The document assessed the knowledge, attitude and practice of patient medication counseling among drug dispensers in Jimma Town, Ethiopia. It found that almost half of dispensers believed patient counseling is the responsibility of pharmacy professionals. However, dispensers only provided about half of key counseling activities besides drug dose, frequency and administration route. High patient loads and lack of time were major barriers to effective counseling. The study concluded formal education and continuous training are needed to improve dispenser knowledge and patient counseling practices.

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Indo American Journal of Pharmaceutical Research, 2014 ISSN NO: 2231-6876
Journal home page:
http://www.iajpr.com
INDO AMERICAN
JOURNAL OF
PHARMACEUTICAL
RESEARCH
ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF PATIENT
MEDICATION COUNSELING AMONG DRUG DISPENSERS IN JIMMA TOWN, OROMIA
REGION, SOUTH WEST ETHIOPIA
Alefe Norahun Mekonnen2*,
Gobezie Temesgen Tegegne 1
, Belayneh Kefale Gelaw1
, Amsalu Degu
Defersha1
, Getasew Amogne Ayinalem3
1
Department of Pharmacy, College of medicine and Health Sciences, Ambo University, Ambo, Ethiopia,
2
Amba georgis Woreda health office
3
Department of Pharmacy, College of medicine and Health Science, Wollo University, Dessie, Ethiopia
Corresponding author
Alefe Norahun
Amba georges woreda health office,
Gondar, Ethiopia
alefe.alefe519@gmail.com
Copy right © 2014 This is an Open Access article distributed under the terms of the Indo American journal of Pharmaceutical
Research, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ARTICLE INFO ABSTRACT
Article history
Received 29/03/2014
Available online
08/07/2014
Keywords
Jimma,
Patient Counseling,
Dispenser,
Patient Medication
Counseling.
Providing counseling to patients regarding their medication is a better means to improve
patient compliance. The way drugs are dispensed and the type of information delivered during
dispensing strictly determine the way drugs are utilized by patients and affect the expected
out come. Clear and complete instructions on how to take or use drugs, risks and benefits of
using medicines, adverse effects, when and how to use drugs are at least the vital drug
information that should be delivered to patients by dispensers. The objective of this study was
to assess knowledge, attitude and practice of patient counseling delivered by drug dispensers
in Jimma town drug retail outlets, 2013. A cross sectional study was conducted by using self
administered semi-structured questionnaire in Jimma town drug dispensers from January 20
to 30, 2013. Among 49 dispensers, 46.94% of them believed that patient counseling is
pharmacy professionals’ responsibility while 44.90% believed it is a shared responsibility of
prescribers and dispensers. 42.86% of dispensers always update their knowledge on drugs and
their most frequently used drug information sources were formularies and guidelines. 82.86%
of the dispensers respond that they know the formal way and the information included in
patient counseling. From ten patient counseling activities assessed, only 18 37% of dispensers
give more than half. Almost half of the dispensers believed that patient counseling is the
responsibility of pharmacy professionals. The dispensers give less counseling activities other
than giving drug information on dose, frequency and route of administration. High patient
load and lack of time was major barrier of patient medication counseling by dispensers. So,
formal education on patient medication should be included in pharmacy schools and
continuous training should be given to increase dispensers’ knowledge on patient counseling.
Please cite this article in press as Alefe Norahun et al. Assessment of Knowledge, Attitude and Practice of Patient Medication
Counseling Among Drug Dispensers in Jimma Town, Oromia Region, South West Ethiopia. Indo American Journal of Pharm
Research.2014:4(06).

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INTRODUCTION
Background information
Patient counseling is an important means for achieving pharmaceutical care. It is defined as providing medication related
information orally or in written form to the patients or their representatives, on topics like direction of use, advice on side effects,
precautions, storage, diet, and life style modifications. Patient medication counseling (PMC) is an interactive in nature and involves a
one to one interaction between a pharmacist and a patient and /or care giver. It should include an assessment of whether or not the
information was received as intended and that the patient understands how to use the information to improve the probability of
positive therapeutic out comes (1).
