title: An assessment of the quality of advice provided by patent medicine vendors to users of oral contraceptive pills in urban Nigeria.
abstract: BACKGROUND
  In Nigeria about 50% of oral contraceptive pill users obtain their products from proprietary patent medicine vendors (PPMVs). This group of service providers are poorly trained and have very limited knowledge about contraception. This paper investigated the nature of the advice offered to simulated current and potential users of oral contraceptive pills. The main objective was to assess the nature and quality of advice provided by PPMVs to pill users.
  
  
  METHODS
  This study is based on findings from a 'mystery client' approach in which three scenarios related to contraceptive pill use were simulated. Each of the 12 mystery clients simulated one of the following three scenarios: new pill users (new to family planning or switching from condom to pills); user seeking a resupply of pills; and dissatisfied pill users intending to discontinue use. Simple random sampling was used to select 410 PPMVs from a total of 1,826 in four states in Nigeria. Qualitative study using in-depth interviews was also conducted.
  
  
  RESULTS
  A majority of the PPMVs had pills in stock on the day of the survey and resupplied pills to the clients. PPMVs also understood the reason and importance of referring clients who were new adopters of oral contraceptive methods to a health facility; 30% of the PPMVs referred new adopters to a health facility. However, demand from clients who do not want to go to health care facilities (for various reasons) necessitated the provision of oral contraceptive pills to 41% of the first time users. Some PPMVs prescribed treatment to mystery clients who presented with perceived complications arising from the use of pills, while 49% were referred to a health facility.
  
  
  CONCLUSIONS
  The advice given by PPMVs often falls short of safety guidelines related to the use of oral contraceptive pills. There is a need to continuously update knowledge among the PPMVs to ensure that they provide quality oral contraceptive services as PPMVs bridge the gap between medical experts and users in rural communities.
authors.affiliation: Research and Evaluation Division, Society for Family Health, Abuja, Nigeria.
authors.forename: Chinazo
authors.initials: C
authors.lastname: Ujuju
authors.affiliation: Planning, Research and Statistics Directorate, National Agency for Food and Drug Administration and Control, Abuja, Nigeria.
authors.forename: Samson B
authors.initials: SB
authors.lastname: Adebayo
authors.affiliation: Technical Services Directorate, Society for Family Health, Abuja, Nigeria.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Anyanti
authors.affiliation: Technical Services Directorate, Society for Family Health, Abuja, Nigeria.
authors.forename: Obi
authors.initials: O
authors.lastname: Oluigbo
authors.affiliation: Family Planning Directorate, Society for Family Health, Abuja, Nigeria.
authors.forename: Fatima
authors.initials: F
authors.lastname: Muhammad
authors.affiliation: Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana.
authors.forename: Augustine
authors.initials: A
authors.lastname: Ankomah
keywords: Nigeria; PPMV; contraceptives; mystery client; oral contraceptive pills; patent medicine vendors; quality of care
references.citation: Am J Trop Med Hyg. 2007 Dec;77(6 Suppl):203-18
references.pmid: 18165494
references.citation: Am J Trop Med Hyg. 2009 Jun;80(6):905-13
references.pmid: 19478247
references.citation: Health Policy Plan. 1996 Jun;11(2):202-5
references.pmid: 10158461
references.citation: PLoS One. 2012;7(9):e44775
references.pmid: 22984555
references.citation: PLoS One. 2013;8(2):e54978
references.pmid: 23405101
references.citation: Malar Res Treat. 2010;2010:470754
references.pmid: 22332020
references.citation: Stud Fam Plann. 1990 May-Jun;21(3):171-7
references.pmid: 2375048
references.citation: Bull World Health Organ. 2004 Jun;82(6):417-23
references.pmid: 15356933
references.citation: Stud Fam Plann. 2007 Dec;38(4):322-30
references.pmid: 18284046
references.citation: Eval Rev. 2005 Dec;29(6):576-90
references.pmid: 16244053
references.citation: Stud Fam Plann. 1985 Sep-Oct;16(5):260-70
references.pmid: 4060211
references.citation: Int Nurs Rev. 2011 Dec;58(4):484-90
references.pmid: 22092328
references.citation: Scand J Infect Dis. 2006;38(6-7):474-8
references.pmid: 16798697
references.citation: East Afr Med J. 1996 Jun;73(6):390-4
references.pmid: 8840600
references.citation: Public Health. 2000 Jul;114(4):282-5
references.pmid: 10962592
references.citation: Health Policy Plan. 2004 May;19(3):177-82
references.pmid: 15070866
references.citation: Soc Sci Med. 1987;25(3):293-305
references.pmid: 3629303
references.citation: Stud Fam Plann. 1993 May-Jun;24(3):187-93
references.pmid: 8351699
references.citation: J Trop Pediatr. 2001 Aug;47(4):230-8
references.pmid: 11523765
references.citation: Malar J. 2006 Nov 01;5:97
references.pmid: 17078875
references.citation: Bull Soc Pathol Exot Filiales. 1986;79(4):557-70
references.pmid: 3802316
references.citation: Trans R Soc Trop Med Hyg. 1992 May-Jun;86(3):237-9
references.pmid: 1412642