Assuntos
Abortivos , Aborto Induzido , Mifepristona , Misoprostol , Serviços Postais , Adolescente , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Abortivos/administração & dosagem , Abortivos/efeitos adversos , Abortivos/provisão & distribuição , Abortivos/uso terapêutico , Aborto Induzido/métodos , Mifepristona/administração & dosagem , Mifepristona/efeitos adversos , Mifepristona/provisão & distribuição , Mifepristona/uso terapêutico , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Misoprostol/provisão & distribuição , Misoprostol/uso terapêutico , Assistência Farmacêutica , Estados Unidos , Resultado do TratamentoRESUMO
BACKGROUND: Despite their importance in reducing maternal mortality, information on access to Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region is limited. METHODS: A standardized assessment tool measuring access to Mifepristone, Misoprostol, and contraceptive medicines included in the WHO essential medicines list (EML) was implemented in eight countries in the Eastern Mediterranean Region (Afghanistan, Iraq, Lebanon, Libya, Morocco, Palestine, Pakistan, and Somalia) between 2020-2021. The assessment focused on five access measures: 1) the inclusion of medicines in national family planning guidelines; 2) inclusion of medicines in comprehensive abortion care guidelines; 3) inclusion of medicines on national essential medicines lists; 4) medicines registration; and 5) procurement and forecasting of Mifepristone, Misoprostol, and contraceptive medicines. A descriptive analysis of findings from these eight national assessments was conducted. RESULTS: Only Lebanon and Pakistan included all 12 contraceptives that are enlisted in the WHO-EML within their national family planning guidelines. Only Afghanistan and Lebanon included mifepristone and mifepristone-misoprostol combination in post-abortion care guidelines, but these medicines were not included in their national EMLs. Libya and Somalia lacked a national regulatory authority for medicines registration. Most contraceptives included on the national EMLs for Lebanon, Morocco and Pakistan were registered. Misoprostol was included on the EMLs-and registered-in six countries (Afghanistan, Iraq, Lebanon, Morocco, Palestine, and Pakistan). However, only three countries procured misoprostol (Iraq, Morocco, and Somalia). CONCLUSION: These findings can guide efforts aimed at improving the availability of Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region. Opportunities include expanding national EMLs to include more options for Mifepristone, Misoprostol, and contraceptive medicines and strengthening the registration and procurement systems to ensure these medicines' availability were permitted under national law and where culturally acceptable.
Ensuring access to Mifepristone, Misoprostol, and contraceptive medicines is critical to improving women's health, and more specifically reducing maternal mortality and improving women's sexual and reproductive health in the Eastern Mediterranean Region.The aim of this study was to analyse findings from national assessments to capture information on the implementation of relevant policies and procedures. Those were the policies that ensure access to Mifepristone, Misoprostol, and contraceptive medicines in the public sector for the eight Eastern Mediterranean Region countries included in the study (Afghanistan, Iraq, Libya, Lebanon, Morocco, Palestine, Pakistan, and Somalia). The assessments were completed between 2020 and 2021.We found that most countries did not include all twelve contraceptives enlisted in the WHO essential medicines list (EML) in their national family planning guidelines. No country had developed a national abortion care guidelines nor included mifepristone (alone or in combination with misoprostol) on national EML. Libya and Somalia lacked a national regulatory authority for medicines registration. Most contraceptives included on the national EMLs for Lebanon, Morocco and Pakistan were registered. Misoprostol was included on the EMLsand registeredin six countries (Afghanistan, Iraq, Lebanon, Morocco, Palestine, and Pakistan) yet, only three countries procured misoprostol (Iraq, Morocco, and Somalia).Our findings provide evidence on system-level barriers to availability of Mifepristone, Misoprostol, and contraceptive medicines (e.g., lack of guidelines or inclusion on EML, lack of registration and procurement) that can support policy and advocacy efforts to strengthen the pharmaceutical sector to better ensure availability of Mifepristone, Misoprostol, and contraceptive medicines to women in reproductive age at the country-level in accordance with the national law and prevailing culture.
