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

Background: Misuse of antifungal agents 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. This study was therefore, conducted 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.
Results: A total of 270 patients were enrolled and interviewed. The mean age was 30±12 years. Majority of patients (59.6%) were females. Of the 270 patients, 188 (69.3%) had dermatophytes. A total of 150 (55.6%, 95%CI 49.6-61) obtained antifungal OTC. Of 150 patients who received antifungal agents OTC, 64 (42.3%) received more than one antifungal agents compared to only 9.2% (11/120) of those with prescription (p<0.001). Clotrimazole was the commonly prescribed antifungal agent while fluconazole was mostly obtained OTC. On univariate analysis, increase in age was found to be associated with the tendency of obtaining antifungal agents 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 those with skin fungal infections. There is a need for the advocacy on appropriate use of antifungal agent to reduce the associated impact of resistance development.