ASSESSMENT OF GOOD DISPENSING PRACTICES IN

PRIVATE DRUG STORES IN JIMMA TOWN, GINJO KEBELE.

BY: ASINAT NIGUSE

A RESEARCH PAPER SUBMITTED TO DEPARTMENT OF

PHARMACY, COLLEGE OF HEALTH SCIENCE, JIMMA UNIVERSITY,
FOR PARTIAL FULFILMENT OF BACHELOR DEGREE IN PHARMACY
(B. PHARM)

JUNE, 2021

JIMMA, ETHIOPIA
 JIMMA UNIVERSITY
COLLEGE OF HEALTH SCIENCES
DEPARTEMENT OF PHARMACY

This is to certify that this research paper prepared by ASINAT NIGUSE, entitled: “Assessment
of Good Dispensing Practice in Private Drug store in JIMMA Town, GINJO KEBELE , South
West Ethiopia” and submitted in partial fulfilment of the requirements for the bachelor degree of
pharmacy complies with the regulations of the university and meets the accepted standards with
respect to originality and quality.

Signed by the Examining Committee:

Examiner: ___________________________ Sig.______________ Date _____________

Advisor: ___________________________ Sig.______________ Date _____________

_____________________________________________
Chair, Department of Pharmacy

I
 ACKNOWLEDGEMENT

I would like to acknowledge JIMMA University, college of health science, department of

pharmacy for giving me this opportunity. I would like to express my heartfelt gratitude to my
advisor DR: RAGHA VENDRAY. Lastly, but not least I would like to extend my appreciation to
my family for their encouragement and irreplaceable assistance throughout the completion of this
research.

I
Table of ContentY

ACKNOWLEDGEMENT........................................................................................................................... I
Table of Content......................................................................................................................................... II
LIST OF ABBREVIATION...................................................................................................................... IV
LIST OF TABLES...................................................................................................................................... V
LIST OF FIGURES................................................................................................................................... VI
ABSTRACT............................................................................................................................................ VII
1. INTRODUCTION................................................................................................................................... 1
1.1 Background....................................................................................................................................... 1
1.2 Statement of the Problem................................................................................................................... 4
1.3 Significance of the Study................................................................................................................... 5
2. LITERATURE REVIEW........................................................................................................................ 6
3. OBJECTIVES......................................................................................................................................... 8
3.1 General Objective.............................................................................................................................. 8
3.2 Specific Objectives............................................................................................................................ 8
4. METHODOLOGY.................................................................................................................................. 9
4.1 Study area and Study Period.............................................................................................................. 9
4.2 Study Design..................................................................................................................................... 9
4.3 Populations........................................................................................................................................ 9
4.3.1 Source Population....................................................................................................................... 9
4.3.2 Study Population......................................................................................................................... 9
4.4 Inclusion and exclusion criteria......................................................................................................... 9
4.4.1 Inclusion criteria......................................................................................................................... 9
4.4.2 Exclusion criteria........................................................................................................................ 9
4.5 Sample size and sample techniques................................................................................................. 10
4.6 Study Variable................................................................................................................................. 10
4.6.1 Dependent variables.................................................................................................................. 10
4.6.2 Independent variables............................................................................................................... 10
4.7 Data collection procedure................................................................................................................ 10
4.7.1 Data Collection Instrument....................................................................................................... 10
4.7.2 Data Collection......................................................................................................................... 10
4.7.3 Data Quality Assurance............................................................................................................ 11

II
 4.7.4 Data Process and Analysis........................................................................................................ 11
4.8 Ethical consideration....................................................................................................................... 11
4.9 Plan for Dissemination of Result..................................................................................................... 11
4.10. Operational definition................................................................................................................... 12
5. RESULTS.............................................................................................................................................. 14
6. DISCUSSION....................................................................................................................................... 21
7. CONCLUSION..................................................................................................................................... 23
8. RECOMMENDATION......................................................................................................................... 24
9. LIMITATION OF THE STUDY........................................................................................................... 25
REFERENCE............................................................................................................................................ 26
ANNEX..................................................................................................................................................... 28

LIST OF ABBREVIATION

DRO:-Drug retail outlets

III
OTC:-Over the counter

POM: - Prescription only medications

WHO: World health organization

STG: Standard treatment guideline

EDL: -Essential Drug List

FMHACA:-Food, Medicine and HealthCare Administration and Control Authority

PFSA: - Pharmaceutical fund and supply agency

LIST OF TABLES
Table 1 Socio-demographic characteristics of respondents in drug retail out lets of jimma town,
Ginjo kebele,south west Ethiopia June, 2021................................................................................15