Assuntos
Acessibilidade aos Serviços de Saúde , Mifepristona , Misoprostol , Misoprostol/provisão & distribuição , Misoprostol/uso terapêutico , Humanos , Feminino , Mifepristona/provisão & distribuição , Mifepristona/administração & dosagem , Região do Mediterrâneo , Anticoncepcionais/provisão & distribuição , Oriente Médio , Aborto Induzido/estatística & dados numéricos , Aborto Induzido/métodos , Gravidez , Serviços de Planejamento Familiar/normasRESUMO
BACKGROUND: Medical abortion with mifepristone and misoprostol can be provided up to 63 days' gestation in India. This accounts for 67.5 percent of all abortions in the country. We conducted an assessment to determine the availability of medical abortion medicines, specifically the combi-pack, in India. METHODS: We applied the World Health Organization landscape assessment protocol at the national level. The assessment protocol included a five-step adaptation of an existing availability framework, including online data collection, desk review, country-level key informant interviews, and an analysis to identify barriers and opportunities to improve medical abortion availability. The assessment was conducted between August and March 2021. RESULTS: Medicines for medical abortion are included in the national essential drug list and available with prescription in India. The assessment identified 42 combi-pack products developed by 35 manufacturers. The quality of medical abortion medicines is regulated by national authorities; but as health is devolved to states, there are significant inter-state variations. This is seen across financing, procurement, manufacturing, and monitoring mechanisms for quality assurance of medical abortion medicines prior to distribution. There is a need to strengthen supply chain systems, ensure consistent availability of trained providers and build community awareness on use of medical abortion medicines for early abortions, at the time of the assessment. CONCLUSION: Opportunities to improve availability and quality of medical abortion medicines exist. For example, uniform implementation of regulatory standards, greater emphasis on quality-assurance during manufacturing, and standardizing of procurement and supply chain systems across states. Regular in-service training of providers on medical abortion is required. Finally, innovations in evidence dissemination and community engagement about the recently amended abortion law are needed.
Medical abortion is popular in India and benefits from a liberal legal context. It is important to understand the availability of quality abortion medicines in the country. Using the World Health Organization country assessment protocol and availability framework for medical abortion medicines we examined the availability of these medicines from supply to demand. We used this information to identify opportunities for increasing availability of quality-assured medical abortion medicines. We found that the context for medical abortion varies across states. Strengthening procurement and supply chain management, with a greater emphasis on quality-assurance and regulation of manufacturing should be instituted at the state-level. Training is also needed to increase provider knowledge of the latest national guidelines and laws to ensure respectful and person-centered services. Finally, the public should be informed about medical abortion as a safe and effective choice, especially for early abortions.
Assuntos
Abortivos , Aborto Induzido , Acessibilidade aos Serviços de Saúde , Misoprostol , Humanos , Índia , Aborto Induzido/estatística & dados numéricos , Aborto Induzido/métodos , Feminino , Gravidez , Abortivos/provisão & distribuição , Misoprostol/provisão & distribuição , Mifepristona/provisão & distribuição , Medicamentos Essenciais/provisão & distribuiçãoRESUMO
OBJECTIVES: To evaluate the availability of mifepristone and misoprostol at pharmacies in a state with protective abortion legislation and variation in access by rurality. STUDY DESIGN: Using a secret shopper survey, researchers attempted to contact all community pharmacies in Oregon and evaluate their mifepristone and misoprostol provisions. RESULTS: Among the 444 pharmacies surveyed, mifepristone was planned at 19.2%. Misoprostol was available at 77.5%, but stocking issues and medication ordering impact access, without significant differences by rurality. CONCLUSIONS: Pharmacy engagement and support are key to increasing access to these essential medicines, which may be improved through education and referral programs.
Assuntos
Acessibilidade aos Serviços de Saúde , Mifepristona , Misoprostol , Misoprostol/provisão & distribuição , Misoprostol/administração & dosagem , Oregon , Mifepristona/provisão & distribuição , Mifepristona/administração & dosagem , Humanos , Feminino , Farmácias/estatística & dados numéricos , População Rural , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/estatística & dados numéricos , Abortivos não Esteroides/provisão & distribuição , Abortivos não Esteroides/administração & dosagem , Gravidez , População Urbana , Abortivos Esteroides/provisão & distribuição , Abortivos Esteroides/administração & dosagem , Serviços Comunitários de Farmácia/estatística & dados numéricosRESUMO
OBJECTIVES: This study aimed to describe the same-day availability of misoprostol for medical management of early pregnancy loss (EPL) at Arizona pharmacies. STUDY DESIGN: We performed a simulated-patient mixed methods study of Arizona pharmacies from October 2022 to February 2023, documenting misoprostol availability and describing pharmacy staff responses. RESULTS: Of 941 pharmacies included, 703 (75%) could fill a misoprostol prescription same day. Ability to fill prescriptions and reasons why the prescription could not be filled varied by pharmacy type. National chain pharmacies most frequently had misoprostol available but also most commonly reported policies restricting dispensing. CONCLUSIONS: Barriers exist to filling misoprostol prescriptions for early pregnancy loss in Arizona that could impact patient care.
