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Estimated extent of purchasing of antibiotics without a prescription from community pharmacies in a rural provincein South Africa and the implications
Maluleke , Tiyani Milta; Maluleke, MorganTiyiselani; Jelić, Ana Golić; Campbell, StephenM.; Marković-Peković, Vanda; Schellack, Natalie; Chigome, Audrey; Cook, Aislinn; Godman, Brian; Meyer, Johanna C. (Frontiers Media, 2025-08-28)
BACKGROUND : Antimicrobial resistance is a considerable global health threat especially among low- and middle-income countries, exacerbated by considerable inappropriate dispensing of antibiotics. There have though been concerns with variable levels of dispensing of antibiotics without a prescription in South Africa. Consequently, a need to comprehensively estimate current levels of dispensing of antibiotics without a prescription, which was the aim of this study. METHODS : Administer a previously piloted questionnaire to all currently operating community pharmacies in a rural province, where dispensing of antibiotics without a prescription is likely to be greatest. The questionnaire included data on the estimated prevalence of antibiotics dispensed, their class and indication, and whether dispensed without a prescription. Community pharmacies were categorized into three: Independent, Chain and Franchise. RESULTS : 128/169 (75.7%) operational pharmacies participated, with independent pharmacies representing the majority (60.9%). There was a 78.3% response rate from 400 distributed questionnaires, including 106 pharmacists (33.9%) and 207 pharmacist assistants (66.1%) from 128 pharmacies. Antibiotics accounted for 47.9% (95% CI: 47.2%-48.6%) of all medicines dispensed. Penicillins were the most prevalent antibiotic dispensed (41.1%). Almost half (47.2%) of the antibiotics dispensed included macrolides, fluoroquinolones and cephalosporins, which are typically antibiotics from the Watch group. Sexually transmitted infections (33.5%) and upper respiratory tract infections (25.8%) were the most frequent indications for antibiotic dispensing. Overall, 69.3% of 128 participating pharmacies in this rural province in South Africa admitted to dispensing antibiotics without a prescription in the past 14 days, principally among independent pharmacies (98.7%). However, estimates suggest only 8.6% of the total volume of antibiotics being dispensed were dispensed without a prescription among the 88 community pharmacies admitting to this practice in the past 3 days. Encouragingly, 98.1% of community pharmacists and 97.6% of pharmacist assistants indicated they always or mostly offered symptomatic relief before dispensing antibiotics without a prescription to patients with self-limiting conditions. CONCLUSION : There were considerable concerns regarding the prescribing and dispensing of antibiotics in this rural province including Watch antibiotics. This included the number of community pharmacies, especially independent pharmacies, where patients could purchase antibiotics without a prescription. Multiple strategies involving all key stakeholder groups are need to improve future antibiotic use across South Africa and reduce AMR.
Current knowledge and attitudes toward antibiotic use among community pharmacy personnel in a rural province in South Africa and the implications
Maluleke , Tiyani Milta; Maluleke, Morgan Tiyiselani; Jelić, Ana Golić; Campbell, Stephen M.; Marković-Peković, Vanda; Schellack, Natalie; Ramdas , Nishana; Godman, Brian; Meyer, Johanna C. (Frontiers Media, 2025-10-02)
BACKGROUND : Antimicrobial resistance (AMR) is an appreciable threat to public health, especially among low- and middle-income countries (LMICs), exacerbated by high levels of inappropriate prescribing and dispensing of antibiotics in these countries. There have been variable levels of dispensing of antibiotics without a prescription among community pharmacies in South Africa. Given the importance of community pharmacies, especially in rural South Africa, there is a need to assess their knowledge and attitudes towards antibiotics, AMR, and antibiotic stewardship. This was the aim of this study. METHODS : A previously piloted questionnaire was administered to pharmacy personnel currently operating community pharmacies in a rural province in South Africa, where dispensing of antibiotics without a prescription is likely to be greatest. The questionnaire included key knowledge questions regarding antibiotics and AMR, as well as ways to reduce AMR. Community pharmacies were divided into three categories: Independent, chain, and franchise pharmacies. RESULTS : A total of 128 pharmacies participated (75.7%), with independent pharmacies representing the majority (60.9%). A total of 313 completed questionnaires were returned (78.3% response rate), including responses from 106 pharmacists (33.9%) and 207 pharmacist assistants (66.1%). Overall, there was very good knowledge among both community pharmacists and pharmacist assistants concerning antibiotics and AMR. However, there was a significant misconception regarding the potential role of antibiotics in relieving pain. Encouragingly, attitudes regarding the risks associated with obtaining antibiotics without a prescription among both community pharmacists and pharmacist assistants were high. There was also strong agreement among both community pharmacists and pharmacist assistants for potential solutions to AMR. CONCLUSION : Overall, the findings showed that most pharmacists and pharmacist assistants in this rural province demonstrated a strong understanding of the effectiveness of antibiotics in bacterial infections and their lack of effectiveness to treat viral infections. They also demonstrated considerable knowledge regarding the risks associated with the inappropriate dispensing of antibiotics without a prescription, as well as ways to address rising AMR rates.
