Knowledge and Inventory INTRODUCTION Reproductive health, simply defined as a Management of Misoprostol for
complete state of physical, mental and social
Reproductive Health Services
well-being and not merely the absence of
Amongst Community
disease or disorder of the reproductive process, constitutes a measure of the social and
Pharmacists in Anambra and
economic well-being of any nation.1,2 Of the
Delta States of Nigeria
various components of reproductive health,
*Adinma ED1, Adinma JIB2
unsafe motherhood represented by maternal
ABSTRACT Background: Misoprostol, a prostaglandin
infringement of the reproductive rights of
analogue used in the management of a wide
women and its address has over several years
range of reproductive health disorders is safe,
posed an intractable challenge to several
inexpensive and easily administered.
countries of the developing world.3 In Nigeria for
Objective: To investigate the knowledge of
instance, the yearly maternal deaths of 59,000
misoprostol amongst Community Pharmacists
women which constitute approximately 10% of
from Anambra and Delta States, Nigeria, with
the overall global maternal mortality statistics
respect to its indications, contraindications, and
have remained a great embarrassment to the
side effects; and also evaluate their stocking and
federal government and its benefactors alike.
Two of the five major direct medical causes of
Method: Cross-sectional, questionnaire based
maternal mortality viz obstetrics haemorrhage
survey of 22 Community Pharmacists from
and abortion, occupy prominent positions for the
Anambra and Delta States, Nigeria.
role they play in the causation of maternal
Result: There were nine participants from Anambra and 13 from Delta State. The majority were of urban location, 77.8% in Anambra and
instance, is known to account for as high as 25-
76.9% in Delta State. There is significantly
30% of maternal deaths, while abortion and its
higher knowledge of misoprostol, 88.9% and 100% respectively for Anambra and Delta
complications have been implicated as the cause
States, compared with current stocking and
of maternal deaths to the magnitude of as high
dispensing of the drug, 22.2% apiece, and
as 50% in some countries.4,5 Reducing the
30.8% apiece respectively for the two States.
burden of maternal mortality in resource poor
Only two of the 6 listed indications for
countries of developing world requires a wide
misoprostol were recognized, each by one
introduction of the application of simple,
participant from Anambra State; while five were
economical, yet safe and effective management
recognized, each also, by one participant
methods, of which misoprostol ranks high.
from Delta State. No respondent from Delta
Misoprostol is a synthetic prostaglandin E
State recognized abortion treatment as an
analogue originally developed and 1 approved
globally for the prevention of peptic ulcer. The
Only 40% respondents in Anambra State
tablet which has no known adverse interaction
recognized the contraindications, and 80%, of
with other drugs is inexpensive and usually
the side effects of misoprostol, while 80% and
stable at room temperature and has long shelf
70% respondents in Delta State recognized the
life.6, 7 The drug is effective in the treatment of
contraindications and side effects respectively.
early pregnancy failure, induction of second
Conclusion: There is gap in knowledge and
trimester abortion, ripening of the cervix and
inventory management of misoprostol for
induction of labour.8-11 It is also used for the
reproductive health problems' management
treatment of post partum haemorrhage. Its use
amongst Community Pharmacists. There is
for obstetrics and gynecological indications is
need for sensitization and advocacy program on
however off label in most countries. the use of Misoprostol for these health
has over the years, been marketed in Nigeria as
Key Words: Knowledge, Inventory
Cytotec for the treatment of peptic ulcer and has
Management, Misoprostol, Pharmacists, Nigeria.
only recently been approved for use by the
Nigerian National Agency for Food and Drug
Afrimedic Journal 2011;2(1):13-18
Administration and Control (NAFDAC) for the
treatment of post partum haemorrhage. In
Nigeria, the provision of maternal healthcare
demographic characteristics of the respondents
services is not restricted to skilled practitioners
for the two States studied. There were nine
alone, that is doctors and nurse-midwives, but
participants in the Anambra State meeting,
also to a wide range of practitioners, orthodox
consisting of eight males and one female, while
Delta State had 13 participants comprising nine
pharmacists are an important group of maternal
males and four females. The majority of the
healthcare providers for the part they play, not
respondents had practiced pharmacy for 21
years and above 7 (77.8%) in Anambra State
reproductive healthcare medications but also in
and 6 (46.2%) in Delta State and most of them
routine consultations and treatment of some
were based in urban location, 7 (77.8%) in
reproductive health problems. This study
investigates the knowledge of misoprostol
The distribution by knowledge, usage, and
amongst community pharmacists from Anambra
availability of misoprostol/cytotec as shown in
and Delta States of Nigeria, with respect to its
Table II indicates that 8 (88.9%) and 13
indications, contraindications, and side effects.
