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) Participated pharmacies (866)

6-Oct 32Alexandria 68Assuit 32Aswan 0Behira 32Beni Sweif 32Cairo 128Daqahlia 95Fayoum 32Gharbia 96Ismaeilia 32Kafr Elsheikh 32Luxor 0Menia 32Menofia 32Port Saeid 32Qaliobia 32Qena 0Sharqia 95Sohag 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

Personnel by Job and Gender

* Owners, directors and hired pharmacists

Knowledge about NTP with age group

Knowledge by governorate

Source of knowledge

*Highest knowledge was from mass media.** Others: Pharmacies inspectors, Government obligatory duty after graduation.

Willing to collaborate with NTP

Suggested collaboration activities

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

Anti-TB medications sold during the study period

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.