Description
Introduction: Anti-malarial drug resistance is a significant global concern, and in Africa, Rwanda's confirmation of artemisinin partial resistance is alarming. While causes and development of antimalarial drug resistance are complex and multifaceted, dispensing antimalarials without malaria confirmation is among the main contributing factors. Regrettably, little is known about the magnitude of requests for antimalarial medicines and their dispensing without a prescription in community pharmacies in Rwanda. To address this research gap, this study aimed to explore the request and dispensing of antimalarial medicines without a prescription in community pharmacies across Rwanda and the possible contributing factors.
Methods: An embedded mixed-methods design involving a convenience sample of 235 licensed community pharmacists between February and April 2022 was employed. To simultaneously collect qualitative and quantitative data, a self-administered questionnaire containing a combination of close and open-ended questions was used . Bivariate and multivariate regression analyses were performed to examine the relationship between dispensing antimalarial medicines without a prescription and the selected independent variables. Statistical significance was set at p<.05, and a 95% confidence interval was applied. The factors influencing the dispensing of antimalarial medicines without a prescription were analysed using thematic content analysis.
Results and Discussions: Clients asked most respondents (88.5%) antimalarial medicines without a prescription, and more than half (54%) agreed, but 34.5% refused. This highlights the risk of malaria misdiagnosis, which could exacerbate the burden of antimalarial drug resistance in Rwanda. Pharmacists with rapid malaria diagnostic tests in stock (OR=2.08, 95%CI:1.1-3.94), and belief in over-the-counter antimalarials as over-the-counter medicines (OR=7.03, 95%CI:2.01-24.5) were more likely to dispense these medications without prescriptions. The current regulations can consider expanding the scope of practice for community pharmacists, particularly in malaria management. The primary reasons reported by community pharmacists for dispensing antimalarial medicines without prescriptions included their prior knowledge of malaria diagnosis, client pressure, and fear of losing clients. However, Pharmacists are aware that such practices lead to overuse of antimalarial medicines and antimalarial drug resistance. Therefore, policymakers may prioritize continuous education and training programs for community pharmacists, ensuring Pharmacists are equipped with the latest knowledge and skills necessary to handle various health issues effectively. However, non-adherence to negative results obtained from formal health facilities and long queues at these institutions have also been cited as additional factors driving clients to seek antimalarial medicines without prescriptions.
Conclusion: This study underscores the potential of community pharmacists as accessible healthcare providers. Policymakers should consider measures to further integrate community pharmacists into the healthcare system to enhance patients’ access to malaria services. This can lead to quicker diagnosis, treatment, and referral, ultimately reducing the burden on secondary healthcare facilities. Despite dispensing antimalarials without a prescription, community pharmacists are aware that such practices lead to overuse of antimalarial medicines and antimalarial drug resistance. As a result, they suggested licensing the use of m-RDTs in community pharmacies to limit the presumptive treatment of malaria. This therefore highlights the need for updates in the legal and regulatory framework governing the practice of community pharmacists.
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