Exploring the knowledge, attitude, and practices of over-the-counter medical sellers in Ghana
Accepted: 8 August 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Background. Rural areas in sub-Saharan Africa face a high prevalence and morbidity of skin disease while also lacking access to dermatologists. In Ghana, where approximately 25 licensed dermatologists are available for 25 million people, community pharmacies, called over-the-counter medical sellers (OTCMS), were established to respond to accessibility inequities, albeit without equitable training.
Objective. Our study evaluates the dermatologic knowledge, attitudes, and practices (KAP) of OTCMS in Ghana’s Ashanti Region.
Methods. To assess dermatologic KAP, we created a standardized questionnaire and recorded 13 interviews with OTCMS in seven communities. Interviews were completed with help from Ghanaian translators and transcripts were transcribed verbatim, then analyzed qualitatively to determine common themes for analysis.
Results. This analysis identified six major themes: i) prescriber qualifications; ii) diagnostics; iii) therapeutics; iv) economics; v) health systems integration; vi) care-seeking behavior. Analysis of these themes outlined many cultural roles and challenges of OTCMS, including serving as the primary contact for dermatologic conditions in rural communities. While possibly necessary due to the lack of accessible dermatologists, this raises concerns for potential harm in diagnostic error and misuse of therapeutics due to the lack of formal dermatology training.
Conclusion. In rural parts of Ghana, the KAP of OTCMS play a pivotal role in assessing and treating skin disease for those who might otherwise lack access to adequate dermatologic management. Furthermore, although our study identifies potential issues related to the roles played by OTCMS, it also suggests strategies to improve the dermatologic health of many Ghanaians by enhancing education and healthcare delivery in rural areas.
Dechambenoit G. Access to health care in sub-Saharan Africa.Surg Neurol Int, 2016. 7:108. Published 2016;7:108 DOI: https://doi.org/10.4103/2152-7806.196631
Karimkhani C, Dellavalle RP, Coffeng LE, et al. Global skin disease morbidity and mortality: an update from the global burden of disease study, 2013. JAMA Dermatol. 2017;153(5):406-12. DOI: https://doi.org/10.1001/jamadermatol.2016.5538
Pharmacy Council, Ghana. Guidelines for OTCMS Application. https://testsite.pcghana.org/wp-content/uploads/2021/02/GUIDELINES-ON-APPLICATION-FOR-OTCMS-LICENCE-1.pdf
Makinen M, Stephanie S, Ricardo B, Adjei S. Private health assessment in Ghana - working paper. World Bank, 2011.
Minisitry of Health (GNDP) Ghana. Essential Medicines List, Seventh Edition, 2017. https://www.moh.gov.gh/wp-content/uploads/2020/07/GHANA-EML-2017.pdf
Ministry of Health (GNDP) Ghana. Ghana National Drug Policy, Second edition, 2004. https://www.moh.gov.gh/wp-content/uploads/2016/02/Ghana-National-Drug-Policy-2nd-edition.pdf
Karima S, The health sector in Ghana: a comprehensive assessment. World Bank, 2012.
Ansah EK, Gyapong M, Narh-Bana S, et al. Factors influencing choice of care-seeking for acute fever comparing private chemical shops with health centres and hospitals in Ghana: a study using case-control methodology. Malar Journal, 2016;15:290 DOI: https://doi.org/10.1186/s12936-016-1351-1
Adjei AA, Winch P, Laar A, Sullivan DJ Jr, et al. Insights into the Affordable Medicines Facility-malaria in Ghana: the role of caregivers and licensed chemical sellers in four regions. Malar J. 2016;15:263 DOI: https://doi.org/10.1186/s12936-016-1307-5
Laggis, C. W., Secrest, A. M., Agyei, M., et al. The impact of skin disease on quality of life in rural communities of Ghana. SKIN The Journal of Cutaneous Medicine, 2020;4:417-23 DOI: https://doi.org/10.25251/skin.4.5.4
Rosenbaum, B. E., Klein, R., Hagan, P. G., et al. Dermatology in Ghana: a retrospective review of skin disease at the Korle Bu Teaching Hospital Dermatology Clinic. The Pan African Medical Journal, 2017;26.
World Health Organization. 19th WHO Model List of Essential Medicines. Accessed June 2019. https://www.who.int/medicines/publications/essentialmedicines/enCONCLUSION
Nolan, B. V, Levender, M. M., Davis, S. A., et al. Trends in the use of topical over the counter products in the management of dermatologic disease in the United States. Dermatology Online Journal, 2012. DOI: https://doi.org/10.5070/D33PK0X5ZV
Sophie A. Greenberg, M. Over-the-counter topical products in dermatology. MD Edge Dermatology, 2020.
Hart C, Kariuki S. Antimicrobial resistance in developing countries. British Medical Journal, 1998;317”647 DOI: https://doi.org/10.1136/bmj.317.7159.647
J. Sergre and J. Tran. Improving Access to Medicines for All. Management Sciences for Health, 2008
Afari-Asiedu, S., Kinsman, J., Boamah-Kaali, et al. To sell or not to sell; the differences between regulatory and community demands regarding access to antibiotics in rural Ghana. Journal of Pharmaceutical Policy and Practice, 2018;11:1-10
Afari-Asiedu, S., Kinsman, J., Boamah-Kaali, E. et al. To sell or not to sell; the differences between regulatory and community demands regarding access to antibiotics in rural Ghana. J of Pharm Policy and Practice, 2018;11:30 DOI: https://doi.org/10.1186/s40545-018-0158-6
Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol, 2014;134:1527-34 DOI: https://doi.org/10.1038/jid.2013.446
Basra M, Fenech R, Gatt R, et al. The dermatology life quality index 1994–2007: a comprehensive review of validation data and clinical results. Br J Dermatol. 2008;159:997-1035 DOI: https://doi.org/10.1111/j.1365-2133.2008.08832.x
Beattie PE, Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006. DOI: https://doi.org/10.1111/j.1365-2133.2006.07185.x
Organization WH. Global report on psoriasis. World Health Organization; 2016.
Gibbs SAM. Skin disease and socioeconomic conditions in rural Africa: Tanzania. Int J Dermatol. 1996;35:633-9 DOI: https://doi.org/10.1111/j.1365-4362.1996.tb03687.x
Lim HW, Collins SAB, Resneck JS, et al. The burden of skin disease in the United States. J Am Acad Dermatol, 2016.
Lebetkin E, Orr T, Dzasi K, et al. Injectable contraceptive sales at licensed chemical seller shops in ghana: access and reported use in rural and periurban communities. Int Perspect Sex Reprod Health. 2014;40:21-7 DOI: https://doi.org/10.1363/4002114
Kwarteng A, Malm KL, Febir LG, et al. The accuracy and perception of test-based management of malaria at private licensed chemical shops in the middle belt of Ghana. Am J Trop Med Hyg. 2019;100:264-74 DOI: https://doi.org/10.4269/ajtmh.17-0970
Copyright (c) 2023 the Authors
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.