IV
Table 2 Standard reference book used by drug retail outlets found in Jimma town, Ginjo kebele
South West Ethiopia, June, 2021...................................................................................................17
Table 3 Dispensing practice of drug retail outlets found in Jimma town, Ginjo Kebele south west
Ethiopia, June, 2021......................................................................................................................18
Table 4 Types of prescription errors encountered and measures taken by drug retail outlets
found in Jimma town,Ginjo Kebele south west Ethiopia, June, 2021........................................19
Table 5 Labeling practice and type of labeling systems used by DROs found in Jimma
town,Ginjo Kebele South West Ethiopia, June, 2021...................................................................20
Table 6: Dispensing time for each patient at selected drug store in Jimma town, Ginjo Kebele
,south west Ethiopia, June, 2021...................................................................................................21
Table 7 The number of drug prescribed per prescription and number of drug dispensed in Jimma
town, Ginjo Kebele south west Ethiopia,June,2021......................................................................21
Table 8:Assessing of patient knowledge from selecting drug store inJima town,south west
Ethiopia,June,2021........................................................................................................................22

LIST OF FIGURES
Figure 1 Standard Reference book used in all drug store, Jimma Town,Ginjo Kebele , southwest
Ethiopia, June 2021.......................................................................................................................16

V
Figure 2 Information source did owners used for update them self in all drug store, Jimmatown,
Ginjo Kebele South west Ethiopia, June 2021..............................................................................17
Figure 3 Respondents that Dispense and not dispense prescribed drugs after 15 days at drug retail
outlets found in Jimma town,Ginjo Kebele South West Ethiopia, June, 2021..............................18
Figure 4 Drug information mostly provided to patient during dispensing by drug retail out let
found in Jimma town ,Ginjo Kebele south west Ethiopia, June, 2021..........................................20

ABSTRACT
Introduction: A community pharmacy, often referred to as retail pharmacy or retail drug outlet,
is place where medicines are stored and dispensed, supplied or sold. Community pharmacy is
expected to provide support for patients to improve adherence to prescribed medicines. In the
hospital and community pharmacy setting, counseling patients is one of the key roles that

VI
pharmacists offer. Similarly, the pharmacist also serves as a vital source of drug information for
the physician and patients.

Method: A cross sectional study was conducted from June, 2021 in all drug store at Jimma
Town, Ginjo Kebele South west Ethiopia. Simple random sampling was used and according to
WHO standard guideline thirty clients from March 18-24, 2021; six sample drug store was
selected and semi-structured and structured questionnaire was used. The findings was analyzed
the result of the finding was presented by using tables, graph and chart.

Results: Out of the 18 respondents in drug retail out let, the largest number of the respondents
belonged to 25-40 age groups. 72.2% were males. 12 (66.7%) did not dispense prescribed drugs
after 15 days. Fourteen (77.8%) practitioners sometimes dispense drugs without prescription and
four (22.2%) never dispense drugs without prescription. Thirteen (72.2%) respondent
encountered incomplete prescriptions and 3(16.7%) had encountered illegible prescriptions.
Fourteen (77.8%) were communicating back with the prescriber, as measure taken for
prescriptions error minimization. From total respondents 9(50%) had standard treatment
guidelines and 4(22.2%) had Formulary.
Conclusion and Recommendation: Most of respondent in drug retail outlets were dispense
prescribed drug with inadequate labeling and not provides all necessary drug information.
Almost all respondents had encountered incomplete prescriptions and encountered illegible
prescriptions. More of practitioners had standard treatment guidelines used as reference material.
Key words: Drug retail outlets, Prescription, Dispense

VII
 1. INTRODUCTION

1.1 Background

Community pharmacy is one of the health care services close to people. The role of this
pharmacy is not only for distributing medication to the community but also acting as a place
that people in the community can rely on when they have health problems. A community
pharmacy is one of their choices when they have a common illness. The main responsibilities of
a community pharmacy include compounding, counseling, and dispensing of drugs to the
patients with care, accuracy, and legality along with the proper procurement, storage, dispensing
and documentation of medicines. The practice of community pharmacy includes not only the
dispensing of medicines but also the provision of information and services that encourage the
quality use of medicines (1).

A community pharmacy, often referred to as retail pharmacy or retail drug outlet, is place where
medicines are stored and dispensed, supplied or sold. The general population usually calls
community pharmacies "medical stores. Community pharmacies have quite a distinct and unique
position in healthcare delivery system as they are the first and/or final contacts between patients
and drugs in majority of cases. All over the world, community pharmacies act on a business
model but they are regulated by health laws (2).

In the past, the responsibility of the pharmacist was only to dispense medicines, but nowadays
the traditional role of pharmacist has been modified and Pharmacists play a role as a vital
team member in the direct care of patients. In the hospital and community pharmacy setting,
counseling patients is one of the key roles that pharmacists offer. Counseling of patients has
a vital role in the outcomes of therapy. Similarly, the pharmacist also serves as a vital source of
drug information for the physician and patients. Community pharmacists are the health
professionals most accessible to the public. They supply medicines in accordance with a
prescription or, when legally permitted, sell them without a prescription (3).

