Prevalence and factor associated with over-the-counter use of antifungal agents, in Mwanza City, Tanzania

Abstract

Background: Misuse of antifungal both in clinics and agriculture has been associated with the increased trend of antifungal resistance. In Tanzania, there is limited information regarding the magnitude of antifungal obtained over the counter therefore this study was performed to determine the extent of over the counter (OTC) antifungal use and factors associated to it . Methods:  This was a cross sectional study involving patients buying antifungal agents from community pharmacies between May and July 2015 in Mwanza city, Tanzania. Data were collected by the investigator using interview guided questionnaire and analyzed using STATA version 11. Results: A total of 270 patients were enrolled and interviewed. The mean age was 30 years±12.  Majority of patients (59.6%) were female.   Out of 270 patients, 188(69.3%) had dermatophytes. A total of 150(55.6%, 95%CI 49.6-61) obtained antifungal OTC.  Of 150 patients received antifungal agents OTC, 64(42.3%) received more than one antifungal compared to only 11/120 (9.2%) of those with prescription p<0.001. Clotrimazole was the commonly prescribed antifungal while fluconazole was mostly obtained OTC. On univariate analysis, increase in age was found to be associated with the tendency of obtaining antifungal over the counter (OR 1.03, 95% CI 1.008-1.05, P<0.006).  Having skin fungal infections was the only predictor of obtaining antifungal agents OTC (OR 3.36, 95% CI 2.34-4.81, P<0.001). Conclusion : In Mwanza City, patients receive multiple antifungal agents over the counter and the practice is significantly more for the patients with skin fungal infections. There is a need for the advocacy on appropriate antifungal use so that associated impact of resistance development can be reduced