,
• Prescribing practices by the pharmacist (over the
counter use of drugs),
• The prescribing practices of the referring physicians,
and the extent of their adherence to the NTP
guidelines.
 Pharmacists were requested to identify and collect
information about TB suspects visiting their
pharmacies during the study period and to refer
them to the nearest TB management unit, TBMU.
 They were subjected to every other week visits by
the field supervisors in each district in order to:
 ensure the quality of data collected
 collect the completed forms
 send them to the NTP central unit
Sample size
• The district is the primary sampling unit for the
study.
• A sampling frame was developed from the list of
pharmacies at the district level in the different
governorates and 30 clusters in 20 governorates
were selected using probability proportionate to
size.
• The final sample size was 960 pharmacies.
• The cluster size was: 960/30= 32 pharmacy in
each selected cluster.
• Only 866 responded in 17 governorates (27
clusters)
Governorate (20)
6-Oct
Alexandria
Assuit
Aswan
Behira
Beni Sweif
Cairo
Daqahlia
Fayoum
Gharbia
Ismaeilia
Kafr Elsheikh
Luxor
Menia
Menofia
Port Saeid
Qaliobia
Qena
Sharqia
Sohag
Participated pharmacies (866)
32
68
32
0
32
32
128
95
32
96
32
32
0
32
32
32
32
0
95
32
Methodology
• Each district was covered by one pharmacist
working at the governorates local authorities
under the supervision of their heads.
• One day orientation was carried (TB overview,
how to choose the selected sample,
questionnaire overview)
• The study period was August, September and
October 2009
Interviewed personnel by gender
70%
65%
60%
50%
40%
35%
30%
20%
10%
0%
Females
Males
Personnel by Job and Gender
* Owners, directors and hired pharmacists
Knowledge about NTP with age
group
80%
70%
70%
68%
66%
63%
59%
60%
58%
53%
47%
50%
41%
40%
30%
30%
42%
34%
37%
Yes
32%
20%
10%
0%
> 25
25-34
35-44
45-54
55-64
65-74
NA
No
Knowledge by governorate
Governorate
Yes (number)
%
Assuit
October
Alexandria
Ismaeilia
Behira
Daqahlia
Sharqia
Gharbia
Fayoum
Cairo
Qaliobia
Menofia
Menia
Beni Sweif
Port Saied
Sohag
Kafr Elsheikh
Grand Total
2
8
19
0
29
43
44
25
19
41
10
25
13
6
2
22
10
318
6%
25%
28%
0%
91%
45%
46%
26%
59%
32%
31%
78%
41%
19%
6%
69%
31%
37%
Source of knowledge
* Media (TV, Radio)
57%
Newspapers
16%
Relatives, friends, peers
11%
**Others
17%
Total
100%
*Highest knowledge was from mass media.
** Others: Pharmacies inspectors, Government obligatory duty after
graduation.
Willing to collaborate with NTP
Yes
684
79%
No
171
20%
Didn’t respond
9
1%
Total
866
100%
Suggested collaboration activities
1-Raising awareness
providing verbal information
2- Distribution of Posters
and fliers
388
45%
121
14%
126
15%
Didn’t specify collaborating
189
22%
Others (specify)
42
5%
866
100%
1&2
Total
Collaboration barriers
• 75% responded that there are no barriers
• 19% mentioned that barriers could be time
constraints, no cases being met, health status
of the pharmacist, not the responsible
personnel to decide…….
• 6% didn’t respond
Suggestions to strengthen
notification to NTP
•
•
•
•
44 % suggested hot line
10% email address
8 % others
38% didn’t offer suggestions
How the pharmacist deal with TB suspects
Dispensing prescribed drugs only
173
20%
Refer suspects to diagnosis
611
71%
Suspicion and referring to treatment
36
4%
Not responding
46
6%
Total
866
100%
Anti-TB medications sold during the study period
Referral site
Drug
(Quinolones)
Public
Public
Private
Hospitals pharmacies Hospital
Private
clinics
Total
11
3
7
31
52
E 500 mg
16
3
4
42
65
H 200 mg
3
0
0
3
6
R 300
22
3
15
154
194
RH (300/150)
11
1
15
108
135
S (1000)
5
1
3
20
29
Z (500)
16
2
8
71
Total
84 (15%)
13 (2%)
97
578
52 (9%) 429 (74%)
TB treatment regimens prescribed
for TB patients
The referring sites were:
• Public hospitals other than NTP units
(minority)
• Private hospitals and clinics (forming the
highest percentage, 83%)
Regimens prescribed
• 446 regimen were prescribed:
– 314 (70%) were mono-therapy either R, Z, E or S
– 78 (17 %) were di-therapy mainly RH
– 44 ( 10%) were treated with combination therapy.
– 5 prescriptions (1%) were with Levofloxacin
(Lfx) in addition to first line drugs.
Recommendations
• Orientation programs to pharmacists working in
private sector concerning TB symptoms, and
referral channels.
• Hot line to NTP aiming at case notifications.
• Distribution of IEC materials to the private sector.
• Strengthening collaboration with private doctors.
• Enhancing community orientation through mass
media.
• Activation of legislation that ban the selling of
anti-TB drugs over the counter.