Climate-smart food systems : integrating adaptation and mitigation strategies for sustainable agriculture in South Africa
Mudzielwana, Rudzani Vhuyelwani Angel (Frontiers Media, 2025-08-14)
AIM : Climate change presents significant challenges to food security, particularly in vulnerable regions like South Africa. This review examines climate-smart food systems (CSFS) as an integrated approach to enhancing agricultural resilience, mitigating greenhouse gas emissions, and ensuring sustainable food production. INTRODUCTION : The agricultural sector must simultaneously adapt to shifting climatic conditions and reduce its environmental impact. METHODS : This study synthesizes current literature on adaptation strategies, such as drought-resistant crops, precision agriculture, and agroecological practices, alongside mitigation efforts, including carbon sequestration, emissions reductions in livestock, and circular food systems. RESULTS : Findings highlight key barriers to CSFS implementation, including financial constraints, inadequate technical support, and fragmented policies. Policy interventions, multi-stakeholder collaborations, and emerging technologies are crucial in overcoming these challenges. DISCUSSION : Strengthening governance, financial mechanisms, and knowledge-sharing platforms is essential for the widespread adoption of climate-smart strategies. CONCLUSION : By aligning adaptation, mitigation, and policy efforts, South Africa can foster a resilient agricultural sector that supports food security and sustainable development in the face of climate change.
The role of underutilized indigenous and traditional food crops in enhancing rural livelihoods and food security in South Africa
Qwabe, Qinisani Nhlakanipho; Munialo, Sussy; Swanepoel, Frans (Frontiers Media, 2025-07-09)
South Africa’s agricultural sector faces a deep economic divide, with small-scale and subsistence black-owned farms struggling while white-owned commercial farms are well-resourced. Despite this polarization, rural farming communities have shown remarkable resilience, which can be leveraged to address socioeconomic disparities. However, in this context, there is limited information on the role of indigenous and traditional foods, particularly underutilized indigenous and traditional food crops (UITFCs). Despite their full significance to rural livelihoods, the agricultural policy has yet to incorporate UITFCs. This paper addresses this gap by analyzing themes related to UITFCs, gender, the environment, and rural livelihoods using a mixed-methods approach, including surveys and interviews. The findings confirm that UITFCs play a vital role in rural farming communities, offering readily available and accessible food sources that align with the FAO’s food policy on food security. The cultivation and use of UITFCs are crucial in addressing food security at the household level while preserving dignity. UITFCs are a critical livelihood strategy for many rural people, helping them improve their socioeconomic status. Therefore, there is a need for these crops to be overtly integrated into South Africa’s national agricultural policy.
The missing puzzle of indigenous crops in Tanzania’s agricultural trade
John, Innocentia; Gandidzanwa, Colleta (Frontiers Media, 2025-07-08)
Existing trade policies in Tanzania can potentially boost or undermine Indigenous crop representation in both domestic and international trade. The trade potential is heavily reliant on the effectiveness of existing trade policies. This paper examines the existing trade policies related to indigenous crops in Tanzania, the challenges faced, and potential strategies to enhance their market integration and trade potential. It uses a mixed methods approach consisting of qualitative and quantitative trend analysis. A policy review process is used to assess the existing policies and their effectiveness in enhancing the trade potential of indigenous crops. The results suggest that existing policies do not sufficiently encompass indigenous crops and that the trade potential of indigenous crops still needs to be realized, with only three crops out of 28 (cassava, sorghum, cowpea) crops available in Tanzania having trade recognition in the international markets. Most indigenous crops remain in domestic markets, with very few reaching urban markets, while most remain in rural markets. Moreover, most of the policies and regulations available in Tanzania have yet to recognize these crops within the policies. This paper contributes to the development of policies that support the inclusion of indigenous crops in trade. It emphasizes the need for a comprehensive review of existing government policies to unlock the trade potential of indigenous crops, recognizing their critical role in Tanzania’s agricultural heritage and food security. Highlights