Management of Simulated Patients with Sexually Transmitted Infections by Staff of Retail Pharmacies in Kibera Slums Of Nairobi

Abstract

Objective: To evaluate the treatment suggested to sexually transmitted infections (STI) self-medicating patients in retail pharmacies. Design: A descriptive cross-sectional survey. Setting: Kibera slum, Nairobi City, Kenya. Subjects: Staff of 50 convenient randomly selected retail pharmacies. Results: The majority (97%) of the pharmacy staff who attended to self-medicating patients asked questions. Most of these questions centered around the onset of the stated symptoms, the health of the partner, patient's current health status and previous medications taken. Of the 99 staff evaluated, 60% correctly diagnosed gonorrhoea and 82% correctly diagnosed genital ulcer disease (GUD). Only nine out of fifty (18%) offered the recommended treatment for gonorrhoea and only one individual offered recommended treatment for GUD. The most commonly offered treatment for gonorrhoea and GUD was metronidazole and penicillin, respectively. Overall, only 10% correctly diagnosed both conditions and offered appropriate treatment. The staff also counselled patients on a wide range of issues including condom use, abstinence and being faithful, contact treatment, seeking prompt treatment and completing treatment. Conclusion: With only about 10% offering appropriate government recommended treatment for gonorrhoea and GUD, these pharmacy staff working in retail pharmacies in Kibera slum put slum dwellers seeking care at an increased risk of STI related morbidity and transmission due to inappropriate or inadequate treatment. Recommendation: To improve management of these conditions, in-service training and enforcement of the relevant legislation and policy is needed.

A review of the provision of appropriate advice by pharmacy staff for self-medication in developing countries

“…Eleven studies were conducted in Asian regions: India, 44 Indonesia, 37 Pakistan, 26,27 Thailand, 19,39,40 Turkey, 18 and Vietnam. 22,24,32 Six studies came from African regions: Gambia, 33 Kenya, 29 South Africa, 41,45 Sudan, 36 and Zimbabwe, 35 Lastly, 11 studies were undertaken in Latin American and Caribbean regions: Bolivia, 25 Brazil, 34,38 Colombia, 43 Mexico, 20,21,31,42 Jamaica, 23 Latin American, 30 and both Guatemala and Mexico. 28 A wide variety of scenarios (n ¼ 64) were covered.…”

“…28 A wide variety of scenarios (n ¼ 64) were covered. This included abortifacients and/or misoprostol requests, 21 34 hypertension, 28 influenza remedies in hypertension, 43 malaria chemoprophylaxis, 41 metronidazole use in pregnancy, 43 migraine, 40 oral and/or emergency contraceptives, 20,23 sexually transmitted infections, 22,29,33,35,38,42,45 steroid requests, 32 and supplying dipyrone or misoprostol without prescription. 43 Several methods were used to conduct these 28 studies.…”

“…43 Several methods were used to conduct these 28 studies. The patient simulation method was employed in 20 studies, 19,[21][22][23][24][25][26][27][28][29]31,[34][35][36][37][38][39]41,43,44 pharmacy staff interview was performed in 4 studies, 20,30,42,45 and a combination of patient simulation with pharmacy staff interview was employed in 4 studies. 18,32,33,40 The provision of appropriate advice…”

“…(continued) guideline to decide on the appropriateness of the product recommended or supplied. 22,24,29,32,33,38,44,45 One study used expert panel consensus to decide on the appropriateness of the advice provided by pharmacy staff. 34 …”

“…Regarding sampling representativeness; 8 studies used non-random sampling, including: convenience sampling (5 studies), 26,27,29,34,36 purposive sampling (2 studies), 23,37 and quota sampling (1 study). 44 One study, however, did not report the type of sampling used.…”