The need and potential for counseling the patients regarding their drug therapy has been an important part of the pharmacy
practice and pharmaceutical care. It has been the responsibility of the pharmacists to counsel the patients before dispensing the
medication. Counseling not only enhances compliance but also reduces complications due to non compliance to treatment (2).
The pharmacist are at highly visible and readily available positions to answer patients concerns and enquires about their
medication and alternative treatments they may read about or hear from others. They have to develop, implement and fulfill plans to
monitor progress towards desired therapeutic outcomes and identify the amount and type of education required by the patient to
maximize their chance of solving or preventing any drug or disease related problems. They have also to identify the degree of
monitoring required by the patients according to the health risk posted on the patient medication, drug related problems or disease (3).
It is the pharmacists’ role to significantly improve medication safety and patient compliance by the way of counseling at the
point of delivery. Pharmacists can help patients to avoid medication misshapes and errors at home by providing them with information
on medication safety. Assessment should also be handled whether or not the information was received as intended and that the patient
understands how to use the information to improve the probability of therapeutic out comes (4).
The pharmacy professionals should appropriately educate patients on the name and description of the medication, duration of therapy,
special directions and precautions for preparing of drugs, common side effects, therapeutic indication and contraindications, proper
storage, refill information and appropriate actions to be taken in case of missed dose, when dispensing prescribed and non prescribed
drugs, when patient counseling on discharge medication or when provided recommendation about management of specific drug
related problems (4).
Often during counseling either the pharmacist or the patient realizes that a wrong drug is originally prescribed or a
prescription is misunderstood. Because drug names are sometimes miswritten, misheard, and misread. It is important that pharmacists
are aware of drugs with such missing, and take extra precautions within their practice to prevent and avoid medication errors often
associated with drugs. Carefully reviewing a patients medication therapy with the patient helps to avoid potentially dangerous
situations; careful review has helped to avoid countless mistakes and errors (5).
To positively influence patient compliance with medication therapies and to help ensure patient safety, the pharmacy community has
to strongly support patient counseling requirements. Leadership within the pharmacy profession has to work with the education
department to develop the counseling requirements. Accordingly, a pharmacist must provide counseling, before dispensing a
medication to a new patient of the pharmacy, before dispensing a new prescription for an existing patient of pharmacy, and every time
the dose, strength, route of administration, or directions for use has changed for an existing prescription previously dispensed to an
existing patient of the pharmacy (6).
Patient medication counseling must include verbal accompanied by written information for patients to refer it at home.
Written material re informs what the pharmacist says and helps the patient to recall what was said. Patients using new drugs under
active surveillance by DACA, those with special storage conditions, and those with significant side effects, those with complicated
direction, those with additional warning labels and those which are alcohol contraindicated will always receive additional verbal or
written information (5).
Effective OTC counseling also needs thorough description of patient symptoms before advice is given. If the dispenser recommends a
non prescription drug, he/she should provide information on direction of use, expected out comes, common adverse effects,
appropriate storage conditions and when to seek medical attention verbally accompanied by written material of patients own language
(7).
Area also affects patients’ willingness for counseling depending on type of their medication. Private or semi private area
away from other peoples is appropriate. This provides an opportunity for the patient to ask questions and to follow the counseling
attentively (7).
Generally, properly implemented and consistently maintained PMC will result in improvement in the patient understanding
about medication, improve therapeutic outcome, minimize waste of resources, improve job satisfaction for pharmacists, improve
patient loyalty, improve pharmacists prescribed relationships and aware the clients about the significance of pharmacy professionals in
the area of health care system (8).
Statement of the problem
Patient education commonly referred to as counseling, during drug dispensing is the most important professional roles of a
licensed pharmacist. Counseling is beneficial for both patient and pharmacists. To avoid medication errors and to help patients
understand about the intended effects and side effects of drugs, communicating and dealing with is one important way. Patient
counseling would serve to not only help educate patients about their medications, but also serve to open communication lines further
between the pharmacist and the patient .This would allow the pharmacist to give better health care as he/she could be better informed
of the patients over all health, and could further help the patient including a healthier life (6).