1
Community pharmacy is expected to provide support for patients to improve adherence to
prescribed medicines, by counseling on advantage of taking right drug for right duration and
frequency, and to help doctors rationalize their prescription. Traditionally, the pharmacists
primary responsibility has been the correct dispensing of drugs and maintain the pharmaceutical
quality of the drugs dispensed. Nowadays, their role has increased to involve advising the
physician and other health professionals about drug therapy, counseling patients about drugs and
monitoring drug use (4).

According to US health care financing administration, Americans Pharmacy services are the
provision or sale of pharmaceutical products by drug retailers. In developing countries, drug
retailers include pharmacists and drug sellers. Pharmacists are individuals who have had formal
training in dispensing pharmaceutical products. In contrast, drug sellers include individuals who
are associated with pharmacies, but do not have formal training in dispensing pharmaceutical
products. Moreover, drug sellers encompass individuals that provide access to pharmaceutical
products outside of the pharmacy. Prescribing -- If prescribing practices are inappropriate, it may
prolong or aggravate a patient's illness. Furthermore, medicines may be used unnecessarily,
creating an unwarranted financial burden for patients (5).

Drugs are among the most salient and cost effective elements of health care and often a key
factor for success of health sector reforms because drugs make healthcare delivery credible by
relieving symptoms and curing disease. These diseases can be prevented, treated or alleviated
with appropriate use of drugs and vaccines. The world health organization (WHO) indicates the
most leading causes of death and disabling particularly in developing countries is due to lack of
accessibility to the drugs (6, 7).

Appropriate use of drugs is also one of the essential elements in achieving quality of health and
medical care for the patients and the community. It has been reported that in most of the cases
dispensers lack formal education and training and those who are trained are mostly not available
at these pharmacies. While supplying medicines it is important to understand that which
medicines can be sold with or without prescription. However studies have reported sale of
prescription only medicines to all patients irrespective of any moral and legal considerations (8).

2
Despite of progress in accessibility of drugs made over the last twenty years, about one third of
the world’s population still lack access to essential drugs, and in developing countries the
proportion is much higher. Irrational use of drugs when they are not needed has been a persistent
global problem (9).

Community pharmacies in developing countries often lack qualified and trained personnel to
store, label and handle medicines in appropriate way; mainly due to an acute shortage of
qualified pharmacists practicing at community pharmacy setting and lack of standard practice
guidelines (10). Lack of dispensers’ qualification, knowledge and skills could lead to medication
errors and increase adverse medicine outcomes, thus compromising at the desired therapeutic
outcomes and safety of the therapy (11).

3
 1.2 Statement of the Problem

Irrational drug use occurs for different reasons. Such as use of wrong or ineffective drugs, under
use or incorrect use of effective drugs. These actions have an adverse impact on the quality of
drug therapy and cost and may cause adverse reactions or negative psychological impacts.

The dispenser plays a crucial role in the therapeutic process, and the quality of dispensing may
be affected by the training and supervision the dispenser has received and the drug information
available to the dispenser. A shortage of dispensing materials and short dispensing time due to
heavy patient load may also have an adverse impact on dispensing. The low status of dispensers
also affects the quality of dispensing (12).

Community pharmacies in developing countries often lack qualified and trained personnel to
store, label and handle medicines in appropriate way; mainly due to an acute shortage of
qualified pharmacists practicing at community pharmacy setting and lack of standard practice
guidelines (10). Therefore this study was conducted to assess good dispensing practice of drug
retail outlets in Jimma town, Ginjo Kebele, south west Ethiopia.

1.3 Significance of the Study

The information generated from this study will be helpful to determine the real problems and
help for further investigation. It also serves as source of data for Jimma town, Ginjo Kebele

4
health office to design appropriate strategy for drugs store management. The result of this study
will help policy makers, health planners and service providers to develop drugs store
management strategy. This study will also use as a base line for further assessments in the area of
community pharmacy by other investigators.

2. LITERATURE REVIEW

In Pakistan, the study done on community pharmacy showed that the average age of pharmacy
attendant lies between 21 and 30 years. It was noted that only 22.6% check prescriber signature

5
before dispensing prescription. Interestingly, 44.93% of the attendants dispense drugs even if
they cannot understand prescriber's handwriting and 45% are sure that they dispense the correct
drug. Similarly, only few respondents (11.39%) told that they return back the prescription in the
case if it does not contain prescriber's signature this study observed the responses of pharmacy
attendants for various activities and it was found that 86.7% respondents agreed that the
handwriting of prescribers does not make any legibility problem to them. However, 81% of these
respondents were unable to understand the prescription orders written by doctors other than their
area (14).

