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Biomedical subjects

G Tomson

Publications and source records attributed to G Tomson.

At least 19 recordsLinked to original sources
PubMed2007

Assessing health worker performance in malaria case management of underfives at health facilities in a rural Tanzanian district.

OBJECTIVE: To study the quality of malaria case management of underfives at health facilities in a rural district, 2 years after the Tanzanian malaria treatment policy change in 2001. METHODS: Consultations of 117 sick underfives by 12 health workers at 8 health facilities in Mkuranga District, Tanzania were observed using checklists for history taking, counselling and prescription. Diagnoses and treatment were recorded. Exit interviews were performed with all mothers/guardians and blood samples taken from the underfives for the detection of malaria parasites and antimalarial drugs. Quality of care was measured using indicators adopted from the integrated management of childhood illnesses multi-country evaluation. RESULTS: Quality of care measured by indicator scores averaged 31% of what was considered optimal. The poorest results were for history taking. Nevertheless, 89% of febrile children were treated with antimalarials, in line with national guidelines for fever treatment. Of these, 61% had a parasitaemia > or =2000/microl. There was no difference in treatment given to those with parasitological malaria compared with those without parasites. Pre-treatment levels of chloroquine and sulphadoxine/pyrimethamine were low and detected in 2% and 13%, respectively. CONCLUSION: Although most febrile children were given antimalarial treatment, quality of care in terms of history taking and counselling was sub-optimal. Despite this, the study community had changed behaviour from self-treatment to seeking care at health facilities. This is encouraging for introduction of artemisinin-based combination therapies policies as one could focus resources into improving care at health facilities and still reach out with treatment to most febrile children.

Antimalarials↗
PubMed2006

Antimicrobial self medication for reproductive tract infections in two provinces in Lao People's Democratic Republic.

OBJECTIVES: To describe antimicrobial self medication for reproductive tract infections (RTI) including sexually transmitted infections (STI), and to explore the understanding and use of health information among the adult population self medicating with antimicrobials for RTI/STI in two provinces of Laos. This could contribute to quality improvement of RTI/STI management. METHODS: Cross sectional community based study. Structured interviews (household survey) were conducted among 500 subjects aged 18 or more, who had used antimicrobials as self medication for RTI/STI during the past year. They were recruited among 3056 family members in Vientiane capital and Champasak province, divided equally between the two study sites, and between urban and rural areas. RESULTS: Among the 500 respondents reporting self medication for RTI/STI, 91% had bought the antimicrobials from local private pharmacies without a physician's prescription. 58% of those were advised to buy the drugs from drug sellers. Ampicillin (not recommended as syndromic treatment for RTI/STI) was used in 83% of all cases, in 28% combined with tetracycline. 79% of respondents used antimicrobials for a non-recommended duration of time. Most respondents had access to health messages for RTI/STI, largely from radio/television and drug sellers. However, only 17% of all respondents reported that they had ever used a condom. CONCLUSIONS: More than three quarters of respondents, self medicating for RTI/STI with antimicrobials, used inappropriate drugs bought from private pharmacies. There is a need to improve RTI/STI management, including health promotion, through interventions at community level, and to health providers, including private drug sellers.

Adult↗
PubMed2005

Decision-makers and the usefulness of research evidence in policy implementation--a case study from Lao PDR.

The involvement of researchers in the policy process and policy-makers in research is little studied, particularly in developing countries. In 1993, the Lao National Drug Policy (NDP) was endorsed in a consultative process involving many stakeholders. Lao People's Democratic Republic is a poor country in South East Asia. Five pilot provinces were selected for implementation of the policy, which had a health system research (HSR) component. This case study explores decision-makers' knowledge and attitudes regarding the usefulness of HSR in the NDP implementation process. Ninety decision-makers from different health institutions including hospitals, medical schools and main drug suppliers were surveyed using a self-administrated structured questionnaire, filled in during a NDP conference in 2001. Results from six HSR projects related to the NDP implementation had been presented during the conference, but also 6 months previously and through written reports. There were 75 respondents (83% of attendees, 90% of whom were men), 39% with medical, 50% with pharmacy and 11% with other background. Ninety-eight percent of the participants found operational research useful, and 87% supported it to be an element of the NDP. Two-thirds knew the objectives of the NDP. There was no significant difference in knowledge and attitudes between pilot and non-pilot provinces and between professions. Ninety-two percent were aware of the Essential Drug List, and 88% found it adequate to drug need. Ninety-seven percent agreed with generic drug prescribing. Seventy percent reported to have heard about Good Pharmacy Practice (GPP), but only a few could explain it. Although most participants agreed that HSR should be one main component of the NDP and found HSR results useful, few had heard about them before the conference, and research was not well understood. The paper discusses various factors influencing decision-makers' perceptions of usefulness of research in this case during the NDP implementation process. It is concluded that the acceptance of research and major NDP concepts probably is a result of close interaction between researchers and policy-makers and that the interface between research and policy-making needs further studies.