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Infact, an estimate of three quarters of pharmacists who attended continuing education sessions presented by the state board
of pharmacy in USA indicated that errors have been prevented as a result of patient counseling. Studies have shown that the
professional expertise provided by a pharmacist during counseling can save money, prevent unnecessary hospitalization and in some
cases prevent patient harm/death (6).
In Ethiopia, however, it seems that health planners have often overlooked dispensing when they develop health care delivery
system. Dispensing is hence regarded as less important than diagnosis, procurement, inventory control and distribution. In reality
inappropriate or incorrect dispensing results in all the benefits of health care system valueless. Regardless of the modern facilities,
extensive education and careful diagnosis, the proper medication must be dispensed to patients with appropriate information and the
patient must comply with therapy for the health care system to have accomplished its task (8).
In 1993 GC North Carolina added a section mandating and describing the essentials of patient counseling to its pharmacy
rules. Subsequently, pharmacy schools in North Carolina and across the US began to institute education and training to pharmacy
students on how to appropriately counsel patients on their medication. Since this period, there is patient counseling legislation and this
was introduced into pharmacy school curriculum (9).
An offer to provide counseling must also be made every time a patient has a prescription refilled or has a prescription filled
for a medication therapy that has been reauthorized by a prescriber. Worldwide more than 50% of all medicines are prescribed,
dispensed or sold inappropriately, while 50% of patients fail to take them correctly. In appropriate use of drugs waste resources of out
of pocket payment by patients and result significant patient harm in terms of poor patient outcomes and adverse drug reactions (9).
Even though providing patients with adequate and clear information on drugs is one of the basic services expected to be
rendered by the pharmacist, it seems that it has received little attention in Ethiopia. It is presumed that shortage of qualified personnel,
lack of preparedness of the practicing pharmacists, and community perception towards practicing pharmacist have significantly
contributed to the existing several problems in the clinical practice of pharmacy in general and patient counseling in particular (10).
Significance of the study
Patient medication counseling, being a critical part of dispensing is the final link between professional health care providers
and patients which significantly determines the outcome of all health care procedures and facilities. The way drugs are dispensed and
the quality of information given during dispensing greatly affects the way drugs are utilized by patients. Being this is the reality, in
most developing countries, dispensing is done by those who have had no formal training on dispensing in which one can say that
patient medication counseling is being inadequately delivered(11).
This study will provide information about the scope of problems of patient medication counseling in Jimma town. This will
help local regulatory bodies and other concerned bodies to prepare plan and make interventions accordingly to the result obtained for
the improvement of patents’ benefits. This will also awaken pharmacy professionals to take the responsibility of PMC and broaden
their role in health care services. Moreover, this study will put an insight for future researchers who will conduct a similar study.
OBJECTIVES
General objective
To assess the knowledge, attitude and practice of patient medication counseling provided by drug dispensers in Jimma town
drug retail out lets.
Specific Objectives
 To assess the knowledge of drug dispensers on patient medication counseling (PMC);
 To assess how much dispensers are near to drug information;
 To assess the sources of drug information used by dispensers;
 To determine the extent of PMC provided by drug dispensers; and
 To explore drug dispensers’ attitudes towards PMC and to identity the major barriers for effective counseling.
METHODS AND MATERIALS
Study area
The study was conducted in Jimma town located 346 km from Addis Ababa. The town has 2 health centers, one specialized
teaching hospital and 36 drug retail outlets. It has a geographical location of 70
9’ latitude 360
56’˙
.6” longitude, 1740 m altitude and
average rain fall of 153 mm .Based on central statistical agency in 2005, this town has an estimated total population of 159,009.
Study period
The study was conducted from January 20-30, 2013.
