title: Management of sexually transmitted diseases in urban pharmacies in The Gambia.
abstract: This study aimed to describe the quality and costs of sexually transmitted disease (STD) case management in urban pharmacies in The Gambia, and explore pharmacy workers' (PWs) willingness to improve the STD care they provide. PWs from 24 registered pharmacies were interviewed in order to collect information on their knowledge and practices regarding management of STDs. The same pharmacies were visited by a male 'simulated client' (SC) to ascertain how urethral discharge syndrome (UDS) cases were managed in practice. Fifteen (63%) pharmacies were equipped for treatment of UDS, pelvic inflammatory disease (PID) and genital ulcer syndrome (GUS), according to national guidelines. Appropriate syndromic management for UDS was mentioned by 11% of PWs but actually given to 4.4% of the SC visits. None of the PID or GUS cases would be treated correctly. Forty-two per cent of PWs advised on partner notification, 38% on safe sex and 29% on treatment compliance in the SC visits. The reported costs for treatment of UDS, PID and GUS ranged from $2.5-$15.0. The cost of treatment actually purchased by the SC averaged $3.5 (range $1.5-$9.6) for UDS. Excluding the pharmacy sector from interventions will limit the impact of STD control measures. Regular training in syndromic management and rational drug use, with a concise manual for reference are recommended. Strategies to lower the cost of drugs should be explored.
authors.affiliation: London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. ALeiva@phls.org.uk
authors.forename: A
authors.initials: A
authors.lastname: Leiva
authors.forename: M
authors.initials: M
authors.lastname: Shaw
authors.forename: K
authors.initials: K
authors.lastname: Paine
authors.forename: K
authors.initials: K
authors.lastname: Manneh
authors.forename: K
authors.initials: K
authors.lastname: McAdam
authors.forename: P
authors.initials: P
authors.lastname: Mayaud
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000600:supply & distribution / Q000627:therapeutic use*; D019090:Case Management / Q000592:standards* / Q000706:statistics & numerical data; D003157:Community Pharmacy Services / Q000191:economics / Q000592:standards*; D003365:Costs and Cost Analysis; D003376:Counseling; D005260:Female; D052776:Female Urogenital Diseases / Q000188:drug therapy*; D005714:Gambia; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D052801:Male Urogenital Diseases; D008875:Middle Aged; D016544:Patient Simulation; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy; D012749:Sexually Transmitted Diseases / Q000188:drug therapy*; D014456:Ulcer / Q000188:drug therapy; D014505:Urban Population
chemical_list: D000900:Anti-Bacterial Agents