title: Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study.
abstract: BACKGROUND
  The irrational overuse of antibiotics should be minimized as it drives the development of antibiotic resistance, but changing these practices is challenging. A better understanding is needed of practices and economic incentives for antibiotic dispensing in order to design effective interventions to reduce inappropriate antibiotic use. Here we report on both quantitative and qualitative aspects of antibiotic sales in private pharmacies in northern Vietnam.
  
  
  METHODS
  A cross-sectional study was conducted in which all drug sales were observed and recorded for three consecutive days at thirty private pharmacies, 15 urban and 15 rural, in the Hanoi region in 2010. The proportion of antibiotics to total drug sales was assessed and the revenue was calculated for rural and urban settings. Pharmacists and drug sellers were interviewed by a semi-structured questionnaire and in-depth interviews to understand the incentive structure of antibiotic dispensing.
  
  
  RESULTS
  In total 2953 drug sale transactions (2083 urban and 870 rural) were observed. Antibiotics contributed 24% and 18% to the total revenue of pharmacies in urban and rural, respectively. Most antibiotics were sold without a prescription: 88% in urban and 91% in rural pharmacies. The most frequent reported reason for buying antibiotics was cough in the urban setting (32%) and fever in the rural area (22%). Consumers commonly requested antibiotics without having a prescription: 50% in urban and 28% in rural area. The qualitative data revealed that drug sellers and customer's knowledge of antibiotics and antibiotic resistance were low, particularly in rural area.
  
  
  CONCLUSIONS
  Over the counter sales of antibiotic without a prescription remains a major problem in Vietnam. Suggested areas of improvement are enforcement of regulations and pricing policies and educational programs to increase the knowledge of drug sellers as well as to increase community awareness to reduce demand-side pressure for drug sellers to dispense antibiotics inappropriately.
authors.affiliation: Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam. ngadtt@oucru.org.
authors.forename: Do Thi Thuy
authors.initials: do TT
authors.lastname: Nga
authors.forename: Nguyen Thi Kim
authors.initials: NT
authors.lastname: Chuc
authors.forename: Nguyen Phuong
authors.initials: NP
authors.lastname: Hoa
authors.forename: Nguyen Quynh
authors.initials: NQ
authors.lastname: Hoa
authors.forename: Nguyen Thi Thuy
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Hoang Thi
authors.initials: HT
authors.lastname: Loan
authors.forename: Tran Khanh
authors.initials: TK
authors.lastname: Toan
authors.forename: Ho Dang
authors.initials: HD
authors.lastname: Phuc
authors.forename: Peter
authors.initials: P
authors.lastname: Horby
authors.forename: Nguyen
authors.initials: N
authors.lastname: Van Yen
authors.forename: Nguyen
authors.initials: N
authors.lastname: Van Kinh
authors.forename: Heiman F L
authors.initials: HF
authors.lastname: Wertheim
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics*; D003132:Commerce; D024881:Drug Resistance, Bacterial; D007722:Health Knowledge, Attitudes, Practice; D004366:Nonprescription Drugs / Q000191:economics*; D010594:Pharmacies / Q000191:economics*; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D014744:Vietnam
chemical_list: D000900:Anti-Bacterial Agents; D004366:Nonprescription Drugs