Study Design
A cross sectional study was conducted by using self administered semi-structured questionnaire
Population
Source population
The source population was dispensers working in Jimma town in private as well as governmental sectors

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Study population
All the dispensers who work in rural drug venders, drug stores, community pharmacies and health institution DROs, of the town
were study population
Study unit
A drug dispenser in rural drug vender, drug stores, community pharmacy or health institution DRO was the study unit
Sample size and sampling technique
All private and institutional dispensers in Jimma town were involved so, no sample size and sampling technique was used
Study variables
Independent variables
 age
 Educational qualification
 Sex
Dependent variables
 Patient medication counseling practice
 Attitude towards PMC
 Knowledge of dispensers about PMC
Data collection procedure
Data collection instruments
A Semi- structured questionnaire prepared by the principal investigator was used to collect the information on patient medication
counseling
Data collection Methods
The questionnaire was given to the dispensers to fill it in their home or at their free time and was collected in the next day
Data collector
The data was collected by the principal investigator
Data processing and analysis
The collected data was cleaned, checked for its completeness, categorized, coded and analyzed using scientific calculator.
The result was interpreted and presented using appropriate tables, graphs and charts.
Data quality assurance
The quality of the study was improved by explaining highlight of the questionnaire to the dispenser by the investigator during
delivery of the questionnaire. During collection of the questionnaire in the next day, the dispensers were asked if there was any
unclear ideas in the questionnaire and was checked for any unfilled information.
Ethical considerations
Ethical approval to conduct this study was obtained from Jimma university students’ research program and it was given to Jimma
zone health bureau and another letter was obtained from the bureau to the dispensers in the drug retail outlets (DROs) of the town for
cooperation. Moreover, verbal consensus was obtained from dispensers during questionnaire distribution.
RESULTS
Socio – demographic characteristics
In this study, a total of 49 drug dispensers were included.10( 20.41%) were pharmacists, 35(71.43%) were druggists and the
rest 4(8.16%) were pharmacy technicians. 34(69.39%) of the dispensers were males where as 15 (30.61%) of them were females.
15(30.61%) of the dispensers were between 31 and 50 years old age group while all the rest under the age of 31 years old.33(67.35%)
were privately working, 12(24.49%) were working in a governmental facilities and 4(8.16%) were working in NGO (Table 1).

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Table 1 socio-demographic characteristic of drug dispensers in Jimma town, January 20-30/2013.
Socio demographic Characteristics Frequency (%)
Pharmacist Druggist Phar.T
Sex Male 9(90%) 22(62.85%) 3(75%)
Female 1(10%) 13(37.15%) 1(25%)
Age 30 9(90%) 23(65.71%) 2(50%)
31-40 1(10%) 8(22.84%) 1(25%)
41-50 0% 4(11.43%) 1(25%)
Working sector Private 2(20%) 28(80 %) 3(75%)
Government al 8(80%) 4(11.43%) 0%
NGO 0% 3(8.57%) 1(25%)
Phar.T=pharmacy technician
Dispensers’ attitude towards patient counseling.
According to the response, 23(46.94%) of the dispensers have an attitude that pharmacy professionals / dispensers should
counsel the patient, while 22(44.90%) of dispensers responded that it is the responsibility of both dispensers and prescribers. The other
respondents, 4(8.16%) believed that physicians and other prescribers should carry out the counseling activities. There is no statically
significant association between response and other factors like educational qualification, age and sex (Table 2).
Table 2 Attitude of drug dispensers in Jimma town towards the responsible body for counseling the patient on their medication
based on their educational qualification, age and sex, Jan 20-30/2013.
Factors that affect Attitude Responsible body Total p-value
Pharmacy Physicians both
professionals prescribers
Educational
qualification
Pharmacist 6 0 4 10
0.252
Druggist 17 3 15 35
Phar.T 0 1 3 4
Total 23 4 22 49
Age group 030 17 2 13 32
0.658
31-40 4 1 7 12
41-50 2 1 2 5
 51 0 0 0 0
Total 23 4 22 49
Sex Male 13 2 19 34
0.064
Female 10 2 3 15
Total 23 4 22 49
Frequency of knowledge updating on drugs by drug dispensers.
