Most pharmacists in Bengaluru--often the first point of contact for many patients of tuberculosis (TB) and childhood diarrhoea--did not follow guidelines on referring a tuberculosis suspect to a healthcare provider for sputum testing, or provided Oral Rehydration Solution (ORS) and Zinc supplements to children with diarrhoea, according to a new study published on September 22, 2017, in BMJ Global Health, a health journal.
“Management of childhood diarrhoea and suspected TB was woefully substandard” across 103 pharmacy chains and 230 independent stores in Bengaluru, found the study, conducted by Rosalind Miller and Catherine Goodman of the Department of Global Health and Development at the London School of Hygiene and Tropical Medicine.
Appropriate care is incredibly important in a country where diarrhoea killed 117,285 children and TB 480,000 people in 2015.
TB--one of the biggest infectious disease killers in India—is curable, but inaccurate treatment can lead to death or drug-resistant TB.
Diarrhoea, which results in dehydration, is a leading cause for malnutrition, a major problem in a country that ranks 114th out of 132 nations in stunting, which refers to low height for age, as IndiaSpend reported in July 2017. Repeated episodes of diarrhoea can also have long-term impact on the growth and potential of children and contribute to a cycle of poverty.
In the Bengaluru study, standardised patients (SP), trained to give symptoms of TB and childhood diarrhoea visited chemists, and reported their experiences to researchers. Pharmacy chains are concentrated in populous cities, with the greatest concentration in South India, the study said.
“History taking of the SP was limited; unnecessary and harmful medicines, including antibiotics, were commonly sold; and advice giving was near non-existent,” found the study. This brings to attention the “lack of guidance for the treatment of minor ailments in the Indian (and other LMIC) pharmacy setting”.
These findings are worrying especially since a high number of patients in India first go to a chemist and not a healthcare provider, the authors wrote. Inaccurate medicines lead to higher mortality, suffering, unnecessary patient spending, and antibiotic resistance.
Both chains and independent stores treated patients similarly but “chains sold significantly fewer harmful antibiotics and anti-diarrhoeals (35% vs 48%),?and prescription-only medicines (37% vs 49%) for the patient with diarrhoea compared with independent shops”, the study found, suggesting that though pharmacy chains are unlikely to solve quality problems in care, they may offer scope for interventions in improving quality.
The study was conducted in one city, and might not be generalizable to other urban centres where chains operate, but similar results were likely since many of the same chains operate across cities, under the same regulatory controls, the authors wrote.
Do Indian chemists follow TB(kills 1315/day), child diarrhoea(kills 321/day) guidelines?thread on @rosalind_miller,Catherine Goodman study— IndiaSpend (@IndiaSpend) September 28, 2017
Patients with std. TB, diarrhoea visited 103 pharmacy chains, 230 independents in Bengaluru. Found ‘woefully substandard’ mgmt of diseases— IndiaSpend (@IndiaSpend) September 28, 2017
<½ pharmacies (43% chains, 45% independents) managed the TB case correctly; none managed diarrhoea correctly https://t.co/DWU2WGhRRL— IndiaSpend (@IndiaSpend) September 28, 2017
Few shops told patient TB treatment available free of charge from govt., ~60% pharmacies sold meds not recommended for TB treatment pic.twitter.com/AeIYp6tFx1— IndiaSpend (@IndiaSpend) September 28, 2017
No shop sold first line anti-TB meds that cannot be sold without prescription— IndiaSpend (@IndiaSpend) September 28, 2017
For diarrhoea, no shops sold recommended ORS, zinc together. 3% of chains, 42% of independents sold antibiotics pic.twitter.com/qhQOZS8VXk— IndiaSpend (@IndiaSpend) September 28, 2017
12% of chains, 10% of independents sold ORT for diarrhoea cases, but in ½ of cases ORT sold with harmful medicines— IndiaSpend (@IndiaSpend) September 28, 2017
One independent and no chains explained the importance of giving the child extra fluids to prevent dehydration— IndiaSpend (@IndiaSpend) September 28, 2017
Dangers of wrong treatment: morbidity, mortality; threat of antimicrobial resistance; needless patient spending— IndiaSpend (@IndiaSpend) September 28, 2017
Theory that chains better than independent pharmacies found false in study but chains sold fewer schedule H, no H1 prescription meds— IndiaSpend (@IndiaSpend) September 28, 2017
Large no. of childhood deaths by diarrhoea in India, high utilisation of pharmacies, suggests need of pharmacy-specific guidelines (11/11)— IndiaSpend (@IndiaSpend) September 28, 2017
(Shah is a reporter/writer with IndiaSpend.)
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