A study done in the Mambere-Kadei health district of the Central African Republic in April 2008
shows 21.2% of the dispensed drugs were inadequately labeled. Patients understood the
modalities of use for 69.6% of prescribed drugs. The averaged dispensing time was 5 minutes.
Excessive use of antibiotics and injections blunderbuss therapy was observed. Other problems
identified in the survey include poor information on drug use, inadequate labeling of dispensed
drugs and lack of access to standard drug use tools such as a locally doped Essential Drug list,
Formularies and standard Treatment Guidelines (15).

A study done on 2008 in Ghana show that in most developing countries drug dispensing is
usually done by untrained staff. Only 8.35%of the dispensing staff actually interacting with
patients had received formal training as dispensers. The rest were mainly dispensing assistants,
dispensary attendants, medical assistants, muses or orderlies (16).

A study done in Harar town on a total of 41 drug retail outlet showed that 26(63.4%) of which
were drug store and 15(36.6) were pharmacy. 25(69.4%) of respondents were male and 34
(94.4%) of drug retail outlets select over the counter drugs, 22 (61.1%) of the dispensers
always check legality of prescription in dispensing and 26 (72.2%) label all medications before
dispensing. 30 (83.3%) of the dispensers give counseling for all dispensed prescription drugs and
29 (80.6%) of the patient advice include Adherence, frequency and duration, and storage and 20
(55.6%) of the dispensers provide drug and health information for their community(17).

A study conducted on 15 community pharmacy in Ambo Town, Ethiopia showed that, Out of
18 dispensers working at these settings, only 3(16.7%) were pharmacists and the rest 15( 83.3%)

6
 were druggist. For most of the clients (90%), drugs were dispensed without checking patients’
identity like age. While for 6.7% wrong strength, 12% incorrect frequency and 24.4% incorrect
total quantity were dispensed. Dispensing spoon was the only dispensing aid available at all
settings. None of them were found to check the temperature of the refrigerator regularly and
maintained within acceptable range (4).

The study conducted on assessment of the dispensing practices of drug retail outlets in selected
towns, North West Ethiopia, showed that the average dispensing time was 1.86 minutes while
the provision of written information was about 66 %. A study done in North-west Ethiopia shows
that 3.8% of the patients was non-compliant with the drug regiments due to misunderstanding of
instructions (18).

3. OBJECTIVES

3.1 General Objective

 To assess Good dispensing practice in private drug store of Jimma Town,Ginjo Kebele
South West Ethiopia

7
3.2 Specific Objectives
 To assess the drug labeling practices
 To assess drug information counseling practice
 To assess availability of resources for dispensing

4. METHODOLOGY

4.1 Study area and Study Period

This study was conducted in Community drug store found in Jimma Town,Ginjo Kebele,wich is
located 350 KM far from addis abeba in the south west direction .it has 111 pharmacis, 69 drug
store,3 private Hospitals, 2 governmental Hospitals and 4 Health centers.

8
 4.2 Study Design

A descriptive cross sectional study design was utilized.

4.3 Populations

4.3.1 Source Population

All dispensers working at drug retail outlets and all clients

4.3.2 Study Population

All dispensers who are works at drug retail outlets of Jimma town, Ginjo Kebele and thirty
clients from each selected six drug store

4.4 Inclusion and exclusion criteria

4.4.1 Inclusion criteria

 All dispensers who are available at selected drug store

 Functioning drug retail outlets during study period.
 Client comes to selected drug store during data collection period.

4.4.2 Exclusion criteria

 Non-professional person who dispense drugs.

 Pharmacy professionals who are not willing to respond.

4.5 Sample size and sample techniques

All drug stores found in Jimma town,Ginjo Kebele included in this study and based on WHO
guidline 30% of them were selected to access patient related data. Therefore six drug store were

9
 selected randomly and from each of them thirty clients came during data collection are included
in this study (7). .

4.6 Study Variable

4.6.1 Dependent variables

 Good dispensing practices

4.6.2 Independent variables

 Training
 Supervision
 Work experience
 Qualification
 Working set up
 Type of retail drug outlet
4.7 Data collection procedure

4.7.1 Data Collection Instrument

Data was collected by using prepared questionnaires to collect data from druggist and clients and
also checklist was applied to abstract data through observation. Data Collection Instrument
composed of both closed and open-ended questionary. The questioner contains socio-
demographic background information, knowledge and experience on dispensing practice, patient
care indicators. Data was collected by 5th yr pharmacy student.

4.7.2 Data Collection

Data was collected using prepared questionnaires and checklist which composed of both closed
and open-ended questions. The principal investigator was involved in the data collection. Data
collection was both interview and observation, and an observational study using checklists
containing standards and some general criteria were carried out.