Assuntos
Abortivos não Esteroides , Acessibilidade aos Serviços de Saúde , Misoprostol , Farmácias , Misoprostol/provisão & distribuição , Misoprostol/uso terapêutico , Misoprostol/administração & dosagem , Humanos , Arizona , Feminino , Gravidez , Abortivos não Esteroides/provisão & distribuição , Abortivos não Esteroides/administração & dosagem , Aborto EspontâneoRESUMO
Importance: The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32â¯360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied. Objective: To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs. Design, Setting, and Participants: Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients. Exposure: Abortion restrictions following the Dobbs decision. Main Outcomes and Measures: Provision and use of medications for a self-managed abortion. Results: In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27â¯838 (95% credible interval [CrI], 26â¯374-29â¯175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27â¯145; 95% CrI, 25â¯747-28â¯246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26â¯055 (95% CrI, 24â¯739-27â¯245) vs what would have been expected had the Dobbs decision not occurred. Conclusions and Relevance: Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions.
Assuntos
Abortivos , Aborto Induzido , Acessibilidade aos Serviços de Saúde , Decisões da Suprema Corte , Feminino , Humanos , Gravidez , Abortivos/provisão & distribuição , Abortivos/uso terapêutico , Aborto Induzido/legislação & jurisprudência , Aborto Induzido/métodos , Aborto Legal/legislação & jurisprudência , Aborto Legal/métodos , Estudos Transversais , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/tendências , Mifepristona/provisão & distribuição , Mifepristona/uso terapêutico , Misoprostol/provisão & distribuição , Misoprostol/uso terapêutico , Autocuidado/métodos , Autocuidado/tendências , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Stock-outs of some life-saving drugs, such as emergency obstetric drugs, are evident in many health facilities and have been reported to be the leading cause of maternal mortality and morbidity for women from low and middle income countries (LMICs). For many cases, this situation is associated with poor inventory management practices. The aim of this study was to investigate the influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: case of the Rwanda Southern Province. Moreover, to gain a better grasp of the problem and to suggest possible areas for improvement. METHODS: An institutional-based cross-sectional study was carried out in all ten district hospitals (DHs) providing maternal health care and dispensing emergency obstetric drugs namely; Kigeme DH, Munini DH, Kabutare DH, Kibilizi DH, Gakoma DH, Nyanza DH, Ruhango DH, Gitwe DH, Kabgayi DH and Remera Rukoma DH. Both quantitative and qualitative data were collected and analyzed. Oxytocin injection, Misoprostol tablet and Magnesium sulphate injection as recommended emergency obstetric drugs by WHO, UNFPA and Rwanda Essential Medicines list were included in the study. RESULTS: The study revealed that keeping logistics management tools up to date is the backbone of inventory management practices in the availability of medicines and medical supplies. The results showed that hospitals with up-to-date logistics tools for their pharmaceutical management were 33.25 times more likely to have their emergency obstetric drugs in stock at all times compared to those that do not regularly update their logistics tools. The proper use of bin cards and electronic software (e-LMIS) contributed greatly to reducing the stock-out rate of emergency obstetric drugs by 89.9% and reduction of unusable to usable stock ratio by appropriate use of simple techniques such as the Min-Max inventory control model by 79%. Over an 18-month period, misoprostol tablet had the highest average days (32) of stock-outs (5.9%), followed by magnesium sulphate injection with an average of 31 days (5.7%), and oxytocin injection with an average of 13 days (2.4%). CONCLUSION: Proper use of pharmaceutical management tools within hospitals premises positively influence the availability of life-saving drugs, such as emergency obstetric drugs. Adequate supply chain staffing in health facilities is the most important key to improving inventory management practices and medicine availability.
