Assessment of pharmacies at community level in Rawalpindi, Pakistan
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
Drug sellers operating in the informal sector are often the first source of health care in developing countries. However majority of them have minimal formal education or professional training and inappropriate dispensing practices. Augmenting this problem are the pharmaceutical companies (which influence over the counter sales of medicines at pharmacies through aggressive marketing strategies) and the relative paucity of health services. This interplay of factors contributes towards drug side effects, antibiotic resistance, self-medication, and the commodification of health. Therefore to enhance the prevailing health care system in Pakistan, it is essential that special attention be paid to pharmacies; where along with sale of medicines, information and advice on common health problems and treatment is sought routinely. To achieve this purpose, a cross-sectional study was conducted to estimate the prevalence of pharmacies meeting licensing requirements and identify factors associated with pharmacies meeting licensing requirements in urban Rawalpindi. A simple random sample of 311 pharmacies selling allopathic medications in urban Rawalpindi was obtained from July to September 2001. From each pharmacy, a pharmacist or in case of non-availability, the most experienced person in terms of working as a drug seller was interviewed using a structured questionnaire. Prevalence of pharmacies situated in urban Rawalpindi meeting licensing requirements was 19.3% (95 % C.I, 15.1, 24.2) in our study. Mean age of the drug sellers was 39 years, almost all of them (99%) being males. About one-fifth (22%) were qualified as pharmacists. A major proportion of drug sellers (7l %) obtained their current knowledge of drugs from representatives of pharmaceutical companies while only 6Vo of the pharmacies had a visibly displayed license. The majority (76Vo) had a refrigerator present however a temperature-monitoring device or an alternate power supply for the refrigerator was found in scarcity with figures of 10% and 4% respectively. Vaccines were available in 60Vo of the pharmacies. Pharmacies meeting licensing requirements were more likely to have, a knowledge of not giving Septran (a prescription drug) without prescription (OR = 2.0, 95% CI: 1.1, 3.6), knowledge of the temperature range for vaccines (OR - 2.6i 95% CI: 1.4, 4.8), vaccines available (OR = 2.8, 95% CI: 2.g, 18.4) and alternate power supply for the refrigerator (OR = 6.0; 95% CI: 1.5, 23.7) than pharmacies not meeting licensing requirements. The practice of selling drugs without a prescription was not found to have a significant association (OR = l.li 95% CI: 0.5, 2.3) with pharmacies meeting licensing requirements however it did show a trend indicating discrepancy between knowledge and practice. Most of the pharmacies did not meet licensing requirements. Therefore existing legislations should be enforced. Additionally special training programs and courses should be directed towards drug sellers to enhance their knowledge and to promote safer drug practices. It is also necessary to involve pharmaceutical companies, being major source of drug information for the drug sellers through medical representatives and to conduct more studies integrating simulated client method and direct observation techniques to further assess the situation of pharmacies in Pakistan.
Butt, Z. A. (2002). Assessment of pharmacies at community level in Rawalpindi, Pakistan (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.