10
 4.7.3 Data Quality Assurance

The data collection tool was carefully designed to extract all necessary information needed to
meet study objectives. Completeness and consistency of the collected data was ensured by
making frequent checks on the data collection process.

4.7.4 Data Process and Analysis

The collected data was entered, cleaned & rechecked for its completeness, anomalies and
consistency again and stored in to Epi info version 3.5 and then was exported to SPSS window
versions 21 for analysis. The result was presented as frequency tables, graphs chart and discussed
with previous findings. Finally, possible recommendation was made based on the findings of the
study.

4.8 Ethical consideration

A formal letter of cooperation was obtained from Jimma University college of Health Sciences
Department of Pharmacy. After that Permission was obtained from each selected drug store to
cascade the research. After explaining the purpose of the study, the principal investigators were
obtain voluntary verbal consent from each study participant. The participants were informed that
participation was on voluntary basis and they could withdraw from the study at any time if they
were not comfortable about the questionnaire. Personal identifier was not be included so that a
participant`s confidentiality was assured.

4.9 Plan for Dissemination of Result

The final result of this paper will be presented to Jimma University; College of Health Science
School of pharmacy.

4.10. Operational definition

Community pharmacy: is defined broadly to include all those establishments that are
privately owned and whose function, in varying degrees, is to serve societies need for both
drug products and pharmaceutical services

11
 Rational use of drug: is receiving medications that are appropriate to their clinical needs, in
needs, in doses that meet their own individual requirements for an adequate period of time
and at the lowest cost to them and their community.

Standard treatment guidelines (STGs): STGs are disease-oriented guidelines that reflect a
consensus on the treatments of choice for common medical conditions. They help
practitioners make decisions about appropriate treatments and help to minimize variation in
treatments offered by practitioners in the health care system.

Drug retail outlets: place where drugs are dispensed to patient. It includes rural drug
vendors, drug shops, drug store and pharmacy and health institutions pharmacies.

Patient medication counseling: A “one to one” interaction b/n dispensers and a patient
and/or care giver. At a minimum it should include how to take medication and other drugs
information as well.

Drug Formulary; - is a list of prescription drugs, both generic and brand products that are
preferred by your health plan. your health plan may only play for medications that are on this
preferred list.

5. RESULTS

Socio demographic background of the druggist worked in selected drug store

A total of 18 respondents in drug store were from Jimma town,Ginjo Kebele with response rate
of 100%. Of the total 18 respondents in drug retail out lets, the largest number of the respondents
belonged to 25-40 age groups and 72.2% were males. Majority of the respondents 12(66.7%)

12
had work experience (service year) greater than 5 years. From total 18 respondents eleven
(61.1%) are married and seven (38.9%) are unmarried. All respondents had electrical supply,
fridge and telephone as fulfilling Criteria of good premises. From a total of drug store majority
12(66.7%) had two and more staff including supportive staff such as casher and cleaner. (Table
1)

Table 1 Socio-demographic characteristics of respondents in drug retail out lets of Jimma

town,Ginjo Kebele south west Ethiopia June, 2021.

Variables Frequency Percentage (%)

Age
<30 12 66.7
≥30 6 33.3
Sex
Male 13 72.3
Female 5 27.7
Work experience (service year)

≤5 6 33.3

>5 12 66.7

Staff member
1 6 33.3
>1 12 66.7

Knowledge and experience on dispensing practice

From a total of respondanties nearly half of them are use STG as a reference material (42.3%).
(Figure 1)

13
 45.00% 42.30%
40.00%
34.60%
35.00%

30.00%

25.00%

20.00%

15.00%

10.00% 9.00%

5.00%

0.00%
STG Formulary EDL

Figure 1 Reference book used in all drug store Jimma Town, Ginjo Kebele southwest Ethiopia,
June 2021.
From 18 drug stores majority of drug store update themselves by standard reference book
(61.1%) and 27.8% through internet.

perio
dic
bulleti
n stand
from ard
intern standard reference book
et;FMHArefere internet
CA; nce
27.80 periodic bulletin from FMHACA
%; 11.10book;
28%%; 61.10
11% %;
61%

Figure 2 Information source they used for update them self in all drug store Jimma town, Ginjo
Kebele South west Ethiopia, June 2021.

From respondents that has standard reference majority of them eleven (45.8%) had standard
treatment guidelines and nine (37.5%) had Formulary.

14
Table 2 Standard reference book used by drug retail outlets found in Jimma town, Ginjo Kebele
South West Ethiopia, June, 2021.

S.No Standard reference book Frequency Percentage

1. EDL 4 16.6
2. Formulary 9 37.5
3. STG 11 45.8
Total 24 100

Out of 18 drug retail outlets six (33.3%) did dispense prescribed drugs after 15 days and 12
(66.7%) drug retail outlets did not dispense prescribed drugs after 15 days.

