Patterns and trends in antimalarial dispensing practices in Ghana: a retrospective analysis of outreach training and supportive supervision data (2018-2022).

BACKGROUND

The increasing production of antimalarials and the growing emergence of partial resistance to artemisinin necessitate effective antimalarial stewardship. The Outreach Training and Supportive Supervision (OTSS) provides an effective quality assurance framework to foster such stewardship. OTSS data has been analysed and utilized to strengthen various aspects of malaria care. However, improvements in dispensing practices remain undocumented. This study sought to describe dispensing practices and to characterize their temporal trends in Ghana from 2018 to 2022.

METHODS

An analytical observational study was designed to analyse secondary data from Ghana's annual OTSS visits from 2018 to 2022. The visits covered selected health facilities in all 16 administrative regions. Data was extracted from the Electronic Data System, a digital tool used for OTSS. Indicators included region, level of service delivery, facility name, and all pharmacy-related indicators; 3 under labelling and 12 under adherence. Dispensing practice was defined as the median-dichotomized composite of labelling and adherence. After data cleaning, there were 7193 valid records of visits to 4471 facilities (2722 were repeat visits). Dispensing practices across regions and service levels were reported annually. Mixed-effects logistic regression was used to predict the odds of dispensing practice by year and over time.

RESULTS

The highest rates of adequate dispensing practices for the regions in each year were 85.7% in 2018, 70.8% in 2019, 58.8% in 2020, and 66.0% in 2022. By level of service, the highest was 57.7% in 2018, 56.3% in 2019, 57.8% in 2020, and 45.8% in 2022. Eight regions had similar levels of appropriate dispensing practices as Greater Accra. Three regions exhibited lower, and four had higher levels. Dispensing practices were frequently appropriate in Community-based Health Planning and Services (CHPS) compounds compared to hospitals (Adjusted Odds Ratio (AOR) = 0.48), clinics (AOR = 0.37), and maternity homes (AOR = 0.33).

CONCLUSION

Dispensing practices remained consistently low across regions and service delivery levels over the assessed years. However, CHPS compounds and health centres demonstrated comparatively better dispensing practices than higher-level facilities. Continuous investment in training, supervision, and resources is needed to ensure equitable improvements in dispensing practices.