title: Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh.
abstract: BACKGROUND
  Pharmacies in Bangladesh serve as an important source of health service. A survey in Dhaka reported that 48% of respondents with symptoms of acute respiratory illness (ARI) identified local pharmacies as their first point of care. This study explores the factors driving urban customers to seek health care from pharmacies for ARI, their treatment adherence, and outcome.
  
  
  METHODS
  A cross-sectional study was conducted among 100 selected pharmacies within Dhaka from June to December 2012. Study participants were patients or patients' relatives aged >18 years seeking care for ARI from pharmacies without prescription. Structured interviews were conducted with customers after they sought health service from drug sellers and again over phone 5 days postinterview to discuss treatment adherence and outcome.
  
  
  RESULTS
  We interviewed 302 customers patronizing 76 pharmacies; 186 (62%) sought care for themselves and 116 (38%) sought care for a sick relative. Most customers (215; 71%) were males. The majority (90%) of customers sought care from the study pharmacy as their first point of care, while 18 (6%) had previously sought care from another pharmacy and 11 (4%) from a physician for their illness episodes. The most frequently reported reasons for seeking care from pharmacies were ease of access to pharmacies (86%), lower cost (46%), availability of medicine (33%), knowing the drug seller (20%), and convenient hours of operation (19%). The most commonly recommended drugs were acetaminophen dispensed in 76% (228) of visits, antihistamine in 69% (208), and antibiotics in 42% (126). On follow-up, most (86%) of the customers had recovered and 12% had sought further treatment.
  
  
  CONCLUSIONS
  People with ARI preferred to seek care at pharmacies rather than clinics because these pharmacies were more accessible and provided prompt treatment and medicine with no service charge. We recommend raising awareness among drug sellers on proper dispensing practices and enforcement of laws and regulations for drug sales.
authors.affiliation: Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Fahmida
authors.initials: F
authors.lastname: Chowdhury
authors.affiliation: Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Katharine
authors.initials: K
authors.lastname: Sturm-Ramirez
authors.affiliation: Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Abdullah Al
authors.initials: AA
authors.lastname: Mamun
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: A Danielle
authors.initials: AD
authors.lastname: Iuliano
authors.affiliation: Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Mejbah Uddin
authors.initials: MU
authors.lastname: Bhuiyan
authors.affiliation: Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Mohammod Jobayer
authors.initials: MJ
authors.lastname: Chisti
authors.affiliation: Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Makhdum
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
authors.forename: Sabbir
authors.initials: S
authors.lastname: Haider
authors.affiliation: Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh.
authors.forename: Mahmudur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Azziz-Baumgartner
keywords: acute respiratory illness; customers; dispensing practice; drug sellers; health care seeking; pharmacy