(100%) respectively of the participants in
It also evaluates their stocking and dispensing
pattern of the drug for the management of
misoprostol. Only 2 (22.2%) pharmacists in
reproductive health problems. Information
Anambra State and 4 (30.8 %) in Delta State
obtained from this study will determine whether
have treated 5-10 patients with misoprostol over
the 3 months preceding this study. Knowledge
sensitization of health practitioners to an
of misoprostol therefore is statistically
increased use of this vital drug for reproductive
significantly high compared with use, ever
stocked, current stocking, and dispensing of the
drug by the community pharmacists for both
This is a Cross-sectional, questionnaire-based
Anambra and Delta States. P <0.05 for each of
survey of 22 Community Pharmacists attending
a lunch meeting at two locations Nnewi in
Table III shows the distribution by knowledge of
indications, contraindications, as well as the side
respectively of South-east and South-south
effects of misoprostol. Of the 6 indications for
Nigeria. The survey was carried out on 18th
misoprostol listed in the questionnaire, only 2
June 2009 and 2nd September 2009 at Nnewi
(post partum hemorrhage and abortion) were
and Asaba respectively. The questionnaire
recognized, each by one of the 9 respondents
from Anambra State; and 5 were recognized,
respondents with respect to their bio-social
again each by only 1 of the 13 Community
characteristics sex, duration and location of
Pharmacists from Delta State. No respondent
practice, and number of clients receiving
from Anambra State recognized the treatment of
misoprostol within three months preceding the
peptic ulcer as an indication for the use of
study; respondents' knowledge , usage , and
misoprostol. Similarly, no community pharmacist
availability of misoprostol/cytotec; and their
from Delta State recognized the treatment of
knowledge of indications, contraindications, and
abortion as an indication for the use of
side effects of misoprostol/cytotec. Data
misoprostol. Of the 5 contraindications to the
obtained were analyzed using Statistical Package
use of misoprostol and 10 side effects of the
for Social Sciences (SPSS) version 15.0, and
drug listed in the questionnaire, only 2
displayed in Tables. Statistical comparison of
(40.0 %) of the contraindications and as high as
variables was made where necessary using Chi-
8 (80 %) of the side effects were recognized by
respondents in Anambra State while 4 (80 %)
recognized by respondents in Delta State.
Afrimedic Journal 2011;2(1):13-18 Afrimedic Journal 2011;2(1):13-18 DISCUSSION
incomplete abortion and other reproductive
health related problems.13-15 The reproductive
management of Misoprostol for reproductive
healthcare practitioners are therefore expected
health services was undertaken for a total of 22
to have considerably clear knowledge and usage
pharmacists practicing in two States of Nigeria.
of this life saving drug. This unfortunately is not
Most of these Pharmacists practice in urban
the case amongst the community pharmacists
centres and had done so for more than 20
participating in this study evident from the very
years, they are therefore expected to have built
high number of pharmacists, 7 (53.8%)-11
up a reasonably large clientele. The findings
(84.6%) and 5 (55.6%)-7 (77.8%) respectively
from the questionnaire studies were interesting.
from Delta and Anambra States that failed to
In spite of a considerably high knowledge of
respond to the knowledge of the indications,
misoprostol amongst the pharmacists, only a
contraindications, and side effects of the drug.
paltry 2 (22.2 %) and 4 (30.8 %) from Anambra
Of the 6 indications for misoprostol listed in the
and Delta States respectively were currently
questionnaire, only 2 (post partum hemorrhage
stocking misoprostol, and in fact had prescribed
and abortion) were recognized, each by one of
the drug for as few as only 5-10 patients over
the 3 months preceding the study. The poor
Similarly, 5 of the 6indications listed were
stocking and prescription of misoprostol by
recognized, again each by only 1 of the 13
community pharmacists may indicate an unclear
community pharmacists from Delta State. It is
Reports from studies conducted both in Africa
and Europe have highlighted the undoubtful
efficacy of misoprostol in the treatment of
Afrimedic Journal 2011;2(1):13-18
to put in place, a sensitization and advocacy
Anambra State recognized the treatment of
program on the use of misoprostol for the
peptic ulcer as an indication for the use of
management of reproductive health problems,
misoprostol even though the drug has been
not just for community pharmacists, but also for
approved for that purpose in Nigeria for a long
all other cadres of health professionals involved
time. In addition, none of the community
in women's health management in the country.
pharmacists from Delta State recognized the
This advocacy and sensitization program efforts
treatment of abortion as an indication for the
can be enriched through the development of
use of misoprostol. These are important findings
misoprostol treatment and dosage protocol
and when combined with the similar scenario
presented to the responses to the knowledge of
America.18 In the words of Weeks et al “If we
side effects and contraindications to the use of
can develop practical training programs and
misoprostol, attest unequivocally to the lack of
treatment protocols for use in rural areas, then
clear information on this very important drug
the use of misoprostol could potentially lead to a
major reduction in abortion-related maternal
healthcare professionals. The reason for this
morbidity and mortality”. 13 This statement is no
may not be far-fetched and can be considered in
less applicable to abortion management as it is
the light of the fact that it is only recently that
to other similarly important practical obstetric
misoprostol had been approved for use in
problems such as post partum hemorrhage.
reproductive health management treatment of
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1Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria 2Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria *Email: drechenduadinma@yahoo.com Afrimedic Journal 2011;2(1):13-18
President of the Consultative Council, Faculdade Pitágoras, Rua Timbiras 1532 Belo Horizonte, MG, Brazil 30140-061 Lead Economist, the World Bank, 1818 H Street NW Abstract Education and health—or more precisely, schooling and health care —are often lumped together as the major components of something called “the social sector”. There are some important similarities, but they are
REVISTA CIENCIACTUAL ISSN 2248-468X Cienciactual Revista de la Facultad de Ciencias de la Salud Universidad de San Buenaventura, Seccional Cartagena Número 2, Vol. 1, Cartagena de Indias D.T. y C. Enero/Junio, 2012. Créditos Institucionales. Secretario General: Vicerrector Académico: Vicerrector Administrativo y Financiero: Director: Co-Editor:
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