Administrative Personnel↗
PubMed2005

Use of traditional medicine in Lao PDR.

OBJECTIVES: Exploring the attitudes and knowledge of household members and health staff in Lao PDR regarding the use of traditional medicine. BACKGROUND: Along with modern medicine, traditional medicine utilisation is officially supported in Laos, being part of the cultural heritage and considered useful for this low-income country in relation to the problems with access to modern pharmaceuticals. METHODS: The study population comprised 600 households from one lowland (Pakse) and one mountainous (Paksong) district. In a stratified two-stage sampling procedure, household surveys were conducted and focus group discussions (FGD) were performed among health staff and villagers in the same districts. RESULTS: Seventy-seven per cent of the households stated the ever use of traditional medicine including herbal medicines, sauna, massage and acupuncture. The main reason given was perceived efficacy. Traditional medicine was used for both chronic and acute diseases. The FGD revealed the perceived need to have training courses for traditional medicine providers and to have a medicinal garden in the villages. Utilisation was similar in lowland and mountainous districts as well as in urban and rural areas. CONCLUSIONS: The study indicates that traditional medicine is widely used and perceived as effective by a fairly large proportion of Lao people. The findings may form a basis for health sector reforms that are congruent with perceived local needs, e.g. in establishing a strategic plan for the development of the traditional medicine sector in Lao PDR.

Acute Disease↗
PubMed2005

Effectiveness of a multi-component intervention on dispensing practices at private pharmacies in Vietnam and Thailand--a randomized controlled trial.

Private pharmacies are the first line of health care in many communities, commonly selling antibiotics in small doses and prescription-only drugs such as steroids without medical supervision. The aim was to study the effectiveness of a multi-faceted intervention on the dispensing practices of drug sellers in Hanoi and Bangkok. The study was a randomized, controlled trial with 68 Hanoi and 78 Bangkok pharmacies, randomly selected and assigned for intervention and control. Behaviour was assessed by five simulated client visits per pharmacy per dispensing practice, at baseline and a month or more after each intervention. Three three-month interventions were implemented sequentially with four months in between: enforcement of regulations with local inspectors visiting to emphasize the importance of prescription-only medicine legislation; education, performed face-to-face in Hanoi and by a large group in Bangkok; and peer review, voluntary in Bangkok and compulsory in Hanoi. The intervention resulted in significant improvements in Hanoi, reducing the dispensing of illegal steroids (29% vs. 62%) and low dose antibiotics (69% vs. 90%), sustained by means of the peer review (17% vs. 57% steroids and 71% vs. 95% antibiotics), and in fewer dispensers asking no questions and giving no advice (11% vs. 30% steroids and 51% vs. 81% antibiotics). The only significant improvement in Bangkok was the reduction in illegally dispensing steroids (25% vs. 44%) after the regulatory intervention. In Bangkok, fewer of those in the group who volunteered for the peer review asked no questions and gave no advice for low-dose antibiotics requests after the peer review (58% vs. 81%). A multi-component intervention can have a profound effect in changing dispensers' behaviour, but the effect is dependant on the context and the method of implementation. Possible reasons for differences are discussed.

Anti-Bacterial Agents↗
PubMed2004

Patterns of resistance and DHFR/DHPS genotypes of Plasmodium falciparum in rural Tanzania prior to the adoption of sulfadoxine-pyrimethamine as first-line treatment.

A study was carried out to assess the patterns of resistance and occurrence of DHFR/DHPS genotypes of Plasmodium falciparum prior to the adoption of sulfadoxine-pyrimethamine (SP) as first-line treatment for uncomplicated malaria in Tanzania. Children under five years (n = 117) with clinical, uncomplicated malaria were randomly allocated to standard treatments of either chloroquine (CQ) (25 mg/kg) or SP (25 mg sulfadoxine and 1.25 mg pyrimethamine/kg). Patients were monitored for 28 days. Clinical recovery was achieved in 98% (n = 58) and 90% (n = 59) of the patients in the SP and CQ groups, respectively. Parasitologically, 14% of the patients in the SP group and 51% in the CQ group exhibited RII/RIII resistance. When relating pre-treatment blood drug levels to treatment outcome and the degree of parasite resistance to the number of mutations, no relationships could be detected. There was an overall significant increase in haemoglobin levels from day 0 to day 28 in both patient groups. Sulfadoxine-pyrimethamine produced an acceptable clinical response but the high degree of parasitological resistance (RII/RIII) observed two years prior to the introduction of the drug as first-line treatment is of concern, especially considering the long half-lives of sulfadoxine and pyrimethamine.

