Many Bangladeshi Pharmacies Do Not Provide Accurate Information on How to Use Misoprostol

Pharmacy workers in urban Bangladesh commonly provide medicines and dosing regimens for menstrual regulation that are not effective, according to a cross-sectional survey that used trained individuals posing as clients. (1) When these mystery clients inquired about obtaining a drug to end a pregnancy or induce menstruation, three-quarters of pharmacy workers offered misoprostol, another medication or both. But fewer than one in 10 of those who provided misoprostol recommended an effective dosing regimen for menstrual regulation, and more than seven in 10 did not provide any advice on what to do in the event of complications. In additional, the vast majority of pharmacy workers did not provide post-menstrual regulation family planning methods or refer clients for such services. Investigators conducted the survey in 2011 in the Mirpur and Badda areas of Dhaka district, and the Sadar area of Gazipur district. They trained young (aged 18-24) and middle-aged (25 or older) male and female mystery clients to approach pharmacy workers and ask about the use of misoprostol specifically or the use of a drug generally for menstrual regulation, either for themselves, a friend or a spouse. (At the time of the study, misoprostol was approved in Bangladesh only for treatment of peptic ulcer and prevention of postpartum hemorrhage.) The mystery clients asked about the availability, cost, dosage, route of administration, effectiveness, adverse effects and complications of any drugs they received, as well as about family planning methods and counseling. Researchers interviewed the "clients" immediately afterward to capture details about the encounter. The investigators computed descriptive statistics and compared differences in study outcomes by characteristics using chi-square tests. The mystery clients interacted with workers (all of whom were male) at 331 pharmacies. Overall, 76% of clients were offered one or more medications, 23% received information and referrals (usually to a private clinic or hospital) and 2% received neither. When pharmacy workers offered medicines, 39% offered only misoprostol, 16% offered another drug (e.g., emergency contraceptive pills, herbal medicines, hormonal preparations or the combination of methylestrenolone and methylestradiol) and 46% offered both. Among pharmacy workers who provided misoprostol, just 7% told the client the effective dosage (four pills daily for two days), while the rest gave ineffective ones. Only 32% correctly indicated that the drug should be taken orally, while 65% said that it should be used both vaginally and orally; the remaining 3% indicated that they did not know the route of administration. …