Evaluating access to Anti-malaria medicines and quality of Service delivery by community pharmacies and licensed chemical shops in Ashanti Region, Ghana.

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In Ghana, most people seek primary healthcare from either their families, relatives or from the private pharmaceutical service providers (ie community pharmacies and licensed chemical shops) rather than from hospitals and clinics initially. Private pharmaceutical facilities are the main port of call for the management of uncomplicated in sub-Saharan Africa. However, often the course of treatment given is sub-optimal. The objectives of the study were to assess the stocks of anti-malarials in private pharmaceutical service provider’ facilities and their operating hours, the quality assurance procedures available in the facilities, their knowledge in malaria control and to evaluate the study communities’(Kumasi Metropolitan (KMA) and Obuasi Municipal (OMA) Assemblies) health seeking behavior and their level of awareness in malaria control. Two complementary studies, the Drug Availability Study (DAS) and the Drug Use Study (DUS) were employed to determine the degree to which the medicines recommended for the treatment of malaria are available and used. Four data collection techniques were used namely; structured interviews, simulated client interviews, Focus Group Discussions (FGDs) and document reviews. The mystery clients posed either as caretakers of children under-5 years, pregnant women, or adults all presenting signs of clinical malaria in all the fifty (50) pharmaceutical facilities sampled. In addition, key informant semi-structured interviews were conducted to ascertain their views about the study. The knowledge and practices of staff of pharmacies and LCS shops in malaria control was generally acknowledged to be inadequate and not consistent with the current Anti-Malaria Drug Policy (AMDP). Ninety four (94%) percent of community pharmacies and 28% of LCS shops had the recommended anti-malaria medicines available in their facilities. 53% of LCS shops had Sulphadoxine-Pyrimethamine (SP) as the only anti-malaria medicine in their facilities. None of the LCS Shops managed mystery client with uncomplicated malaria according to the policy whilst 47% of community pharmacies did manage according to policy. Only 25% and 28% of LCS shops and community pharmacies respectively discussed malaria prevention with mystery clients. Also, 19% of LCS shops and 6% of community pharmacies respectively promoted ITNs use to mystery clients. However, only 3% of LCS and none of the community pharmacies gave instruction on the use of the ITNs offered to the client. Besides, none of the facilities enquired about the malaria immune status of the client. Regular and comprehensive training of all staff of pharmacies and licensed chemical shops in malaria control presents a feasible strategy for achieving significant improvements in malaria control considering their large numbers and extensive distribution in almost every community or village in Ghana
A Thesis submitted to the Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology in partial fufilment for the degree of Master of Science