Delay in dispensing drugs

Dispense Not dispense

33% Dispense

Not dispense
67%

Figure 3 Respondents that Dispense and not dispense prescribed drugs after 15’n days at drug
retail outlets found in Jimma town, Ginjo Kebele South West Ethiopia, June 2021

Fourteen (77.8%) drug retail outlets sometimes dispense drugs without prescription and four
(22.2%) never dispense drugs without prescription.

Table 3 Dispensing practice of drug retail outlets found in Jimma town,Ginjo Kebele south west
Ethiopia, June, 2021

Dispensing practice Frequency Number Percentage (%)

15
 Dispensing Never 4 22.2
Sometimes 14 77.8
prescription drugs
Total 18 100
without prescription

Almost all of the respondents in drug retail outlets had encountered different prescription errors.
Of those who had encountered prescription errors, 18(33.9%) had encountered incomplete
prescriptions, and illegible prescriptions.18(43.9%) were communicating back with the
prescriber and communicating , as measure taken for prescriptions error minimization.

Table 4 Types of prescription errors encountered and measures taken by drug retail outlets
found in Jimma town, Ginjo Kebelesouth west Ethiopia, June, 2021

Type of errors Number Percentage (%)

Legality problem 10 18.8

Containing drug(s) which interact 7 13.2
Illegible prescription 18 33.9
In complete prescription 18 33.9
Total 53 100
Make correction by 18 43.9
communicating with the
patient
Check for reference book 5 12.19

Communicating back with 18 43.9

prescriber
Total 41 100

Out of 18 drug retail outlets 33.9% of them provide drug information on duration and frequency of
administration which is followed by side effects 28.3%.

16
 Drug information
30
26.8
25 24 23

20
16
Percentage

15
9.8
10

0
Duration and Side effects Drug food Storage Adherence
frequency interactions

Types of information

Figure 4 Drug information mostly provided to patient during dispensing by drug retail out let
found in Jimma town, Ginjo Kebele south west Ethiopia, June, 2021.
Out of 18 DROs visited 15 (83.3%) of them did practice labeling using different labeling
methods for illiterate patients, whereas 3(16.7%) DROs did not practiced, and said no need of
labeling; only oral information is enough.

Table 5 Labeling practice and type of labeling systems used by DROs found in Jimma town,
Ginjo kebele South West Ethiopia, June, 2021.

Labeling practice Number Percentage (%)

Those who doesn’t labels 3 16.7

Those who labels 15 83.3
Type of labeling No need of labeling, only oral information 4 22.2
systems used for is enough
Use of pictograms 3 16.7
illiterate
Writing in words and/ or numbers 11 61.1

Patient care indicator

17
Assessments of patient care indicators are done on six randomly selected drug store. 73.9% them
has no patient identifier and the remaining 25.6% has patient identifier. The mean dispensing
time In this study was 169.3±40s. (Table 6)

Table 6: Dispensing time for each patient at selected drug store in Jimma town ,Ginjo Kebele
south west Ethiopia, June, 2021
Dispensing time(minute) Frequency Percentage (%)
<1 69 38.3
1-3 min 92 51.1
3-5 18 10
>5 1 0.6
Table 7: The number of drug prescribed per prescription and number of drug dispensed in
Jimma town,Ginjo Kebele south west Ethiopia,June 2021.
Number of Frequenc Percentag Number Frequency Percentage
drug e
y drug (%)
prescribed (%) dispensed
0 37 20.6 1 75 41.7
1 48 26.7 2 60 33.3
2 42 23.3 3 29 16.1
3 31 17.2 4 14 7.8
4 19 10.6 5 1 0.6
5 2 1.1 6 1 0.6

All selected drug store was not adequately label the information during dispensing the
medication according to WHO guid line study checklist.

Patient knowledge

From the total 180 clients 82(53%) of patients didn’t know the name of the drug and
134(87%) of the client did not knew about the dose of medication dispensed.

18
In other way 113(74%) of them knew the duration and 135(88%) knows the frequency of
dispensed medication. 128(83%) of client didn’t know about any side effects of the
dispensed medication and 65(42%) of the client responded as they don’t received
adequate advice from the dispensers.

Table 8: Assessing of patient knowledge from selecting drug store in Jimma town,Ginjo Kebele
south west Ethiopia,June,2021.

Response
Yes No
Question Frequency Percentage Frequency Percentage
Do you remind the name of drug? 85 47% 95 53%
Do you know the dose of the drug? 24 13% 156 87%

Do you know the duration of 133 74% 47 26%

treatment?
Do you know the frequency of 158 88% 22 12%
administration?
Do you know the possible side 30 17% 150 83%
effect?
Do you get any advice regarding 104 58% 76 42%
the proper use of your medicines?

