title: Availability and provision of misoprostol and other medicines for menstrual regulation among pharmacies in Bangladesh via mystery client survey.
abstract: OBJECTIVE
  To explore the availability and provision of misoprostol and other medicines for menstrual regulation (MR) among pharmacies in Bangladesh.
  
  
  METHODS
  Between March and November 2011, a cross-sectional study using mystery client visits was conducted among pharmacy workers in Dhaka and Gazipur Districts, Bangladesh. Mystery clients were trained to present 1 of 4 pre-developed situations to pharmacy workers to elicit information on the regimen, adverse effects, and complications of misoprostol use.
  
  
  RESULTS
  Mystery clients visited 331 pharmacies. Among the 331 pharmacy workers, 45.8% offered the mystery clients misoprostol and/or other medicines for MR; 25.7% referred them to private clinics or hospitals. Only 7% recommended an effective regimen of misoprostol for MR; 65% suggested administering vaginal and oral misoprostol together. Overall, 72.4% did not provide any advice on complications; the remainder suggested visiting trained providers for complications. Counseling on excessive bleeding as a danger sign was provided by 46% of pharmacy workers. Most (94%) did not provide or refer for post-MR family planning.
  
  
  CONCLUSIONS
  Pharmacy workers in urban Bangladesh are providing ineffective drugs and regimens for MR. A training package is needed to strengthen service delivery by providing accurate information, high-quality products, and referral mechanisms for women seeking MR through pharmacies.
authors.affiliation: Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. Electronic address: fauzia@icddrb.org.
authors.forename: Fauzia A
authors.initials: FA
authors.lastname: Huda
authors.affiliation: Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, London, UK.
authors.forename: Thoai D
authors.initials: TD
authors.lastname: Ngo
authors.affiliation: Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Anisuddin
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Anadil
authors.initials: A
authors.lastname: Alam
authors.affiliation: Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Laura
authors.initials: L
authors.lastname: Reichenbach
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects; D000028:Abortion, Induced; D000328:Adult; D001459:Bangladesh; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016595:Misoprostol; D010594:Pharmacies / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Abortion; Bangladesh; Menstrual regulation; Misoprostol; Pharmacy workers