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Background: Making misoprostol widely available for management of postpartum haemorrhage (PPH) and post abortion care (PAC) is essential for reducing maternal mortality. Private pharmacies (thereafter called “pharmacies”) are integral in supplying medications to the general public in Senegal. In the case of misoprostol, pharmacies are also the main supplier to public providers and therefore have a key role in increasing its availability. This study seeks to understand knowledge and provision of misoprostol among pharmacy workers in Dakar, Senegal. Methods: A cross-sectional survey was conducted in Dakar, Senegal. 110 pharmacy workers were interviewed face-to-face to collect information on their knowledge and practice relating to the provision of misoprostol. Results: There are low levels of knowledge about misoprostol uses, registration status, treatment regimens and side effects among pharmacy workers, and corresponding low levels of training on its uses for reproductive health. Provision of misoprostol was low; of the 72% (n = 79) of pharmacy workers who had heard of the product, 35% (n = 27) reported selling it, though rarely for reproductive health indications. Almost half (49%, n = 25) of the respondents who did not sell misoprostol expressed willingness to do so. The main reasons pharmacy workers gave for not selling the product included stock outs (due to product unavailability from the supplier), perceived lack of demand and unwillingness to stock an abortifacient. Conclusions: Knowledge and availability of misoprostol in pharmacies in Senegal is low, posing potential challenges for delivery of post-abortion care and obstetric care. Training is required to address low levels of knowledge of misoprostol registration and uses among pharmacy workers. Barriers that prevent pharmacy workers from stocking misoprostol, including weaknesses in the supply chain and stigmatisation of the product must be addressed. Low reported sales for reproductive health indications also suggest limited prescribing of the product by health providers. Further research is needed to explore the reasons for this barrier to misoprostol availability.
In September 2013, Marie Stopes International and the Population Council conducted a cross-sectional survey with pharmacy workers in Dakar, Senegal [18]. We obtained the list of all 557 registered pharmacies in the Dakar region (Dakar city and three suburbs located between 15 and 30 km from Dakar city centre) from the Order of Pharmacists, and used simple random sampling to select 110 pharmacies for inclusion in the study. Endorsement for the study was given by the Order of Pharmacists who contacted pharmacy workers in writing prior to data collection to endorse the study. Within each pharmacy, one worker was selected for a face-to-face interview. Selection criteria were (i) being involved in selling/distributing medicine; and (ii) being over 18 years of age. In each pharmacy, the owner or manager was approached first, and if they did not meet the eligibility criteria, for example if they did not directly sell or distribute medicine, the next most senior and eligible staff member was invited to participate. Pharmacy workers received an information sheet explaining the study, and were asked to give informed consent prior to interview. Interviewers were trained to explain the importance of the study and to ensure participants understood that their responses would be anonymised. Interviews took place in a setting within the pharmacy where the interview could not be overheard and where the interviewee felt comfortable providing information. A standardised, structured questionnaire was administered by a trained interviewer. The questionnaire collected information on pharmacy characteristics, staff background, knowledge and current practice relating to misoprostol as well as current frequency of misoprostol sales. Participants were able to refer to sales registers where needed. The questionnaire also included open-ended “Other” categories for some questions to collect answers not pre-coded, and respondents were given the opportunity to provide additional comments at the end of the interview. The instrument was pre-tested in eight pharmacies in Dakar. Data were entered into an access database using Epi Info. Double data entry was used to check for data entry errors. Quantitative data were analysed descriptively using Stata 13 (StataCorp LP, College Station, TX, USA).
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