Animals↗
PubMed2004

Physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system.

Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi-structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way--a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer-independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.

Attitude of Health Personnel↗
PubMed2003

Local understanding, perceptions and reported practices of mothers/guardians and health workers on childhood malaria in a Tanzanian district--implications for malaria control.

Knowledge on local understanding, perceptions and practices of care providers regarding management of childhood malaria are needed for better malaria control in urban, peri-urban and rural communities. Mothers of under five children attending five purposively selected public health facilities in the Kibaha district, Tanzania, were invited to participate in 10 focus group discussions (FGDs). The health workers of these facilities were included in six other FGDs to elicit their professional views. Analysis was done using interpretative and qualitative approaches. Both health workers and all mothers were clear about the signs and symptoms of homa ya malaria, a description consistent with the biomedical definition of mild malaria. Although most of the mothers related this to mosquito bites, some did not. Mothers also described a severe childhood illness called degedege, consistent with convulsions. Most of the mothers failed to associate this condition with malaria, believing it is caused by evil spirits. Urinating on or fuming the child suffering from degedege with elephant dung were perceived to be effective remedies while injections were considered fatal for such condition. Traditional healers were seen as the primary source of treatment outside homes for this condition and grandmothers and mother in-laws are the key decision makers in the management. Our findings revealed major gaps in managing severe malaria in the study communities. Interventions addressing these gaps and targeting mothers/guardians, mother in-laws, grandmothers and traditional healers are needed.

Adult↗
PubMed2003

Evaluation of the quality of amodiaquine and sulphadoxine/pyrimethamine tablets sold by private wholesale pharmacies in Dar Es Salaam Tanzania.

OBJECTIVE: There are several independent reports in Tanzania of treatment failures with commercially available sulphadoxine/pyrimethamine (SP) and amodiaquine (AQ) brands. The aim of this work was to assess the quality of SP and AQ tablets marketed by wholesale pharmacies in Dar Es Salaam, Tanzania. METHODS: All eight wholesale pharmacies authorized to import medicines and located in Dar Es Salaam were included in the study. From each pharmacy, samples of all SP and AQ brands available at the time of sampling were bought, provided they had a shelf-life of at least 1 year. A sample was either an intact box of 100 tablets or a sealed tin of 100 tablets. To ensure blinding, 30 tablets of each sample were removed from their original containers, coded and sent to the quality control laboratory for analysis. The name, strength, batch number, manufacturer and the expiry dates of the tablets were recorded. In total 15 AQ and 18 SP samples were collected. Identity, assay for content of active ingredients and dissolution assay were performed as described in the United States Pharmacopoeia (USP). RESULTS: All samples passed the identity test. Among the AQ samples collected, two of 15 (13%) failed the dissolution test but all passed the assay for content, whereas two of 18 (11%) and eight of 18 (44%) SP samples failed the assay for content and dissolution tests, respectively. None of the pharmacies stocked all AQ and SP brands. CONCLUSION: This work reveals the availability of poor quality antimalarial drugs on the Tanzanian market. Use of substandard drugs could have serious clinical consequences to patients. The results support the need for continuous monitoring of the quality of marketed drugs to ensure safety and efficacy of these products in the treatment of malaria in endemic areas.

Amodiaquine↗
PubMed2002

Private pharmacies in Hanoi, Vietnam: a randomized trial of a 2-year multi-component intervention on knowledge and stated practice regarding ARI, STD and antibiotic/steroid requests.

