Request for Antimalarial Medicines and Their Dispensing Without a Prescription in Community Pharmacies in Rwanda

Amon Nsengimana,1 Emmanuel Biracyaza,2,3 Joyce Isimbi,4 Charles Uwambajimana,4 Jean Claude Hategekimana,4 Vedaste Kagisha,4 Domina Asingizwe,5,6 Jean Baptiste Nyandwi4,6 1US Agency for International Development Global Health Supply Chain Program, Procurement and Supply Chain Management, Kigali, Rwanda; 2School of Rehabilitation, Faculty of Medicine, Université de Montréal, Québec, Canada; 3Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada; 4Department of Pharmacy, University of Rwanda, Kigali, Rwanda; 5Department of Physiotherapy; University of Rwanda, Kigali, Rwanda; 6East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, RwandaCorrespondence: Amon Nsengimana, Email amonnsengimana@gmail.comPurpose: This study aimed to explore the request and dispensing of antimalarial medicines without a prescription in community pharmacies in Rwanda, as well as factors associated.Methods: We employed an embedded mixed-methods design that involved a convenience sample of 235 licensed community pharmacists between February and April 2022. To simultaneously collect qualitative and quantitative data, we used a self-administered questionnaire containing a combination of close and open-ended questions. Bivariate and multivariate regression analyses were performed to examine the relationship between dispensing antimalarial medicines without a prescription and the selected independent variables. Statistical significance was set at p< 0.05, and a 95% confidence interval was applied. The factors influencing the dispensing of antimalarial medicines without a prescription were analyzed using thematic content analysis as a qualitative analysis approach.Results: Most respondents (88.5%) were asked to dispense antimalarial medicines by clients without a prescription. More than half of them (54%) agreed, but 34.5% refused; instead, they referred clients to malaria diagnostic testing facilities. Those who had rapid diagnostic tests for malaria in stock (OR=2.08, 95% CI:1.1– 3.94), and thought that antimalarials were over-the-counter medicines (OR=7.03, 95% CI:2.01– 24.5) were more likely to dispense antimalarial medicines without prescriptions. The primary reasons reported by community pharmacists for dispensing antimalarial medicines without prescriptions included their prior knowledge of malaria diagnosis, client pressure, and fear of losing clients. However, non-adherence to negative results obtained from formal health facilities and long queues at these institutions have also been cited as additional factors driving clients to seek antimalarial medicines without prescriptions.Conclusion: Dispensing antimalarial medicines without prescriptions is a common practice in community pharmacies in Rwanda. The main factors contributing to this practice include lack of awareness regarding the classification of antimalarials as prescription medicines, the availability of malaria diagnostic tests, client pressure, and fear of losing clients.Keywords: request, antimalarial medicines, dispensing, community pharmacies, Rwanda