6. DISCUSSION

The largest number of the respondents was belonged to 25-40 age groups and there was no
respondent above the age group of 60 years, this show that the professional in this study were
younger age group and 72.2% were males

Out of total DROs majority of drug stores (83.3%) did practice labeling using different labeling
system for literate and illiterate clients with inadequate drug information, where as 16.7% DROs
did not practiced. This finding is much higher than the finding of a study done in the Mambere-
Kadei health district of the Central African Republic in 2008 shows 21.2% of the dispensed
drugs inadequately labeled (15).

19
Almost all of the respondents in drug retail outlets had encountered different types of
prescription errors. Of those who had encountered prescription errors, majority 36(67.9%) had
encountered incomplete and illegible prescription errors. As measure taken for error
minimization 18(43.9%), respondents had made correction by communicating back with
prescriber and 5(12.19%) Check reference books for prescriptions error minimization. This
finding is slightly similar study was conducted in Pakistan 81% of these respondents were unable
to understand the prescription orders written by doctors other than their area (14).

Out of the total respondents who were know about drug information, 39.3% know about
frequency and duration and 5.6% Adherence which were lower than the study done in Harer
which had around 80.61% drug information on adherence, frequency and duration (17). Similar
finding was documented in North-west Ethiopia where 3.8% of the patient was non-compliant
with the drug regimen due to misunderstanding of instructions and in Gondar where 13.5% of
patients was non-complained with therapeutic regimens due to misunderstanding or lack of
instruction about dosing schedule of prescribed drugs . The mean dispensing time in this study is
169.3±40s for dispensing which is slightly greater than the study done in north west Ethiopia
which were use 1.86 minute(18) and less than a study done in the Mambere-Kadei health district
of the Central African Republic in April 2008 which were use 5 min (15).

In this study around 52.7% of the patients were advice on adherence, frequency and duration,
and storage so that it’s lower than study done Harar town. Also study done on this area showed
that all 18(100%) of which were drug stores. In a similar fashion this study showed that drug
stores were higher than that of pharmacy. This is most probably due to druggist may get license
for most of them worked in clinical setting however, A study done in Harar town on a total of 41
drug retail outlet showed that 83.3% of the dispensers give counseling for all dispensed
prescription drugs and 80.6% of the patient advice included adherence, frequency and duration,
and storage (17).

Out of total DROs (18) visited only (27.8%) of respondent update themselves using internet.
This is different from a study done in Turkey on 104 drug retail out let’s showed that all the

20
pharmacists used a computer for online connection to update themselves (3). This is may be due
to there is enough amounts of computer and internet access in developed country.

7. CONCLUSION

Most of respondent in drug retail outlets were dispense prescribed drug with labeling but not
provides all necessary drug information Almost all respondents had encountered incomplete
prescriptions and encountered illegible prescriptions. Majority of practitioners had standard
treatment guidelines and good dispensing manual used as reference material.

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 8. RECOMMENDATION

Based on the finding and conclusion drawn from the study, the following recommendations were
forwarded:-

 To Jimma University to provide continuous professional development training on

dispensing practice to reduce dispensing related errors and awareness creation should be
made on the risk related to inappropriate dispensing.
 To drugs regulatory body such as zonal, regional health Bureau and FMHACA should do
intensive and supportive supervision of all drug retail outlets.

22
  To other researcher:- used as base line information for further assessments in the area of
community pharmacy.

9. LIMITATION OF THE STUDY

It constitutes small sample size (18 drug stores are available at Jimma town,Ginjo Kebele) this
restrains us to do associated factor.

23
 REFERENCE

1. Sharma H, Jindal D. A survey of assessment of role of pharmacist in community pharmacy

services. Pharm BioallSci,2009;1:23-6
2. Basak SC, Sathyanarayana D. Community Pharmacy Practice in India: Past, Present and
Future. Southern Med Review,2009;2(1):11-4