Assuntos
Inventários Hospitalares , Sulfato de Magnésio , Misoprostol , Ocitocina , Feminino , Humanos , Gravidez , Estudos Transversais , Hospitais Públicos , Sulfato de Magnésio/provisão & distribuição , Misoprostol/provisão & distribuição , Ocitocina/provisão & distribuição , Ruanda , ComprimidosRESUMO
Hasta diciembre de 2020, en Argentina el aborto era legal ante determinadas causales. Sin embargo, era común que la implementación de esta legislación se viera entorpecida. El objetivo de esta investigación fue identificar las barreras y los factores facilitadores para la accesibilidad a la interrupción legal de embarazo en una institución del subsistema privado y de la seguridad social. Se realizó una investigación con enfoque cualitativo con entrevistas a profesionales del equipo de salud involucrados en el circuito de atención de interrupción legal de embarazo del Hospital Italiano de Buenos Aires. Los resultados se organizan en cinco ejes temáticos que surgieron luego de un proceso de lectura, interpretación y discusión:1) ausencia de una política institucional explícita, 2) los componentes de la práctica (falta de registro en la historia clínica electrónica, desarrollo de circuitos paralelos para acceder a la medicación: misoprostol), 3) el marco jurídico legal y las causales (falta de leyes claras, diversas interpretaciones en lo que respecta al causal salud), 4) la objeción de conciencia y 5) los aspectos contextuales (movimiento feminista, el proyecto de ley desaprobado en el senado en 2018). A pesar de que el equipo de salud contaba con un marco legal claro, implementar una política institucional interna resulta sumamente necesario. (AU)
Up until December 2020, abortion was legal in Argentina on certain grounds. However, it was common for the implementation of this legislation to be hindered. The purpose of this research was to identify the barriers and facilitating factors for the accessibility to legal abortion in both private and public health care institutions. A qualitative research was carried out with interviews with health professionals involved in the health team at Hospital Italiano de Buenos Aires legal interruption of pregnancy care circuit. The results are organized into five thematic axes that emerged after a process of reading, interpreting and discussing: 1) the absence of an explicit institutional policy, 2) the components of the practice (lack of registration in the electronic health records, development of parallel circuits to access medication: misoprostol), 3) the legal framework and grounds (lack of clear laws, different interpretations regarding health grounds), 4) conscientious objection, and 5) contextual aspects (feminist movement, the bill disapproved in the Senate in 2018). Even though the health teamhad a clear legal framework in place, implementing an internal institutional policy is extremely necessary. (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Política Organizacional , Misoprostol/provisão & distribuição , Aborto Legal/legislação & jurisprudência , Aborto Legal/normas , Ética Clínica , Saúde de Gênero/políticas , Argentina , Sistemas Pré-Pagos de Saúde/normas , Inquéritos Epidemiológicos , Hospitais Privados/normas , Aborto Legal/instrumentação , Pesquisa Qualitativa , AbortoRESUMO
BACKGROUND: Hemorrhage is the leading cause of maternal mortality worldwide and accounts for 56% of maternal deaths in Afghanistan. Postpartum hemorrhage (PPH) is commonly caused by uterine atony, genital tract trauma, retained placenta, and coagulation disorders. The purpose of this study is to examine the quality of prevention, detection and management of PPH in both public and private hospitals in Afghanistan in 2016, and compare the quality of care in district hospitals with care in provincial, regional, and specialty hospitals. METHODS: This study uses a subset of data from the 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment. It covers a census of all accessible public hospitals, including 40 district hospitals, 27 provincial hospitals, five regional hospitals, and five specialty hospitals, as well as 10 purposively selected private hospitals. RESULTS: All public and private hospitals reported 24 h/7 days a week service provision. Oxytocin was available in 90.0% of district hospitals, 89.2% of provincial, regional and specialty hospitals and all 10 private hospitals; misoprostol was available in 52.5% of district hospitals, 56.8% of provincial, regional and specialty hospitals and in all 10 private hospitals. For prevention of PPH, 73.3% women in district hospitals, 71.2% women at provincial, regional and specialty hospitals and 72.7% women at private hospital received uterotonics. Placenta and membranes were checked for completeness in almost half of women in all hospitals. Manual removal of placenta was performed in 97.8% women with retained placenta. Monitoring blood loss during the immediate postpartum period was performed in 48.4% of women in district hospitals, 36.9% of women in provincial, regional and specialty hospitals, and 43.3% in private hospitals. The most commonly observed cause of PPH was retained placenta followed by genital tract trauma and uterine atony. CONCLUSION: Gaps in performance of skilled birth attendants are substantial across public and private hospitals. Improving and retaining skills of health workers through on-site, continuous capacity development approaches and encouraging a culture of audit, learning and quality improvement may address clinical gaps and improve quality of PPH prevention, detection and management.
