Study reveals high levels of antibiotic misuse in Tanzania

Mwanza. A study conducted by the Catholic University of Health and Allied Sciences (CUHAS) has revealed that 89 percent of pharmacy dispensers provide antibiotics for urinary tract infections (UTIs) without a doctor’s prescription.

Additionally, 87 percent are willing to offer incomplete doses after patients describe their symptoms.

The research, led by Dr Pendo Ndaki as part of her PhD at CUHAS-Bugando in Mwanza, spanned from April 2019 to June 2022. Its findings have been published in international journals including Antibiotics, BMC Primary Care, PloS One, BMC Public Health, and Qualitative Health Research.

Speaking during her PhD graduation on November 16, 2024, Dr Ndaki said the study focused on behavioral, economic, and systemic factors influencing antibiotic use among dispensers, doctors, and patients in Tanzania. The research involved 1,820 dispensers across Mwanza, Kilimanjaro, and Mbeya regions in both urban and rural settings.

The study found that 90 percent of dispensers provided amoxicillin without a prescription, while 87% offered incomplete doses. “Only seven out of the 32 drugs dispensed for UTIs are recommended for such use in Tanzania’s National Treatment Guidelines,” said Dr. Ndaki.

She added that customer pressure, financial incentives, and patients’ inability to afford healthcare were among the main reasons for improper dispensing practices. Other contributing factors include shortages of antibiotics, poor laboratory infrastructure, and insufficient healthcare providers, which force patients to avoid hospitals due to high costs and long wait times.

The study also highlighted the use of mystery shoppers as a method to gather data, where undercover individuals attempted to purchase antibiotics without prescriptions or described UTI symptoms to dispensers. In-depth interviews were also conducted with 28 dispensers, 10 doctors, and 10 patients.

“This study shows that the misuse of antibiotics is driven by various behavioral, economic, and systemic factors. We recommend that the government, through the Ministry of Health, improve healthcare infrastructure, introduce universal health insurance, and incentivize dispensers while ensuring quality service delivery,” Dr Ndaki said.

In a related study, Dr Upendo Kibwana explored antibiotic resistance among children under five with fever and adults living with HIV in Dar es Salaam. Her research, published in journals such as Journal of Global Antimicrobial Resistance and BMC Infectious Diseases, found that 56 percent of 200 children tested carried extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE).

The study also found that bloodstream infections were significantly higher (78.4 percent) among children carrying ESBL-PE bacteria. Additionally, 68 percent of the bacteria were resistant to ciprofloxacin, while 11 percent of enterococci bacteria isolated from HIV-positive adults exhibited multidrug resistance.

“High resistance levels among children and HIV-positive individuals underline the need for robust national strategies to combat antimicrobial resistance,” said Dr. Kibwana.

According to the World Health Organization (WHO), bacterial resistance to antibiotics caused 1.27 million deaths globally in 2019. The number could rise to 10 million deaths annually by 2050 if immediate action is not taken.

Dr Kibwana and Dr Ndaki both called for urgent interventions, including enhanced laboratory diagnostics, improved healthcare accessibility, and strict enforcement of antibiotic prescription policies.
Experts urge the government to prioritize affordable healthcare systems, such as universal health insurance, and invest in laboratory infrastructure to curb the misuse of antibiotics and address the growing threat of antimicrobial resistance.