Almost all, 97.96% (48) dispensers replied that they update their knowledge on new and existing drugs. 42.86% of drug
dispensers responded that they always update their drug information while 2.04% (1) do rarely. The primarily used drug information
sources were formularies and guidelines by 36 (73.47%) and standard text books by 32(65.31%), leaflets by 32(65.31%) of the
respondents (figure 1).
42.86%
40.82%
14.29%
2.04%
Always
Sometimes
Often
Rarely
Figure1: Frequency of drug information updating by drug dispensers in Jimma town, January 20-30/2013.

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Table 3 Source of drug information for dispensers in Jimma town, January 20-30/2013.
S.No Sources of information Percentage (n=49)
1 Formularies and guidelines 36(73.475%)
2 Standard text books 32(65.31%)
3 Notes from universities / colleges 26(53.06%)
4 Drug information bulletins 13(26.53%)
5 Leaflets 32(65.31%)
6 Internet 21(42.86%)
7 Other people/ friends 6(12.24%)
Most of the dispensers (85.75%) responded that they know the formal way and the information that must be included during
counseling. With respect to educational qualification, 90% of pharmacists, 82.86% of druggists and 100% of pharmacy technicians
responded that they know it (Figure 2).
0
20
40
60
80
100
120
1
Educational qualification
%thatknowtheformalway
Phar.T
Phrmacists
Druggists
Figure 2: knowledge of drug dispensers in Jimma town on the formal way and the information that must be included during
patient medication counseling, January 20-30/ 2013.
Patient medication counseling activities
From 49 dispensers, 45(91.84%) of the dispensers carry out the counseling activities by themselves, while 4(8.16%) of them
responded that the counseling activity is done by their assistant. 44(89.80%) of the dispensers do greeting activities to the patients
before starting counseling (Great/ expend their hand, and /or tell their profession /name) where as 5(10.20%) do none of the greeting
activities.
Ten counseling activities were assessed in 49 of the dispensers. There were 490 responses, out of these, 338(68.98%)
responses showed that they give the counseling activities. The remaining respondents (31.02%) replied no (do not give counseling
activities) (Table 4).
9(18.37%) of the dispensers responded that they give more than half of the counseling activities assessed. The maximum counseling
response given was seven and the minimum was one out of the ten counseling activities assessed.
Table 4 Patient counseling activities given by drug dispensers in Jimma town, January 20-30/2013.
S.No counseling activities Percentage (n=49)
1 Explain purpose of counseling 39(79.59%)
2 Ask the patient what the prescriber told 36(73.47%)
3 Explicitly tell duration of regimen 40(81.63%)
4 Tell drug interactions 32(65.31%)
5 Ask the patient if they have problem in taking medication 34(69.39%)
6 Tell common side effects 26(53.06%)
7 Check the patient for understanding 38(77.55%)
8 Emphasize the benefits of life style modification 32(65.31%)
9 Open the container and show the content 28(57.14%)
10 Tell what to do if dose is missed 33(67.35%)
Total 33.8(68.98%)

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Table 5: Patient counseling activities distribution among different educational qualification, age groups, knowledge of formal
way of counseling, January 20-30/2013.
Factors affecting patient Frequency (%) Total P- value counseling activities
Yes No
0.009
Educational qualification Pharmacist 76 24 100
Druggist 228 122 350
Phar.T 34 6 40
Total 338 152 490
Age group 030 234 101 340
0.631
31-40 73 37 110
41-50 26 14 40
Total 338 152 490
Knowledge of formal way of counseling Yes 292 128 420
0.524
No 46 24 70
Total 338 152 490
Sex Male 232 108 340
0.592
Female 106 44 150
Total 338 152 490
Route of administration, frequency, dose and duration of therapy were the most frequently delivered drug information to the
patients as the dispensers responded. On the contrary, most of the dispensers tell the name of the drug , use of medication, and side
effects of the drug either rarely or never (table 6)
Table 6: Frequencies in which drug dispensers in Jimma town tell basic drug information to patients, January 20-30/ 2013.
