Recent trends of antibiotic misuse with its attendant resistance development neccissated this study to determine patient’s perspective and involvement in the use and abuse of antibiotics in the Cape Coast Metropolis of Ghana.
A purposive sampling of 530 patients from 15 years and above patronizing 11 pharmacy shops in the Cape Coast Metropolis was undertaken by administering questionnaires and interviews. 59.9% of the interviewees were aware of the harmful potential of antibiotics abuse yet a significant number (71.5%) purchase antibiotics without prescriptions with 69.9% personally requesting specific drugs without seeking advice from the pharmacists (P<0.01). A significant amount of the antibiotics purchased was Amoxicillin (71.5%) whilst Cold/Running Nose (50.8%) and Cough/Chest pains (33.1%) were the highest reasons for antibiotic purchases respectively.
About 25.4% of patients purchased the drug without any sign or symptom of illness whilst 18.5% of the patients confirmed the drug did not work when used for the illness for which they were purchasing the last time. However, 70.8% of the patients have at least secondary education.
This research work exposes the abuse of antibiotics, the nature of the abuse and the drugs abused in the Cape Coast Municipality of Ghana.
In many African, Asian, and Latin American countries, antibiotics are readily available on demand from hospitals, pharmacies; patient medicine stalls (drugstores), roadside stalls, and hawkers. Inappropriate prescribing of antibiotics has been attributed to a number of causes including people who insist on antibiotics, physicians who simply prescribe them as they feel they do not have time to explain why they are not necessary, physicians who do not know when to prescribe antibiotics or else are overly cautious for medico-legal reasons and those who just prescribe for economic reasons.
A 1998 study in developing countries showed that the wealthiest 15% of the population consumes 48% of the medication dispensed from the country’s pharmacies, whilst the 51% that earns US$600 a month or less consumes only 16%. Observation has shown that the lack of effective monitoring and enforcement of controls on the sale and use of antibiotics is the main cause of growing resistance of the world’s microbes to antimicrobial drugs. The widespread use of antibiotics both inside and outside of medicine has been found to play a significant role in the emergence of resistant bacteria whilst the volume of antibiotic prescribed is the major factor in increasing rates of bacterial resistance rather than compliance with antibiotics.
A third of people for example believe that antibiotics are effective for the common cold whilst 22% of patients on a course of antibiotics primarily do not finish due to that fact that they feel better (varying from 10% to 44% depending on the country). In one study the use of fluoroquinolones was clearly associated with Clostridium difficile infection, which is a leading cause of nosocomial diarrhea in the United States and a major cause of death, worldwide. A study on the influx of antibiotics into Ghana from both local and foreign manufacturers which leads to over-the-counter services without prescription points to antibiotics19. Thus this research seeks to appreciate patient involvement in antibiotic use and abuse in the Cape Coast Metropolis.
Materials and Methods
Subjects: Subjects were selected by purposive sampling of all persons from 15 years and above visiting all 11 pharmacy shops in the Cape Coast Metropolis of Ghana to purchase medication. A total of 530 medication purchasers responded to the questionnaires. The study was undertaken between October, 2009 and April, 2010.
Instrument and Procedure: A questionnaire was developed to answer questions on the educational background, knowledge of antibiotic abuse, hospital attendance, type of antibiotic purchase, whether antibiotic purchase was based on prescription, pharmacists advise or other, reasons for antibiotic purchase, presence or absence of any symptoms, adverse reactions to antibiotics etc. The questionnaire was completed by the subjects or for illiterates by the interviewer in the same study period.
Data analysis was carried out using SPSS 16.0 software. Microsoft Excel was used in obtaining descriptive statistics of the data, after which Statview Version 5.0 from SAS was used in Chi square analysis.