2023-09-28 14:46:10 +00:00
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abstract: 'Background The National Drug Policy in Bangladesh prohibits the sale and
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distribution of antibiotics without prescription from a registered
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physician. Compliance with this policy is poor; prescribing antibiotics
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by unqualified practitioners is common and over-the-counter dispensing
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widespread. In Bangladesh, unqualified practitioners such as drug shop
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operators are a major source of healthcare for the poor and
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disadvantaged. This paper reports on policy awareness among drug shop
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operators and their customers and identifies current dispensing
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practices, barriers and facilitators to policy adherence. Methods We
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conducted a qualitative study in rural and urban Bangladesh from June
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2019 to August 2020. This included co-design workshops (n = 4) and
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in-depth interviews (n = 24) with drug shop operators and
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customers/household members, key informant interviews (n = 12) with key
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personnel involved in aspects of the antibiotic supply chain including
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pharmaceutical company representatives, and model drug shop operators;
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and a group discussion with stakeholders representing key actors in
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informal market systems namely: representatives from the government,
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private sector, not-for-profit sector and membership organizations.
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Results Barriers to policy compliance among drug shop operators included
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limited knowledge of government drug policies, or the government-led
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Bangladesh Pharmacy Model Initiative (BPMI), a national guideline
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piloted to regulate drug sales. Drug shop operators had no clear
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knowledge of different antibiotic generations, how and for what diseases
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antibiotics work contributing to inappropriate antibiotic dispensing.
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Nonetheless, drug shop operators wanted the right to prescribe
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antibiotics based on having completed related training. Drug shop
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customers cited poor healthcare facilities and inadequate numbers of
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attending physician as a barrier to obtaining prescriptions and they
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described difficulties differentiating between qualified and unqualified
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providers. Conclusion Awareness of the National Drug Policy and the BPMI
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was limited among urban and rural drug shop operators. Poor antibiotic
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prescribing practice is additionally hampered by a shortage of qualified
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physicians; cultural and economic barriers to accessing qualified
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physicians, and poor implementation of regulations. Increasing qualified
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physician access and increasing training and certification of drug shop
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operators could improve the alignment of practices with national policy.'
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affiliation: 'Nizame, FA (Corresponding Author), Int Ctr Diarrhoea Dis Res Bangladesh
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Icddr B, Environm Intervent Unit, Infect Dis Div, Dhaka 1212, Bangladesh.
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Nizame, Fosiul Alam; Shoaib, Dewan Muhammad; Akter, Salma; Islam, Mohammad Aminul;
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Rahman, Mahbubur; Unicomb, Leanne, Int Ctr Diarrhoea Dis Res Bangladesh Icddr B,
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Environm Intervent Unit, Infect Dis Div, Dhaka 1212, Bangladesh.
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Rousham, Emily K., Loughborough Univ, Sch Sport Exercise \& Hlth Sci, Ctr Global
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Hlth \& Human Dev, Loughborough, Leics, England.
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Islam, Mohammad Aminul, Washington State Univ, Paul G Allen Sch Global Anim Hlth,
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Pullman, WA 99164 USA.
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Khan, Afsana Alamgir, Directorate Gen Hlth Serv DGHS, Dhaka, Bangladesh.'
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article-number: '85'
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author: Nizame, Fosiul Alam and Shoaib, Dewan Muhammad and Rousham, Emily K. and Akter,
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Salma and Islam, Mohammad Aminul and Khan, Afsana Alamgir and Rahman, Mahbubur and
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Unicomb, Leanne
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author-email: fosiul@icddrb.org
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author_list:
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- family: Nizame
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given: Fosiul Alam
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- family: Shoaib
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given: Dewan Muhammad
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- family: Rousham
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given: Emily K.
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- family: Akter
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given: Salma
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- family: Islam
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given: Mohammad Aminul
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- family: Khan
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given: Afsana Alamgir
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- family: Rahman
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given: Mahbubur
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- family: Unicomb
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given: Leanne
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da: '2023-09-28'
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doi: 10.1186/s40545-021-00342-7
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eissn: 2052-3211
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files: []
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journal: JOURNAL OF PHARMACEUTICAL POLICY AND PRACTICE
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keywords: 'Antimicrobial resistance (AMR); Irrational antibiotic use; Drug policy;
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Qualified physicians; Quack; village doctor; Low- and middle-income
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countries (LMICs)'
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keywords-plus: HEALTH-CARE; SECTOR
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language: English
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month: NOV 16
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number: SUPPL 1, 1, SI
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number-of-cited-references: '30'
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orcid-numbers: 'Rahman, Mahbubur/0000-0003-0520-2683
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Shoaib, Dewan Muhammad/0000-0002-0168-0031
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Islam, Mohammad Aminul/0000-0001-5107-5289'
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papis_id: 0c07d0fbc8f4429a0b161ae61cb347a3
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ref: Nizame2021barriersfacilitators
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researcherid-numbers: 'Rahman, Mahbubur/HKM-9754-2023
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'
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times-cited: '3'
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title: Barriers and facilitators to adherence to national drug policies on antibiotic
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prescribing and dispensing in Bangladesh
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000719320700008
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usage-count-last-180-days: '1'
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usage-count-since-2013: '6'
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volume: '14'
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web-of-science-categories: Health Policy \& Services; Pharmacology \& Pharmacy
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year: '2021'
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