OBJECTIVES: To assess the effectiveness of a multi-component intervention on knowledge and reported practice amongst staff working in private pharmacies in Hanoi regarding four conditions: urethral discharge [sexually transmitted diseases (STD)], acute respiratory infection (ARI), and non-prescription requests for antibiotics and steroids. METHOD: Randomized controlled trial with staff working in 22 matched pair intervention and control private pharmacies who were administered a semistructured questionnaire on the four conditions before and 4 months after the interventions. The interventions focused on the four conditions and were in sequence (i) regulations enforcement; (ii) face-to-face education and (iii) peer influence. Outcome measures were knowledge and reported change in practice for correct management of tracer conditions. RESULTS: The intervention/control-pairs (22 after drop-outs) were analysed pre- and post-intervention using the Wilcoxon signed rank test. STD: More drug sellers stated they would ask about the health of the partner (P = 0.03) and more said they would advise condom use (P = 0.01) and partner notification (P = 0.04). ARI: More drug sellers stated they would ask questions regarding fever (P = 0.01), fewer would give antibiotics (P = 0.02) and more would give traditional medicines (P = 0.03). Antibiotics request: Fewer said they would sell a few capsules of cefalexin without a prescription (P = 0.02). Steroid requests: No statistical difference was seen in the numbers who said they would sell steroids without a prescription as numbers declined in both intervention and control groups (P = 0.12). CONCLUSION: The three interventions in series over 17 months were effective in changing the knowledge and reported practice of drug sellers in Hanoi.

Acute Disease↗
PubMed2002

Building the national drug policy on evidence--a cross sectional study on assessing implementation in Lao PDR.

The National Drug Policy (NDP) of Lao PDR, endorsed in 1993, has since 1995 been implemented through an intervention program in five pilot areas out of 18 provinces, including training of health personnel. The aim was to assess the impact of the NDP program to get evidence for revising the policy. In a cross sectional design, comparisons were made between the pilot province of Luangphrabang (LPB) and the non-pilot province of Sayabury (SBR). In each province, three districts were purposively chosen. Four pharmacies at the public hospitals were included, while 20 private pharmacies were randomly selected. A set of 29 combined indicators was utilized. One hundred and ten prescriptions for under-five children with simple diarrhea and 240 adult outpatient prescriptions were sampled. Furthermore, twelve health care managers were interviewed on knowledge and attitudes. LPB health managers had better knowledge of NDP concepts. Significantly more essential drugs (ED) were available in the private pharmacies in the pilot province. The proportion of prescriptions of ED in hospitals was higher in the pilot province (95% in LPB vs 86% in SBR; p<0.001). Fewer drugs per patient were prescribed in the pilot province (2.7 vs 3.3, p<0.001), and the management of simple diarrhea in children was significantly more in accordance with Standard Treatment Guidelines. The pilot province performed significantly better regarding several aspects of quality and rational use of drugs, probably related to the implementation program. National as well as regional and global diffusion of research findings is recommended towards evidence-based national drug policies.

Case-Control Studies↗
PubMed2001

The quality of public and private pharmacy practices. A cross sectional study in the Savannakhet province, Lao PDR.

AIM: The aim was to study the practices of public and private pharmacies in the Savannakhet province, Lao PDR, in relation to defined aspects of good pharmacy practice (GPP) and rational use of drugs (RUD). STUDY DESIGN: The study design was cross-sectional using structured interviews and observations. A total of 105 drug sellers (31% and 4% had pharmacy education at public and private pharmacies, respectively) were interviewed, and the pharmacies were inspected. In addition, 576 customers were interviewed immediately after the drug transaction and all their drug purchases were recorded. Facility, patient-care and prescribing indicators covering aspects of GPP and RUD were used to measure and compare the quality of services of the pharmacies. RESULTS: The results showed that public pharmacies differed significantly from private pharmacies, with lower mean scores for availability of essential drugs (5.1 vs 6.4), 95% confidence interval (CI -2.23, -0.34) and essential materials (5.6 vs 6.9, 95% CI -2.40, -0.20), and with a higher percentage of antibiotics dispensed (34% vs 24%, P<0.02), as well as more injections (31% vs 7%, P < 0.001) and drugs per customer (2.4 vs 1.4, 95% CI 0.84, 1.16). More drug purchases were decided by health workers at public pharmacies than at private pharmacies (92% vs 16%). At public pharmacies, significantly more drugs were prescribed from the National Essential Drug List (76% vs 56%, P=0.004), and more drugs had an international non-proprietary name (67% vs 35%, P<0.001). There was no significant difference regarding order in the pharmacy, oral information and drugs adequately labelled at the public pharmacies compared with the private pharmacies. CONCLUSION: In spite of the differences shown, both public and private pharmacies performed suboptimally in relation to several aspects of GPP and RUD. The lack of essential drugs, essential materials, information on drug use and adequate drug labelling all contribute to irrational use of drugs. Interventions are needed to improve practice and drug use.

