Akinyemi Akanni, Owolabi Onikepe Oluwadamilola, Erinfolami Temitope, Stillman Melissa, Bankole Akinrinola
Center for Research, Evaluation Resources, and Development, Abuja, Nigeria.
Department of Demography and Social Statistics, Obafemi Awolowo University, Ife, Nigeria.
Front Glob Womens Health. 2022 Aug 17;3:899662. doi: 10.3389/fgwh.2022.899662. eCollection 2022.
Evidence confirmed that the demand for medical abortion (MA) increased significantly during the COVID-19 outbreak in many developing countries including Nigeria. In an abortion-restrictive setting like Nigeria, local pharmacies, and proprietary patent medicine vendors (PPMVs) continue to play a major role in the provision of MA including misoprostol. There is the need to understand these providers' knowledge about the use of misoprostol for abortion and the quality of information they provide to their clients. This analysis is focused on assessing the quality of care provided by both drug seller types, from drug sellers' and women's perspectives.
This study utilized primary data collected from drug sellers (pharmacists and PPMVs) and women across 6 Local Government Areas in Lagos State, Nigeria. The core sample included 126 drug sellers who had sold abortion-inducing drugs and 386 women who procured abortion-inducing drugs from the drug sellers during the time of the study. We calculate quality-of-care indices for the care women received from drug sellers, drawing on WHO guidelines for medication abortion provision. The index based on information from the sellers had two domains-technical competency and information provided to clients, while the index from the women's perspectives includes an additional domain, client experience.
Results show that the majority of drug sellers in the sample, 56% ( = 70), were pharmacists. However, far more than half of women 60% ( = 233) had visited PPMVs. Overall, the total quality score amongst all drug sellers (mean 0.48, SD0.15) was higher than the total score calculated based on women's responses (mean 0.39, SD 0.21). Using our quality-of-care index, pharmacies and PPMVs seem to have similar technical competency (mean score of 0.23, SD 0.13 in both groups (range 0-1), whilst PPMV's performed better on the information provided to client domain (mean score of 0.79, SD 0.17 compared with pharmacies 0.69, SD 0.25). Based on women's reports, PPMVs scored better on both quality of care domains (technical competency and information provided to clients) compared with pharmacies.
PROGRAM/POLICY IMPLICATION: In resource-constrained settings such as Nigeria, particularly in the context of health emergencies like COVID-19, there is the need to continue to strengthen and engage PPMVs' capacity and skills in dispensing and administration of MA drugs as a harm reduction strategy. Also, there is the need to target frontline providers in pharmacies for training and skill upscale in MA provision.
有证据证实，在包括尼日利亚在内的许多发展中国家，新冠疫情期间药物流产（MA）的需求显著增加。在像尼日利亚这样对堕胎有限制的环境中，当地药店和专利成药销售商（PPMVs）在提供包括米索前列醇在内的药物流产方面继续发挥着重要作用。有必要了解这些提供者关于使用米索前列醇进行堕胎的知识以及他们向客户提供的信息质量。本分析聚焦于从药品销售者和女性的角度评估这两种药品销售者提供的护理质量。
本研究利用了从尼日利亚拉各斯州6个地方政府辖区的药品销售者（药剂师和PPMVs）以及女性那里收集的原始数据。核心样本包括126名曾销售堕胎诱导药物的药品销售者以及386名在研究期间从药品销售者处获取堕胎诱导药物的女性。我们根据世界卫生组织药物流产提供指南，计算女性从药品销售者那里获得的护理质量指数。基于销售者信息的指数有两个领域——技术能力和提供给客户的信息，而从女性角度的指数还包括一个额外领域，即客户体验。
结果显示，样本中的大多数药品销售者，即56%（n = 70）是药剂师。然而，超过一半的女性，即60%（n = 233）曾光顾PPMVs。总体而言，所有药品销售者的总质量得分（均值0.48，标准差0.15）高于根据女性回答计算出的总得分（均值0.39，标准差0.21）。使用我们的护理质量指数，药店和PPMVs似乎具有相似的技术能力（两组的平均得分均为0.23，标准差0.13（范围0 - 1）），而PPMVs在提供给客户领域的信息方面表现更好（平均得分0.79，标准差0.17，而药店为0.69，标准差0.25）。根据女性的报告，与药店相比，PPMVs在护理质量的两个领域（技术能力和提供给客户的信息）得分更高。
项目/政策启示：在像尼日利亚这样资源有限的环境中，特别是在新冠疫情等卫生紧急情况下，有必要继续加强并提升PPMVs在分发和管理药物流产药物方面的能力和技能，作为一种减少伤害的策略。此外，有必要针对药店的一线提供者进行药物流产提供方面的培训和技能提升。
