Summaryobjectives To assess over-the-counter antimicrobial dispensing by drug retailers in Kathmandu, Nepal, for rationality, safety, and compliance with existing government regulations.methods Standardized cases of dysuria in a young adult male and acute watery diarrhoea in a child were presented by a mock patient to retailers at 100 randomly selected pharmacies. Questions asked by retailers and advice and medications given at their initiative were recorded.results All retailers engaged in diagnostic and therapeutic behaviour beyond their scope of training or legal mandate. Historical information obtained by retailers was inadequate to determine the nature or severity of disease or appropriateness of antimicrobial therapy. 97% (95% CI ϭ 91.5-99.4%) of retailers dispensed unnecessary antimicrobials in diarrhoea, while only 44% (95% CI ϭ 34.1-54.3%) recommended oral rehydration therapy and only 3% (95% CI ϭ 0.6-8.5%) suggested evaluation by a physician. 38% (95% CI ϭ 28.5-48.2%) gave antimicrobials in dysuria, yet only 4% (95% CI ϭ 1.1-9.9%) adequately covered cystitis. None covered upper urinary tract or sexually transmitted infections, conditions which could not be ruled out based on the interviews, and only 7% (95% CI ϭ 2.9-13.9%) referred for a medical history and physical examination necessary to guide therapy.conclusions Although legislation in Nepal mandates a medical prescription for purchase of antibiotics, unauthorized dispensing is clearly problematic. Drug retailers in our study did not demonstrate adequate understanding of the disease processes in question to justify their use of these drugs. Risks of such indiscretion include harm to individual patients as well as spread of antimicrobial resistance. More intensive efforts to educate drug retailers on their role in dispensing, along with increased enforcement of existing regulations, must be pursued.
BackgroundObstetric hemorrhage remains the leading cause of maternal mortality in resource limited areas. An inexpensive pneumatic anti-shock garment was devised of bicycle tubes and tailored cloth which can be prepared from local materials in resource-limited settings. The main purposes of this study were: 1) to determine acceptability of the device by nurses and midwives and obtain suggestions for making the device more suitable for use in their particular work environments, 2) to determine whether a three hour training course provided adequate instruction in the use of this device for the application of circumferential abdominal pelvic pressure, and 3) determine production capability and cost in a resource-limited country.MethodsFifty-eight nurse and midwife participants took part in three sessions over eight months in Nepal. Correct device placement was assessed on non-pregnant participants using ultrasound measurement of distal aortic flow before and after device inflation, and analyzed using confidence intervals. Participants were surveyed to determine acceptability of the device, obtain suggestions for improvement, and to collect data on clinical use.ResultsDevice placement achieved flow decreases with a mean of 39% (95% CI 25%-53%, p < 0.001) in the first session, 28% (95% CI 21%-33%, P < 0.001) after four months and 29% (95% CI 24%-34%, p < 0.001) at 8 months. All nurses and midwives thought the device would be acceptable for use in obstetric hemorrhage and that they could make, clean, and apply it. They quickly learned to apply the device, remembered how to apply it, and were willing and able to use the device clinically. Ten providers used the device, each on one patient, to treat obstetric hemorrhage after routine measures had failed; bleeding stopped promptly in all ten, two of whom were transported to the hospital. Production of devices in Kathmandu using local tailors and supplies cost approximately $40 per device, in a limited production setting.ConclusionsPreliminary data suggest that an inexpensive, easily-made device is potentially an appropriate addition to current obstetric hemorrhage treatment in resource-limited areas and that further study is warranted.
Physician-patient interactions often lead to prescription of medicines. Safety andcompliance in the use of these medicines are largely dependent on proper verbal aswell as written communication between prescriber and patient. However, severalpublished reports suggest that such communication is often inadequate. The presentstudy indicated suboptimal doctor-patient communication at a tertiary care hospitalin Nepal. Fifty-two (21.7%) of the 240 patients/caregivers interviewed after out-patientconsultation claimed that doctors did not provide any information on prescribedmedicines. Nearly a quarter of the 188 patients/caregivers who did report havingreceived information could not recall what they had been told, and in more than halfof these cases the lack of recall was attributed to problems in communication. Frequentuse of the English language and Latin abbreviation in prescribed dosing schedulesindicated a need for improvement in written communication as well.Key Words: prescribing information; communication; physician-patient interaction; Nepal.
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