RESUMEN
Health workers in Tanzania struggle to provide adequate health care for populations with high maternal, neonatal, and child mortality and high prevalence of communicable and non-communicable diseases. There are longstanding shortages of staff and resources. Universities are training more health professionals and revising curricula to be sure that staff have the specific skills needed to work in rural districts. This includes training people from different disciplines to work more effectively together. While teamwork is important in all settings, it is particularly critical in rural areas where there are few trained professionals. The health professional schools at Muhimbili University of Health and Allied Sciences (MUHAS) developed curricula that share common competencies to promote interprofessional cooperation. In this article, we describe a pilot program developed by MUHAS to train its professional students (dentists, doctors, environmental health officers, nurses, and pharmacists) to work collaboratively with each other and with other health staff at the district level. We describe the reactions of participants, and identify some considerations for taking such an exercise to scale for education.
Asunto(s)
Educación Médica/métodos , Personal de Salud/educación , Relaciones Interprofesionales , Servicios de Salud Rural/normas , Conducta Cooperativa , Estudios de Factibilidad , Humanos , Proyectos Piloto , Facultades de Medicina , TanzaníaRESUMEN
BACKGROUND: Studies indicate that antibiotics are sold against regulation and without prescription in private drugstores in rural Tanzania. The objective of the study was to explore and describe antibiotics sale and dispensing practices and link it to drugseller knowledge and perceptions of antibiotics and antibiotic resistance. METHODS: Exit customers of private drugstores in eight districts were interviewed about the drugstore encounter and drugs bought. Drugsellers filled in a questionnaire with closed- and open-ended questions about antibiotics and resistance. Data were analyzed using mixed quantitative and qualitative methods. RESULTS: Of 350 interviewed exit customers, 24% had bought antibiotics. Thirty percent had seen a health worker before coming and almost all of these had a prescription. Antibiotics were dispensed mainly for cough, stomachache, genital complaints and diarrhea but not for malaria or headache. Dispensed drugs were assessed as relevant for the symptoms or disease presented in 83% of all cases and 51% for antibiotics specifically. Non-prescribed drugs were assessed as more relevant than the prescribed. The knowledge level of the drugseller was ranked as high or very high by 75% of the respondents. Seventy-five drugsellers from three districts participated. Seventy-nine percent stated that diseases caused by bacteria can be treated with antibiotics but 24% of these also said that antibiotics can be used for treating viral disease. Most (85%) said that STI can be treated with antibiotics while 1% said the same about headache, 4% general weakness and 3% 'all diseases'. Seventy-two percent had heard of antibiotic resistance. When describing what an antibiotic is, the respondents used six different kinds of keywords. Descriptions of what antibiotic resistance is and how it occurs were quite rational from a biomedical point of view with some exceptions. They gave rise to five categories and one theme: Perceiving antibiotic resistance based on practical experience. CONCLUSIONS: The drugsellers have considerable "practical knowledge" of antibiotics and a perception of antibiotic resistance based on practical experience. In the process of upgrading private drugstores and formalizing the sale of antibiotics from these outlets in resource-constrained settings, their "practical knowledge" as well as their perceptions must be taken into account in order to attain rational dispensing practices.