S.No Information they give Percentage of responses (n=49)
Always Often Sometimes Rarely Never
1 Tell the name of the drug 44.90 20.41 30.61 4.08 0
2 Tell route of administration 100 0 0 0 0
3 Tell the frequency 100 0 0 0 0
4 Tell the dose 93.80 6.12 0 0 0
5 Tell uses of medicine 46.94 24.49 20.41 6.12 2.04
6 Tell duration 89.8 6.12 2.04 2.04 0
7 Tell drug-drug, drug-food 73.47 12.25 12.24 2.04 0
interactions
8 Tell risks if dose is missed 69.39 6.12 18.37 4.08 0
9 Tell storage conditions 71.42 14.29 12.25 2.04 0
10 Tell common side effects of 40.80 20.41 26.53 10.20 0 drugs
OTC drugs dispensing
Almost half (46.94%) of the respondents do not ask symptoms when they dispense OTC drugs. Most of them (81.63%) and
(77.55%) responded that they tell direction for use and proper storage condition respectively. Significant number of respondents
(40.82%) showed that they tell common side effects to their patients (Table 7).
Table 7: Information given by drug dispensers in Jimma town during dispensing of OTC drugs, January 20-30/2013.
S.No Information they give No of respondents (%)
1 Direction for use 40(86.63%)
2 Expected outcome of therapy 18(36.74%)
3 Common side effects 20(40.82%)
4 When to seek medical attention 26(53.06%)
5 Proper storage condition 38(77.55%)
Dispensers concern to special condition
All of the drug dispensers (100%) responded that they give special attention to pregnant women during dispensing drugs
among the patient conditions. Relatively, less attention (73.47%) was given to functional illiterates. Among disease conditions, a
maximum response (89.80%) showed that epilepsy took the highest concern. On the other hand, hypertension took relatively least

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concern (67.35%) by the respondents. With respect to drug conditions, dispensers give more attention for dispensing of drugs with
special storage conditions (79.59%), but the least concern was given for drugs under active surveillance by DACA (46.94%).
Generally, dispensers give more attention for disease conditions than drug condition during their dispensing (Table 8).
Table 8 Conditions in which dispensers in Jimma town given special attention and/or give additional information during drug
dispensing, January 20-30/2013.
Special conditions Percentage (%), n = 49
Patient condition Pregnant 49(100%)
Visual/ Hearing problematic 39(79.59%)
Functional illiterate 36(73.47%)
Child/elder patient 45(91.84%)
Taking multiple medicines 37(75.51%)
Disease condition Asthma 37(75.51%)
Diabetes mellitus 38(77.55%)
Epilepsy 44(89.80%)
Hypertension 33(67.35%)
Tuberculosis 42(85.71%)
Drug condition Under active surveillance by DACA 23(46.94%)
With significant side effect 28(57.14%)
With additional warning 34(69.39%)
With complicated direction 32(65.31%)
With special storage condition 39(79.59%)
Barriers to patient counseling
High patient load and lack of time was the first contributing factor that prohibit dispensers from counseling their patients
(79.59%) followed by lack of knowledge on drugs and updated drug information(65.35%). Patient factors (interest to be counseled)
and no legalization of counseling were also other factors assessed during the study (Table 9).
Table 9 Factors that prohibit dispensers from counseling patients on their medication among dispensers in Jimma town,
January 20-30/ 2013.
S.No Barriers to counseling Percentage of respondents (%)
Pharmacist Druggist Phar.T Total
1 High patient load and lack of time 6(60%) 30(85.71%) 3(75%) 39(79.59%)
2 Lack of updated drug information 3(30%) 29(82.86%) 0 32(65.31%)
3 Patient factor 6(60%) 24(68.56%) 1(25%) 31(63.27%)
4 No legalization 1(10%) 3(8.57%) 0 4(8.16%)
Finally, most of the dispersers added that all pharmacy professionals have to contribute their own effort to improve
counseling given by pharmacy professionals so that pharmacy becomes more care related. Updating drug information timely,
preparing work shop concerning PMC by the concerned body and the likes were some points raised as an additional issue by the
respondents.
