Table 4.
Pharmacy responses to SPs
| Total SP scenarios | Presumptive TB | MDR-TB |
| Frequency/proportion (%) | Frequency/proportion (%) | |
| N=318 | N=320 | |
| Medical history taken* | ||
| No | 123 (38.7) | 75 (23.4) |
| Yes | 195 (61.3) | 245 (76.6) |
| Referral to medical facility | ||
| Total referrals (any of the following) | 39 (12.3) | 116 (36.3) |
| To TB centre | 07 (2.2) | 57 (17.8) |
| To private clinic | 12 (3.8) | 28 (8.8) |
| To district healthcare centre/hospital | 31 (9.7) | 46 (14.4) |
| Referral without giving antibiotics (subgroup of all aforementioned referrals) | 17 (5.3) | 68 (21.3) |
| Number of ‘all medications’ dispensed | ||
| Median (IQR) | 5 (4–6) | 4 (0–5) |
| 0 (no other medicine dispensed) | 24 (7.5) | 86 (26.9) |
| 1 | 2 (0.6) | 1 (0.3) |
| 2 | 2 (0.6) | 4 (1.3) |
| 3 | 30 (9.4) | 23 (7.2) |
| 4 | 66 (20.8) | 64 (20.0) |
| 5 | 105 (33.0) | 83 (25.9) |
| ≥6 | 89 (27.9) | 59 (18.4) |
| Categories of medicines dispensed | ||
| Number different types of medicines received in total | 1475 (100) | 1127 (100) |
| Unlabelled medicines | 436 (29.6) | 311 (27.6) |
| Antibiotics (general) | 244 (16.5) | 217 (19.3) |
| Antibiotics (with anti-TB activity) | 14 (0.9) | 24 (2.1) |
| Cough medicine | 230 (15.6) | 207 (18.4) |
| Steroids/NSAIDS (anti-inflammatory) | 113 (7.7) | 107 (9.5) |
| Antihistamines | 64 (4.3) | 51 (4.5) |
| Pain/fever relief | 46 (3.1) | 16 (1.4) |
| Vitamin supplementary | 70 (4.7) | 32 (2.8) |
| Other identified medicine (bronchodilators, proton-pump inhibitors, etc) | 106 (7.2) | 81 (7.2) |
| Any combined formulation (combination of cough and cold formulations that included antitussives, antihistamines and/or analgesics) | 152 (10.3) | 81 (7.2) |
| Class of antibiotic dispensed† | N=258 | N=241 |
| Fluoroquinolones | 45 (17.4) | 39 (16.2) |
| Broad-spectrum antibiotics other than fluoroquinolones | 202 (78.3) | 190 (78.8) |
| Other antibiotic (includes lincomycins and unknown) | 11 (4.3) | 12 (5.0) |
| Number of pharmacies sold one antibiotic | 238 (92.2) | 196 (78.7) |
| Number of pharmacies sold two antibiotics | 20 (7.8) | 45 (18.7) |
| Prescription for an antibiotic requested by pharmacy staff | ||
| No | 312 (98.1) | 212 (97.5) |
| Yes | 6 (1.9) | 8 (2.5) |
| Antibiotic offered‡ | ||
| No | 32 (10.1) | 95 (29.7) |
| Yes | 286 (89.9) | 225 (70.3) |
| Level of demand required to obtain antibiotic | N=286 | N=225 |
| Level 1 (Can I get some medicine to alleviate the symptoms?) | ||
| Antibiotic given | 264 (92.3) | 218 (96.9) |
| Antibiotic not given | 13 (7.7) | 7 (3.1) |
| Level 2 (Can I get something stronger?) | ||
| Antibiotic given | 13 (4.5) | 3 (1.3) |
| Antibiotic not given | 9 (3.1) | 4 (1.8) |
| Level 3 (I would like an antibiotic.) | ||
| Antibiotic given | 9 (3.1) | 4 (1.8) |
| Antibiotic not given | 0 | 0 |
*Possible history taken by staff in relation to reported symptoms.
†Actual antibiotics received after being verified by study pharmacists.
‡Reported by standardised patient prior to verification by study pharmacists but not necessarily bought by SP due to several reasons (eg, no change cash notes available, told that antibiotics was dispensed but could not find these and vice versa, etc).
MDR-TB, multidrug-resistant tuberculosis; NSAID, non-steroidal anti-inflammatory drug; SP, standardised patient; TB, tuberculosis.