Adult↗
PubMed2001

Real world pharmacy: assessing the quality of private pharmacy practice in the Lao People's Democratic Republic.

The private sector is a dominant actor in the provision of pharmaceuticals, particularly in developing countries. Private provision of drugs has been associated with risks regarding availability, affordability, rational use and drug quality. Ensuring an effective regulatory framework is therefore a major challenge for governments, yet the capacity of regulatory authorities is often outstripped by private sector growth. In the Lao People's Democratic Republic (Lao P.D.R.), a poor, landlocked country in South East Asia, the private provision of drugs has increased dramatically since the liberalisation of the economy in the late 1980s. This paper aims to describe the quality of the private pharmacy services in the Savannakhet province of Lao P.D.R. In order to do this, a monitoring instrument which serves to make the concept of Good Pharmacy Practice (GPP) operational was developed and applied to a sample of pharmacies. Service quality, as measured by three facility-specific indicators, showed a tendency to be lower in the most distant districts. Poor dispensing practices were manifest by a lack of information about drugs sold in 59% of cases, drugs not being labelled in 47% and different drugs being mixed in the same package in 26% of cases. The prices of four sample drugs were slightly higher in the remote districts. A 10-fold price difference for the same drug was recorded in one district. After reporting the findings, the paper discusses the possible influence of district and pharmacy variables on the quality of services, and goes on to discuss the price differences. It is concluded that further government interventions are needed in order to improve the quality of services and to focus regulatory action on a limited number of aspects, to ensure that drugs can be traced before trying to establish a comprehensive regulatory system.

Developing Countries↗
PubMed2001

Private pharmacy practice and regulation. A randomized trial in Lao P.D.R.

OBJECTIVES: The objective of this study was to assess the effectiveness of government regulation of private pharmacy practice in a low-income country. METHODS: The intervention comprised inspections of the pharmacies, information, and distribution of documents to drug sellers and sanctions. It was implemented at two different intensity levels, active and regular intervention. The methods used to assess the effect of the interventions were interviews with the district drug inspectors, drug sellers and customers, inspection of drug purchases, and indicator surveys of pharmacies. Indicators for pharmacy-specific quality as well as for dispensing quality were developed. RESULTS: The main finding was one of strong overall improvements from initially low levels. The improvements were particularly marked by increases in the availability of essential materials for dispensing by 34% and in order in the pharmacy by 19%. Information given to customers increased from 35% to 51% and the mixing of different drugs in the same package went down from 17% to 9%. The pharmacies in the active intervention districts showed greater improvements for four of the six indicators, although statistically significant compared with the regular intervention districts only for the essential materials indicator. CONCLUSIONS: It was concluded that the regulatory activities have probably been an important factor behind the service quality improvements. It appeared feasible as well as effective to regulate private pharmacy practice in this particular low-income setting.

Developing Countries↗
PubMed2000

Antibiotic medication and bacterial resistance to antibiotics: a survey of children in a Vietnamese community.

OBJECTIVE: To investigate antibiotic use and antibiotic susceptibility of respiratory tract pathogens in children aged 1-5 years in Bavi, Vietnam. METHOD: Nasopharynx and throat specimens were collected from 200 children from randomly selected households in a demographically defined population. Respiratory isolates were tested for antibiotic susceptibility according to the standard disk diffusion method. A questionnaire survey of carers elicited information on type of antibiotic used, duration of treatment, where the antibiotics had been purchased, type of treatment information retained by carers and episodes of illness preceding the study. RESULTS: 82% of the children had at least one symptom of acute respiratory tract infection (ARI) in the 4 weeks prior to the study, and of these 91% were treated with antibiotics. The most commonly used antibiotics were ampicillin (74%), penicillin (12%), amoxicillin (11%), erythromycin (5%), tetracycline (4%) and streptomycin (2%). Ampicillin was used for 3.3 days on average (SD:1.8) and penicillin for 2.6 days (SD:0.7). When deciding which antibiotic to use, 67% of the carers consulted the pharmacy seller, 11% decided themselves and 22% followed the doctor's prescription. The carrier rate of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis was 50%, 39% and 17%, respectively. Isolates from 145 children were susceptibility tested, and 74% were found to carry resistant pathogens. Of the tested isolates, 90% of S. pneumoniae, 68% of H. influenzae and 74% of M. catarrhalis were resistant to at least one antibiotic. The mean number of antibiotics (susceptible strains excluded) to which resistance was found was 2.0 (SD:1.2), 2.5 (SD:1.8) and 2.1 (SD:0.9), respectively. S. pneumoniae and H. influenzae showed high resistance to tetracycline (88% and 32%, respectively), trimethoprim/sulphonamide (32% and 44%), and chloramphenicol (25% and 24%). 23% of S. pneumoniae were erythromycin-resistant and 18% of H. influenzae isolates were resistant to ampicillin. There was a significant difference in ampicillin and penicillin resistance between the group of children previously treated with beta lactam antibiotics and the group of children who did not receive antibiotics. CONCLUSION: As reported by the carers, children in Bavi are treated with antibiotics frequently. Most antibiotics were obtained without consulting a doctor. High levels of antibiotic resistance and high prevalence of multidrug-resistant strains were found among respiratory pathogens. The existence of a large reservoir of resistance genes among children in low-income countries represents a threat to the success of antibiotic therapy throughout the world. Multi-faceted programmes to improve rational use of antibiotics in Vietnam are urgently needed.

