Compliance of private pharmacies in Uganda with controlled prescription drugs regulations: A mixed-methods study

Pakoyo Fadhiru Kamba, John Mulangwa, Bruhan Kaggwa, Freddy Eric Kitutu, Nelson Kaulukusi Sewankambo, Elly Tebasoboke Katabira, Pauline Byakika-Kibwika, Richard Odoi Adome, Robert Cyril Bollinger

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Abstract

Background: Controlled prescription drug use disorders are a growing global health challenge in Sub-Saharan Africa. Effective supply chain regulations on dispensing and stock control are important for controlling this epidemic. Since compliance with these regulations in resource-limited countries is poor, there is need to understand its predictors in order to reduce the risk of prescription drug use disorders. Methods: A mixed-methods study utilizing a structured questionnaire and a simulated client guide was undertaken in Kampala and Mbale towns in Uganda. The questionnaire recorded self-reported dispensing and verified stock control practices and their covariates from 101 private pharmacies. The guide recorded actual dispensing practices from 27 pharmacies. Snowball sampling was done to enrich the sample with pharmacies that stock opioids. The mean compliance with good dispensing and stock control practices was calculated. Multivariate logistic regression analyses were applied to identify predictors of compliance. Results: The mean compliance with dispensing and stock control requirements was 82.9% and 23%, respectively. Twenty percent and 40% of the pharmacies dispensed pethidine without a prescription and with invalid prescriptions, respectively. Having a pharmacist on duty (OR = 5.17; p = 0.02), prior in-service training on narcotics regulations (OR = 3.51; p = 0.04), and previous narcotics audits by the regulator (OR = 5.11; p = 0.01) were independent predictors of compliance with stock control requirements. Pharmacies with a previous history of poor compliance with dispensing requirements were less likely to demonstrate good compliance (OR = 0.21; p = 0.01). Conclusions: There is suboptimal compliance to controlled prescription drug regulations among Uganda's pharmacies. A previous history of poor compliance to dispensing requirements predicted low compliance in subsequent assessments. Training and regulatory audits increased compliance in stock control but not dispensing. Expansion of training and audits to more pharmacies and/or incentives for compliance are necessary.

Original languageEnglish (US)
Article number16
JournalSubstance Abuse: Treatment, Prevention, and Policy
Volume15
Issue number1
DOIs
StatePublished - Feb 18 2020

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Keywords

  • Compliance predictors
  • Controlled drug regulations
  • Controlled prescription drugs
  • Dispensing practices
  • Opioids
  • Stock control practices

ASJC Scopus subject areas

  • Health Policy
  • Psychiatry and Mental health

Cite this

Kamba, P. F., Mulangwa, J., Kaggwa, B., Kitutu, F. E., Sewankambo, N. K., Katabira, E. T., Byakika-Kibwika, P., Adome, R. O., & Bollinger, R. C. (2020). Compliance of private pharmacies in Uganda with controlled prescription drugs regulations: A mixed-methods study. Substance Abuse: Treatment, Prevention, and Policy, 15(1), [16]. https://doi.org/10.1186/s13011-020-00261-x