Assuntos
Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/prevenção & controle , Qualidade da Assistência à Saúde , Afeganistão , Feminino , Pesquisa sobre Serviços de Saúde , Hospitais de Distrito/estatística & dados numéricos , Humanos , Misoprostol/provisão & distribuição , Ocitocina/provisão & distribuição , GravidezRESUMO
BACKGROUND: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in low- and middle-income countries (LMICs). Oxytocin and misoprostol are used for the prevention and treatment of PPH. However, both medicines are chemically unstable and sensitive to environmental conditions. Previous studies reported a high prevalence of substandard oxytocin and misoprostol preparations in LMICs. METHODS: In randomly selected health facilities of four districts of Malawi, the availability of oxytocin and misoprostol was determined, and the knowledge of health workers on storage requirements and use of oxytocics was assessed. Temperature loggers were used to record the storage temperature of oxytocics. Samples of oxytocin injections and misoprostol tablets were collected from the health facilities and from wholesalers. Oxytocin samples were analysed for identity, assay (= quantity of oxytocin) and for pH value according to United States Pharmacopeia 40. Misoprostol samples were analysed for identity, assay, dissolution and related substances according to the International Pharmacopeia 2017. RESULTS: All visited hospitals and health centers had oxytocin available. At non-refrigerated storage sites, the recorded mean kinetic temperature exceeded the oxytocic's storage temperature stated on the labels in 42% of the sites. At refrigerated storage sites, the required temperature of 2-8 °C was exceeded in 33% of the sites. Out of 65 oxytocin samples, 7 (11%) showed moderate deviations from specification, containing 82.2-86.8% of the declared amount of oxytocin. Out of 30 misoprostol samples, 5 (17%) showed extreme deviations, containing only 12.7-30.2% of the declared amount. The extremely substandard misoprostol was reported to the national authorities and to WHO, leading to an immediate recall of the respective brand in Malawi. The UK-based distributor of this brand closed its business shortly thereafter. CONCLUSION: Availability of oxytocin was excellent in Malawi, and its quality was better than reported in previous studies in other LMICs. However, storage conditions at the health facilities often did not meet the requirements. Extremely substandard misoprostol tablets were found, representing a serious risk to maternal health. This shows the need for continued efforts for quality assurance in medicine procurement and registration, as well as for post-marketing surveillance.
Assuntos
Armazenamento de Medicamentos/normas , Misoprostol/normas , Ocitócicos/normas , Ocitocina/normas , Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Malaui , Misoprostol/análise , Misoprostol/provisão & distribuição , Ocitócicos/análise , Ocitócicos/provisão & distribuição , Ocitocina/análise , Ocitocina/provisão & distribuição , Garantia da Qualidade dos Cuidados de Saúde , Controle de QualidadeRESUMO
We performed a search in PubMed and Web of Science on the self-use of abortion medication after online access. Studies published between January 1, 1995, and March 31, 2019, were considered. We included studies of online services that were (i) led by healthcare staff (n = 14), (ii) led by non-healthcare staff (n = 4), and (iii) providing noninteractive access (n = 17). Our outcomes were utilization (frequency and demand for services), acceptability for women, safety, and success rate. Key findings: Women are increasingly using the Internet to access abortion medication. Available services are of varying quality. Women accessing noninteractive services report feelings of distress related to the lack of medical guidance, and the demand for interactive guidance through the abortion process is high. Women using services led by healthcare staff report high rates of satisfaction and similar rates of clinical outcomes as those of in-person abortion care.
Assuntos
Abortivos , Aborto Induzido , Acessibilidade aos Serviços de Saúde , Misoprostol , Telemedicina , Abortivos/administração & dosagem , Abortivos/provisão & distribuição , Feminino , Humanos , Internet , Mortalidade Materna , Mifepristona/administração & dosagem , Mifepristona/provisão & distribuição , Misoprostol/administração & dosagem , Misoprostol/provisão & distribuição , Gravidez , Qualidade da Assistência à SaúdeRESUMO
OBJECTIVES: In many sub-Saharan African countries with restricted safe abortion services, community pharmacies are important sources of abortifacients. However, data on stocking and over-the-counter sale of abortifacients in community pharmacies are often limited. The main objective of this study was to compare stocking and over-the-counter sale of misoprostol at community pharmacies using questionnaire and mystery client surveys in Ghana. METHODS: A cross-sectional questionnaire-based survey, complemented with a mystery client survey, was conducted at 165 randomly selected community pharmacies in Accra, Ghana. Structured questionnaires were administered to pharmacists/pharmacy workers. A mystery client survey to each of these pharmacies was also undertaken. Descriptive statistical techniques (frequencies and proportions) were used to estimate and compare stocking and over-the-counter sale of misoprostol at community pharmacies from the two data collection methods. KEY FINDINGS: Some 50.3% (83) of community pharmacists/pharmacy workers reported stocking misoprostol and selling it over-the-counter for medical abortion in the questionnaire-based survey. However, in the mystery client survey, 122 (74%) pharmacists/pharmacy workers reported stocking misoprostol and actually selling it over-the-counter to the mystery clients. Thus approximately 39 (24%) more pharmacies stocked misoprostol and sold it over-the-counter even though they originally denied stocking the drug in the questionnaire survey. Also, the drug was often sold without a prescription, and many did so without asking for a confirmatory pregnancy test or gestational age. CONCLUSIONS: In contexts where access to safe abortion services is restricted, mystery client surveys, rather than conventional questionnaire-based survey techniques, may better illuminate stocking and over-the-counter sale of abortifacients at community pharmacies.