Adult↗
PubMed2000

The World Bank and pharmaceuticals.

Within less than a decade the World Bank has become the largest single source of finance (loans) for health in low and middle income countries as well as a major player in the field of pharmaceuticals. Often 20-50% of the recurrent government health budget in developing countries is used to procure drugs. Drugs are among the most salient and cost-effective elements of health care and often a key factor for the success of a health sector reform. However, pharmaceuticals are frequently being used irrationally, mainly due to market imperfections in health care, such as information asymmetries, leading to serious health problems and a heavy financial burden on the health system. Lending priorities set by the World Bank could be used to promote public health sector reform, leading to the rational use of affordable and available drugs of good quality in developing countries. This report provides the first analysis of World Bank activity in the pharmaceutical sector worldwide. The analysis of 77 staff appraisal reports, describing the planning phase of World Bank country projects, shows that 16% of the total World Bank health, nutrition and population budget, or approximately US$1.3 billion, has been committed to loans or credits supporting pharmaceutical activities in the programme countries between 1989-95. Roughly US$1.05 billion has been committed to procurement of drugs and medical equipment. Only 5% of the total pharmaceutical sector lending is committed to software components such as drug policy work and rational use of drugs. No more than 45% of the projects were developed in collaboration with pharmaceutical expertise. The World Bank is recommended to improve its pharmaceutical sector involvement by promoting drug policy research and development including national and international dialogue on pharmaceutical issues to ensure rational use of both drugs and loans. In this, the World Bank has an advantage given its experience from working with both the private and the public sector, its in-house expertise in health economics, and lastly its ability to be listened to by governments through its power.

Data Interpretation, Statistical↗
PubMed2000

STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers.

BACKGROUND: Prompt treatment of sexually transmitted infections may reduce the incidence of HIV/AIDS infections. With health sector reforms private pharmacies are increasingly the first and only contact with health delivery services. OBJECTIVES: To find out how patients with STDs are treated at private pharmacies in Hanoi, and what drug sellers know about STD management. METHODS: Five simulated clients were taught to adopt a scenario stating that their friend had a urethral discharge. They visited 60 randomly selected private pharmacies in urban Hanoi and noted all questions asked, advice offered, and treatment given. Afterwards interviewers administered a semistructured questionnaire to all people working in the 60 pharmacies. RESULTS: Drug treatment was given in 84% of the 297 encounters averaging 1.5 drugs and 1.2 antibiotics per encounter. Quinolones were given 188 times. No dispensing was adequate for chlamydia or was in accordance with the national guidelines. No questions were asked in 55% of encounters and no advice was given in 61%. Questions on sexual activity were asked in 23% (69) of cases and about the health of the partner twice (1%). Advice to practise safe sex was given in 1% of encounters and for the partner to seek treatment only once. Of 69 questionnaires administered 51% said they would refer to a doctor, 16% said they would ask about the sexual activity 1% said they would ask about the health of the partner, 7% said they would advise using a condom, and 1% advised telling the partner to seek treatment. Even after prompting, 61% would ask no questions and 80% would give no advice. CONCLUSIONS: Even though 74% of pharmacists and drug sellers know that they should not treat STD patients, 84% actually did. None gave syndromically correct treatment. In both the questionnaire and during the simulated client methods, numbers advising on partner notification and condom use were very poor. Educational or peer awareness interventions are urgently needed among private pharmacists in Vietnam.

Community Pharmacy Services↗