DISCUSSION
Among several strategies, counseling is the best means to improve patient compliance to drug therapy. Non- compliance to
drug therapy is a common problem worldwide which can lead to adverse drug reaction and therapeutic failure. Several studies have
acknowledged that counseling by pharmacists (pharmacy professionals) can improve patients understanding about medication and life
style modification. Failure of achieving therapeutic goals and reduction in quality of life of the patients is usually due to lack of
adequate information on drugs usage which leads to non adherence to their medication (12).
As a health care provider, Pharmacists must be very clear on what important duties they have to deliver to their patients.
They are morally, ethically and legally obligated to provide patients with adequate and clear information on drugs. In this study
46.94%(n=49)of respondents believed that counseling of patients is the responsibility of pharmacy professionals, while 44.90% of
them replied that it is the responsibility of both prescribers and dispensers. A study conducted in the state of Karnataka (India) showed
that majority respondents (80%) agreed that patient counseling is their professional obligation while a small number of respondents
believed that it is a shared responsibility (12). High number of respondents on patient medication counseling as a shared responsibility
on this study may be due to absence of any course to dispensers about patient counseling on their professional training since pharmacy
departments in Ethiopia have no courses on patient counseling and pharmacist’s communication with patient and other professionals.
A study conducted in North Carolina (USA) showed that, in 1993, pharmacy schools in North Carolina and across the United States
began to institute education and training to pharmacy students on how to appropriately counsel patients on their medications (9).

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New information on drugs is rapidly expanding because of new drug products entering into the drug market and new information
about the existing drugs. Persons involved in drug dispensing require updating their drug information in order to provide adequate and
clear information on drugs to their patients, other health professionals and to the general public (13). In this study, 42.86% (n=49) of
the dispensers responded that they update their knowledge of drugs always, while 40.82% and 2.04% of the dispensers update their
knowledge often and rarely respectively. This low frequency of knowledge updating may be due to; in Ethiopia up-to-date drug
information is not accessible to the majority (80%) of drug dispensers (14).
Their main sources of drug information were formularies and guide lines by 73.47% and leaflets by 65.31% of dispensers.
WHO prohibit use of leaflets as a source of drug information and promote use of drug information bulletins due to leaflets contain
manipulated information about a particular drug since they are prepared by drug manufacturing companies and thus are subjected to
bias (4). High use of leaflets in this study may be due to lack of up to dated drug information, from other sources.
Among ten counseling activities in the 49 dispensers, 338(68.98%) response were yes (give one or more counseling
activities) while 152(31.02%) responses were no. Educational qualification was having statistically significant influence (p=0.009) on
the response they have given while age and knowledge of formal way of counseling showed insignificant influence (p=0.524 and
0.631 respectively). Pharmacists provide more counseling activities compared to druggists (76% and 65.41% respectively). This
difference may be due to, pharmacists have more understanding of the disease process, more drugs have been studied by them during
their stay in universities or colleges and they are trying to play their role in the health care system. In a study conducted on dispensing
practice of selected pharmacies and rural drug venders in Gonder, kolladuba and Debark towns, counseling was given relatively more
in RDV (druggists) than pharmacies (pharmacists)(15).
Counseling provides the individual with the knowledge which will enable him/her to achieve an optimal state of health. To
make it successful, current methods of giving information such as patient counseling by pharmacy professionals need to be examined.
The counseling activities in this study, as the respondents responded are not satisfactory (68.98%), the outcome is not also proved by
examining patents. In a study conducted in Israel on patients’ knowledge about their medication, only 27% of them were aware of
possible side effects related to their medication. On the other studies in this area, researchers found that 40% of the patients needed
more specified directions for care, such as how or when to take medication (12). In addition to this there may be training and
regulation differences. In relation to this, in a study done in Ghana, only 24% of the pharmacists provide any information on how to
take the recommended medication (11). Similarly, in this study 18.37%of the dispensers provide more than half of the counseling
activities.
Route of administration, frequency, dose and duration of therapy were always told drug information to the patient as the
dispensers responded in this study (100%,100%,93.88%and 89.8%), respectively. As compared to this a research done on outpatient
counseling in four hospital of Addis Ababa showed that the most type of drug information desired by the patients and offered by
pharmacists were frequency of administration (84%) and route of administration (56%)(16). Others like name of drug, Storage
conditions, drug interaction were also delivered by some dispensers sometimes and rarely in this study.