Assuntos
Abortivos não Esteroides/provisão & distribuição , Misoprostol/provisão & distribuição , Medicamentos sem Prescrição/provisão & distribuição , Farmácias , Inquéritos e Questionários , Abortivos não Esteroides/economia , Comércio , Estudos Transversais , Humanos , Misoprostol/economia , Medicamentos sem Prescrição/economiaRESUMO
INTRODUCTION: Community distribution of misoprostol to pregnant women in advance of labor is one of the compelling strategies for preventing postpartum hemorrhage. Concerns have been reported that misoprostol distribution could reduce facility delivery or lead to misuse of the medication. This scoping review was conducted to synthesize the evidence on the effect of community-based misoprostol distribution on rates of facility delivery, and to assess the frequency of mothers taking distributed misoprostol before delivery, and any harmful outcomes of such misuse. METHODS: We included peer-reviewed articles on misoprostol implementation from PubMed, Cochrane Review Library, Popline, and Google Scholars. Narrative synthesis was used to analyze and interpret the findings, in which quantitative and qualitative syntheses are integrated. RESULTS: Three qualitative studies, seven observational studies, and four experimental or quasi-experimental studies were included in this study. All before-after household surveys reported increased delivery coverage after the intervention: ranging from 4 to 46 percentage points at the end of the intervention when compared to the baseline. The pooled analysis of experimental and quasi-experimental studies involving 7564 women from four studies revealed that there was no significant difference in rates of facility delivery among the misoprostol and control groups [OR 1.011; 95% CI: 0.906-1.129]. A qualitative study among health professionals also indicated that community distribution of misoprostol for the prevention of postpartum hemorrhage is acceptable to community members and stakeholders and it is a feasible interim solution until access to facility birth increases. In the community-based distribution of misoprostol programs, self-administration of misoprostol by pregnant women before delivery was reported in less than 2% of women, among seven studies involving 11,108 mothers. Evidence also shows that most women who used misoprostol pills, used them as instructed. No adverse outcomes from misuse in either of the studies reviewed. CONCLUSIONS: The claim that community-based distribution of misoprostol would divert women who would have otherwise had institutional deliveries to have home deliveries and promote misuse of the medication are not supported with evidence. Therefore, community-based distribution of misoprostol can be an appropriate strategy for reducing maternal deaths which occur due to postpartum hemorrhages, especially in resource-limited settings.
Assuntos
Atenção à Saúde/métodos , Trabalho de Parto/efeitos dos fármacos , Misoprostol/provisão & distribuição , Ocitócicos/provisão & distribuição , Hemorragia Pós-Parto/prevenção & controle , Feminino , Saúde Global , Humanos , Incidência , Misoprostol/farmacologia , Ocitócicos/farmacologia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Fatores de Risco , Taxa de Sobrevida/tendênciasRESUMO
The Saving Mothers Project was conducted from September 2015 to March 2017 in Bunda and Tarime Districts, Mara Region, Tanzania. The purpose of this project was to train community health workers (CHWs) to use mobile phones applications to register and educate pregnant women about safe deliveries and encourage them to access skilled health care providers for antenatal care and delivery, and to provide nurses and CHWs with clean birth kits with misoprostol to distribute to women. The birth kits were for use in case women could not access the health facility, or if the health facility was lacking supplies at the time of delivery. The overall goal of the study was to reduce the maternal mortality rate by increasing women's access to health services where possible, and to clean supplies when a non-facility birth was unavoidable. This paper reports on a mixed methods evaluation of the project including a survey of over two thousand four hundred women, and focus groups with women, community health workers, and nurses participating in the project. The results of the survey and focus groups demonstrate a high degree of satisfaction with the birth kits and misoprostol and an increase in facility birth rates where the project was implemented. Differences between the two districts illustrate that policy maker support is key to successful implementation.