24
3. Hale Z. Toklu etal. The pharmacy practice of community pharmacists in Turkey. Marmara
Pharm J,2010;(14);53-60,
4. JL Lenjisa, Biruk M. Analysis of Dispensing Practices at Community Pharmacy Settings in
Ambo Town, West Shewa, Ethiopia. J Community Med Health Educ, 2015:8(5);329.
5. Remington. The science and practice of pharmacy, 21st edition. Volume 2, page, 2082
6. World health organization selection and rational use of medicines, 2016.
7. World Health Organization (WHO), Promoting rational use of medicines: core components.
In: WHO Policy Perspectives on Medicines No. 5, Geneva; WHO: 2002; 97-101.
8. World Health Organization. The Role of pharmacist in Heath Care System; 1998.
9. Hodgkin c. drug issues discussion paper: written for the WHO round table discussion with
consumer and other health related NGOs involved in pharmaceuticals issues, use and
supply,HAI-Europe, Geneva, Switzerland. 9 Oct, 1998.
10. Azhar S, Mahar D etal.The Role of Pharmacist in developing countries: The current scenario
in Pakistan.HumResourHealth, 2009:7:54.
11. Bruden P. World drug situation. Geneva: WHO; 1988.
12. HAIPAP press release. Rational use of medicines. Health action international Asia pacific,
2012.
13. Progress in implementation of national drug policy in Armenia during 1994-2000. (2001),
report on working meeting agency on drugs and medical technologies. Yerevan. 1994-2000.
14. Aslam N, Bushra R, Khan MU. Community pharmacy practice in Pakistan. Arch
PharmaPract 2012;3:297-302
15. Mouala C, AbeyeJ. prescribing and dispensing generic drugs in the Membere-Kadei health
district of the central Africa Republic. Med Trop (Mars), 2008:149-154.
16. Trap.B. Zimbabwe essential drug action program, ministry of health and child welfare.
International conferences on improving use of medicines (ICIUM): practice of dispensing.
17. Shemsedin R and Tigabu BM: Community Drug Retail Outlet Services in Harar Town,
Eastern Ethiopia. IntJ Pharm SciRes.2015; 6(3): 1083-90.
18. AbulaT,WorkuA,Thomas k. Assessment of the dispensing practices of drug retail outlets in
selected towns, Northwest Ethiopia. Ethiop med J. 2006; 44(2):145-50.

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 ANNEX

I Socio-demographic Background Information

1. Name of drug store (code)_________

2. What is your age? _________
3. Gender

26
 A, Male B, Female
4. Marital status

A, married B, unmarried

5. How money staff is there?

A, 1 B, 2

C, 3 D, more than 3

6. Education level
A, pharmacist C, pharmacy technician
B, druggist D, other
7. Working experience (years) _________

8. Is there telephone service?

A. Yes B.No

9. Is there electric supply?

A. Yes B.No

10. Is there refrigerator?

A. Yes B.No

PART II: KNOWLEDGE AND EXPERIENCE ON DISPENSING PRACTICE

11. Do you have Good dispensing manual?

A. Yes B. No

12. Which type of Standard reference books do you have?

27
A. EDL B. STG C. Formulary D. other

13. Do you have list of over the counter (OTC) drugs?

A. Yes B .No

14. Do you update yourself in searching for recent information regarding drugs?

A. Yes B. No

15. If Q14 is yes, which information source did you use?

A. Standard reference books C. Medical and pharmaceutical journals

B. Periodical bulletins from FMHACA D. Internet

E. Another, (Specify)_________________

16. Do you dispense prescribed drugs after 30 days and controlled drugs after 15days?

A. Yes B. No

17. How often you dispensed prescription drugs with out prescription?

A. Always B. Some times C. Never

18. Have you ever encountered any prescription error?

A. Yes B. No

19. If Q 18 is yes type of error you encountered?

A. Illegible prescription C. Containing drugs which interact

B. incomplete prescription D. legality problems

E. other, specify_____________

20. What measure have you taken for the prescription error you encountered?

A. dispensed by guess

28
B. makes correction by communicating with the patient

C. check for reference books (if needed)

D. Communicate with the prescriber back

21. What drug information you mostly provide to patient during dispensing?

_________________________________________________________

22. Do you label?

A. Yes B. No

23. If yes, for which labeling system do you follow when dispensing to illiterate patients?

A. writing in words and / or numbers. C, no need of labeling, only oral information is

enough

B. use of pictograms D. other, (specify)

24. If yes Q 22for which type of patients do you write labels on the dispensed drugs?

A. Literate B. Illiterate C. Both

Assessing of Patient Care Indicators

Patient Consulting Dispensing # drugs # drugs #adequately Knows

NO Identifier time (min) time (sec) prescribed dispensed labeled dosage
(O/1)*

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 Count

Total

Average

% % % % % Cases
Prescribed Dispensed adequately knows
labeled

* O=No, 1=Yes

Assessment of Patients knowledge

1. Do you remind the name of drug (s)? A) YES B) NO

2. Do you know the dose of the drug(s)? A) YES B) NO

3. Do you know the duration of treatment? A) YES B) NO

4. Do you know the frequency of admin? A) YES B) NO

5. Do you know the possible side effect? A) YES B) NO

Medicines? A) YES B) NO

6. Do you get any advice regarding the proper use of your

medicines? A) YES B) NO

Drug labeling checklist

S.n Criteria If YES=1, If NO=0

o
Name of patient
1.

Description of drug (name of the drug)

2.

Dosage regimen(dose , frequency, duration)

3.

strength of the drug

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4.

Precautions
5.

Total quantity dispensed

6.

31