In this study most of the dispensers (85.7%) respond that they know the formal way and the information that must be
included during counseling. However, only 18.37% of them respond that they give more than half of the counseling activities
assessed. This may be due to the factors that prohibit them from counseling, because most response (54.08%) showed that there are
different factors, such as high patient load and lack of time, lack of sufficient knowledge and others that prohibit them from their
counseling activities.
The numerous switches of drugs from prescription to OTC status since the 1980s have increased the public health importance
of self medication worldwide. This situation presents an opportunity for pharmacists to counsel consumers on self care and the proper
use of these products. Here the role of the pharmacists is to ensure that all necessary information and advice is given to encourage safe
and effective use of medicines (17). In this study, 46.94% of the respondents do not ask symptoms when they dispense OTC drugs.
However most of the dispensers said that they tell some important information such as: direction for use, when to seek medical
attention, proper storage condition and common adverse effect frequently (81.63%, 53.06%, 77.55% and 40.82% respectively) when
they dispense OTC drugs. A study conducted in central Sweden to assess the quality of the self-care advice provided by pharmacy
professional showed that they consider symptoms during their OTC dispensing of which allergy (26.4%), musculoskeletal symptoms
(8.4%) and dyspepsia (7.2%) were some of them. This study also showed that 84% of customers had completely followed the advice
received and a great relief of symptoms had been experienced by 62.4% and some relief by 21.6% of customers (17).
In this study, high patient load and lack of time (79.59%), lack of sufficient knowledge on PMC (65.31%), patient factors
(63.27%) and no legalization (8.16%) were barriers to patient counseling as the dispensers respond. In another study conducted in
Nepal, lack of time (54%), lack of knowledge(28%), and lack of patient willingness (10%) were the barriers for patient counseling by
dispensers(17). High percentage of lack of knowledge in this study showed that pharmacy professionals are far away from drug
information and they are in need of getting professional education regarding PMC in Ethiopia and high percentage of patient factors in
this study may due to less development of pharmacy practice in Ethiopia in which community does not understand the need for drug
information as compared to Nepal pharmacy practice (4).
CONCLUSION
Almost half of the dispensers believe that patient counseling is the responsibility of pharmacy professionals and majority of
the rest agreed that it is a shared responsibility of both prescribers and dispensers. Drug information on dose, frequency, route of
administration and duration of therapy were most frequently delivered by dispensers. Educational qualification was affecting patient
medication counseling activities by dispensers. Nearly half of the dispensers do not ask symptoms during their OTC dispensing, but
they deliver drug information like direction for use, when to seek medical attention, proper storage condition and some common side

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effects. Most of the dispensers are not accessible to up-to-date drug information. High patient load and lack of time, lack of
knowledge, patient factors and no legalization were barriers to patient medication counseling by drug dispensers.
RECOMMENDATIONS:
 Update drug information and training should be frequently given to those involved in dispensing.
 Pharmacy schools in Ethiopia should include patient medication counseling as one course in their education curriculum.
 Further research aided by recorder should be done that include every parts of Ethiopia for some significant data.
ACRONYMS
DACA: Drug administration and control authority
DRO: Drug retail outlet
GC: Gregorian calendar
NGO: Non – governmental organization
OTC: Over the counter
PMC: Patient medication counseling
POM: Prescription only medication
RDV: Rural Drug vender
TB: Tuberculosis
USA: United States of America
WHO: World health organization
ACKNOWLEDGMENT
We are very grateful to our college staff members for unreserved guidance and constructive suggestions and comments from
the stage of proposal development to this end. We would like to thank Jimma University for supporting the budget which required for
this research. Finally our deepest gratitude goes to dispensers, who help and allow us in collecting and gathering data from the
hospital.
Funding: Jimma University
Conflict of interest: None declared
Ethical Approval: The study was approved by the institutional Ethics committee.
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