Assuntos
Agentes Comunitários de Saúde/educação , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Materna/organização & administração , Mortalidade Materna , Tocologia/educação , Misoprostol/provisão & distribuição , Ocitócicos/provisão & distribuição , Hemorragia Pós-Parto/prevenção & controle , Adulto , Telefone Celular , Feminino , Humanos , Misoprostol/administração & dosagem , Aplicativos Móveis , Ocitócicos/administração & dosagem , Guias de Prática Clínica como Assunto , Gravidez , Resultado da Gravidez , Gestantes , Cuidado Pré-Natal , População Rural , Tanzânia , Adulto JovemAssuntos
Aborto Legal/legislação & jurisprudência , Abortivos não Esteroides/provisão & distribuição , Atenção à Saúde/legislação & jurisprudência , Feminino , Serviços de Assistência Domiciliar/legislação & jurisprudência , Humanos , Misoprostol/provisão & distribuição , Gravidez , Reino Unido , Direitos da Mulher/legislação & jurisprudênciaRESUMO
OBJECTIVE: To assess misoprostol availability at community pharmacies and determine factors affecting misoprostol prescription for medical abortion. METHODS: A cross-sectional quantitative survey of randomly sampled community pharmacies and their corresponding pharmacists/pharmacy workers was conducted in the city of Accra, Ghana. Structured questionnaires were administered to collect data between May 1 and July 28, 2016. Descriptive statistics (frequencies and proportions) and bivariate and logistic regression analysis were used to analyze the data. RESULTS: Of the 165 community pharmacies surveyed, approximately half (83 [50.3%]) stocked misoprostol. Availability of misoprostol however decreased when moving from first class to third class residential areas. 44 (26.7%) of the respondents had prescribed the drug at some time for medical abortion, but 140 (84.6%) indicated they would not prescribe the drug for medical abortion in future. Factors that significantly predicted misoprostol prescription for medical abortion included sex of the pharmacist/pharmacy worker, demand, and availability of misoprostol. CONCLUSIONS: Demand for misoprostol for medical abortion was found to be high but only half of community pharmacies stocked it, and most pharmacy workers did not wish to prescribe the drug. If community pharmacies are to effectively contribute to expanding access to safe abortion services in Ghana, the disparity between misoprostol provision and demand needs to be addressed.
Assuntos
Abortivos não Esteroides/provisão & distribuição , Atitude do Pessoal de Saúde , Misoprostol/provisão & distribuição , Farmácias/estatística & dados numéricos , Farmacêuticos/psicologia , Aborto Induzido/métodos , Adulto , Estudos Transversais , Feminino , Gana , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Gravidez , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Post-partum haemorrhage is the leading cause of maternal deaths in Mozambique. In 2015, the Mozambican Ministry of Health launched the National Strategy for the Prevention of Post-Partum Haemorrhage at the Community Level. The strategy included the distribution of misoprostol to women in advance at antenatal care and via Traditional Birth Attendants who directly administer the medication. The study explores the role of Traditional Birth Attendants in the misoprostol program and the views of women who used misoprostol to prevent post-partum haemorrhage. METHODS: This descriptive study collected data through in-depth interviews and focus group discussions. Traditional Birth Attendants between the ages of 30-70 and women of reproductive age participated in the study. Data was collected between June-October 2017 in Inhambane and Nampula Provinces. Line by line thematic analysis was used to interpret the data using Nvivo (v.11). RESULTS: The majority of TBAs in the study were satisfied with their role in the misoprostol program and were motivated to work with the formal health system to encourage women to access facility based births. Women who used misoprostol were also satisfied with the medication and encouraged family and friends to access it when needed. Women in the community and Traditional Birth Attendants requested assistance with transportation to reach the health facility to avoid home births. CONCLUSIONS: This study contributes to the evidence base that Traditional Birth Attendants are an appropriate channel for the distribution of misoprostol for the prevention of post-partum haemorrhage at the community level. More support and resources are needed to ensure Traditional Birth Attendants can assist women to have safe births when they are unable to reach the health facility. A consistent supply of misoprostol is needed to ensure women at the community level receive this life saving medication.
