Huda Fauzia Akhter, Mahmood Hassan Rushekh, Alam Anadil, Ahmmed Faisal, Karim Farzana, Sarker Bidhan Krishna, Al Haque Nafis, Ahmed Anisuddin
icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh.
icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh.
Contraception. 2018 Feb;97(2):144-151. doi: 10.1016/j.contraception.2017.11.006. Epub 2017 Nov 22.
The objective was to assess the provision of the combination of mifepristone-misoprostol for menstrual regulation (MR) in randomly selected urban pharmacies in Bangladesh.
We conducted a cross-sectional survey among 553 pharmacy workers followed by 548 mystery client visits to the same pharmacies in 3 municipal districts during July 2014-December 2015.
The survey found that 99% of pharmacy workers visited had knowledge of MR procedures but only two-thirds (67%) could state the legal time limit correctly; they mentioned misoprostol (86%) over mifepristone-misoprostol combination (78%) as a procedure of MR with medication (MRM); 36% reported knowing the recommended dosage of mifepristone-misoprostol combination; 70% reported providing information on effectiveness of the medicines; 50% reported recommending at least one follow-up visit to them; 63% reported explaining possible complications of using the medications; and 47% reported offering any post-MR contraception to their clients. In contrast, mystery client visits found that the mifepristone-misoprostol combination (69%) was suggested over misoprostol (51%) by the pharmacy workers; 54% provided the recommended dosage of mifepristone-misoprostol combination; 42% provided information on its effectiveness; 12% recommended at least one follow-up visit; 11% counseled on possible complications; and only 5% offered post-MR contraceptives to the mystery clients.
We found knowledge gaps regarding recommended dosage for MRM and inconsistent practice in informing women on effectiveness, follow-up visits, possible complications and provision of post-MR contraceptives among the pharmacy workers, particularly during the mystery client visits.
Pharmacy workers in Bangladesh need to be trained on legal time limits for MR services provision, on providing accurate information on disbursed medicine, and on proper referral mechanisms. A strong monitoring and regulatory system for pharmacy provision of MRM in pharmacies should be established.
评估在孟加拉国随机选取的城市药店中米非司酮 - 米索前列醇联合用药用于月经调节（MR）的供应情况。
2014年7月至2015年12月期间，我们对553名药店工作人员进行了横断面调查，随后对3个市政区的同一药店进行了548次暗访。
调查发现，99%接受访问的药店工作人员了解MR程序，但只有三分之二（67%）能正确说出法定时限；在提及药物性月经调节（MRM）程序时，他们提到米索前列醇的比例（86%）高于米非司酮 - 米索前列醇联合用药（78%）；36%报告知晓米非司酮 - 米索前列醇联合用药的推荐剂量；70%报告提供了有关药物有效性的信息；50%报告至少向她们推荐了一次随访；63%报告解释了用药可能出现的并发症；47%报告向客户提供了任何MR后的避孕措施。相比之下，暗访发现药店工作人员推荐米非司酮 - 米索前列醇联合用药的比例（69%）高于米索前列醇（51%）；54%提供了米非司酮 - 米索前列醇联合用药的推荐剂量；42%提供了其有效性的信息；12%推荐了至少一次随访；11%就可能的并发症提供了咨询；只有5%向暗访客户提供了MR后的避孕药具。
我们发现药店工作人员在MRM推荐剂量方面存在知识空白，在向女性告知药物有效性、随访、可能的并发症以及提供MR后的避孕措施方面做法不一致，尤其是在暗访期间。
孟加拉国的药店工作人员需要接受关于提供MR服务的法定时限、提供所售药物准确信息以及适当转诊机制的培训。应建立一个强大的药店提供MRM的监测和监管系统。
