Exploring the knowledge, attitude, and practices of over-the-counter medical sellers in Ghana

Background and objectives: Rural areas in sub-Saharan Africa face a high prevalence and morbidity of skin disease while also lacking access to dermatologists. In Ghana, where approximately twenty-five licensed dermatologists are available for twenty-five million people, community pharmacies, called over-the-counter medical sellers (OTCMS), were established to respond to accessibility inequities, albeit without equitable training. Our study evaluates the dermatologic knowledge, attitudes, and practices (KAP) of OTCMS in Ghana’s Ashanti Region. Methods: To assess dermatologic KAP, we created a standardized questionnaire and recorded thirteen interviews with OTCMS in seven communities. Interviews were completed with help from Ghanaian translators and transcripts were transcribed verbatim, then analyzed qualitatively to determine common themes for analysis. Results: Our analysis identified six major themes: 1) prescriber qualifications; 2) diagnostics; 3) therapeutics; 4) economics; 5); health systems integration; and 6) care-seeking behavior. Analysis of these themes outlined many cultural roles and challenges of OTCMS, including serving as the primary contact for the dermatologic conditions for rural communities. While possibly necessary due to the lack of accessible dermatologists, this raises concerns for potential harm in diagnostic error and misuse of therapeutics due to the lack of formal dermatology training. Conclusion: In rural parts of Ghana, the KAP of OTCMS play a pivotal role in assessing and treating skin disease for those who might otherwise lack access to adequate dermatologic management. Furthermore, although our study identifies potential issues related to the roles played by OTCMS, it also suggests strategies to improve dermatologic health of many Ghanaians by enhancing education and healthcare delivery in rural areas.