Assuntos
Instalações de Saúde/normas , Serviços de Saúde Materna/normas , Tocologia , Misoprostol/administração & dosagem , Misoprostol/provisão & distribuição , Hemorragia Pós-Parto/prevenção & controle , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/provisão & distribuição , Adulto , Idoso , Feminino , Humanos , Mortalidade Materna , Pessoa de Meia-Idade , Moçambique , Período Pós-Parto , Gravidez , Pesquisa QualitativaRESUMO
La autora de este artículo hace una síntesis de la evolución histórica y de las diferentes posturas religiosas frente al abor-to, describe su epidemiología mundial y la posición de la Organización Mundial de la Salud frente a esta problemática, resume el desarrollo y el desenlace del recientemente instalado debate sobre la legalización del aborto en Argentina y, finalmente reflexiona sobre lo que nos ha dejado este proceso político. (AU)
The author of this article summarizes the historical evolution and the different religious positions regarding abortion, describes its global epidemiology and the position of the World Health Organization in relation to this problem, summarizes the development and the outcome of the recently installed debate on the legalization of abortion in Argentina and, finally, reflect on what this politi-cal process has left us. (AU)
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Aborto Criminoso/história , Aborto Criminoso/legislação & jurisprudência , Aborto Induzido/legislação & jurisprudência , Aborto Legal/ética , Aborto , Argentina/epidemiologia , Religião e Medicina , Filosofias Religiosas , Educação Sexual/organização & administração , Classe Social , Aborto Criminoso/mortalidade , Aborto Criminoso/estatística & dados numéricos , Saúde Pública/legislação & jurisprudência , Fatores de Risco , Misoprostol/provisão & distribuição , Aborto Induzido/mortalidade , Aborto Induzido/estatística & dados numéricos , Aborto Legal/história , Aborto Legal/legislação & jurisprudência , Aborto Legal/estatística & dados numéricosRESUMO
BACKGROUND: The high level of maternal mortality and morbidity as a result of complications due to childbirth is unacceptable. The impact of quality medicines in the management of these complications cannot be overemphasized. Most of those medicines are sensitive to environmental conditions and must be handled properly. In this study, the quality of oxytocin injection, misoprostol tablets, magnesium sulfate, and calcium gluconate injections was assessed across the six geopolitical zones of Nigeria. METHOD: Simple, stratified random sampling of health facilities in each of the political zones of Nigeria. Analysis for identification and content of active pharmaceutical ingredient was performed using high-performance liquid chromatography procedures of 159 samples of oxytocin injection and 166 samples of misoprostol tablets. Titrimetric methods were used to analyze 164 samples of magnesium sulfate and 148 samples of calcium gluconate injection. Other tests included sterility, pH measurement, and fill volume. RESULTS: Samples of these commodities were procured mainly from wholesale and retail pharmacies, where these were readily available, while the federal medical centers reported low availability. Approximately, 74.2% of oxytocin injection samples failed the assay test, with the northeast and southeast zones registering the highest failure rates. Misoprostol tablets recorded a percentage failure of 33.7%. Magnesium sulfate and Calcium gluconate injection samples recorded a failure rate of 6.8% and 2.4%, respectively. CONCLUSION: The prevalence of particularly of oxytocin and misoprostol commodities was of substandard quality. Strengthening the supply chain of these important medicines is paramount to ensuring their effectiveness in reducing maternal deaths in Nigeria.
Assuntos
Ocitócicos/normas , Preparações Farmacêuticas/normas , Controle de Qualidade , Tocolíticos/normas , Gluconato de Cálcio/normas , Gluconato de Cálcio/provisão & distribuição , Parto Obstétrico/normas , Feminino , Humanos , Sulfato de Magnésio/normas , Sulfato de Magnésio/provisão & distribuição , Misoprostol/normas , Misoprostol/provisão & distribuição , Nigéria , Ocitócicos/provisão & distribuição , Ocitocina/normas , Ocitocina/provisão & distribuição , Preparações Farmacêuticas/provisão & distribuição , Farmácias/normas , Gravidez , Tocolíticos/provisão & distribuiçãoRESUMO
OBJECTIVES: We aimed to document the experience of buying abortion pills from online vendors that do not require a prescription and to evaluate the active ingredient content of the pills received. STUDY DESIGN: We searched the internet to identify a convenience sample of websites that sold mifepristone and misoprostol to purchasers in the United States and attempted to order these products. We documented price, shipping time and other aspects of ordering. We sent the samples received to a testing laboratory that measured the amount of active ingredient in individual tablets. RESULTS: We identified 18 websites and ordered 22 products: 20 mifepristone-misoprostol combination products and 2 that contained only misoprostol. We received 18 combination products and the 2 misoprostol products from 16 different sites. No site required a prescription or any relevant medical information. The time between order and receipt of the 20 products ranged from 3 to 21 business days (median 9.5 days). The price for the 18 combination products ranged from $110 to $360, including shipping and fees; the products without mifepristone cost less. Chemical assays found that the 18 tablets labeled 200 mg mifepristone contained between 184.3 mg and 204.1 mg mifepristone, while the 20 tablets labeled 200 mcg misoprostol contained between 34.1 mcg and 201.4 mcg of the active ingredient. CONCLUSIONS: Obtaining abortion medications from online pharmaceutical websites is feasible in the United States. The mifepristone tablets received contained within 8% of the labeled amount of active agent. The misoprostol tablets all contained that compound but usually less than labeled. IMPLICATIONS STATEMENT: Given our findings, we expect that some people for whom clinic-based abortion is not easily available or acceptable may consider self-sourcing pills from the internet to be a rational option.