Transcript MISOPROSTOL AT GRASSROOTS

MISOPROSTOL AT GRASSROOTS
Dr Joachim Osur
Drug Availability
 Misoprostol is registered for PUD in almost all countries.
 As a result not strictly controlled.
 Not always bought on prescription.
 Long shelf life – 7 years
 No special storage conditions
 Affordable
Availability in Chemists in Nairobi
Can Pharmacists Help Women in
Need?
 A number of pharmacy workers lack knowledge of how to
terminate pregnancy.
 While the majority have heard of or sold Misoprostol, they
still suggest ineffective remedies for pregnancy termination.
What Would They Provide For Termination of Pregnancy
Can Pharmacy Workers Help Women?
 Most pharmacy workers were ready to sell the drug in
confidence to mystery clients
 When interviewed, they insisted on patients having a
prescription.
On Interview: Pharmacy Workers Say They Ask for
Prescriptions
Can Pharmacy Workers Help Women?
 Even where there is a will to help, knowledge of dosing is
seriously lacking.
 Wrong dosing could lead to complications:
 Under dose – no termination or incomplete abortion
 Failed termination can lead to foetal malformations
 Overdose – more side effects, uterine rapture in advanced
pregnancy.
Doses Recommended by Pharmacy Workers
Frequency
Percent
OD
„20
55.6%
„200
1
2.8%
400 µg stat
2
5.6%
According to prescription
3
8.3%
BD
7
19.4%
BD *5/7
1
2.8%
BD 800 µg
1
2.8%
Stat dose
1
2.8%
Total
36
2.8%
Can Pharmacy Workers Help Women?
 A number of pharmacy workers give information on the
Misoprostol (even if it is wrong information)
 Others do not give any information for a variety of reasons.
Reasons For Not Giving Information to
Women
Importance of Use of Misoprostol at
Pharmacy/Community Level
 Urugway harm reduction model has shown that use of
Misoprostol at community level reduces complications,
mortality.
What Women Chose to Do After
Counseling (Urugway Harm Reduction
Model)
OUTCOME
Illegal abortion (but under safer conditions: misoprostol)
Continued with the pregnancy
Spontaneous abortion/other pathologic pregnancies
They were not pregnant
Abortion conducted under legal conditions
No data available (did not return for the “after visit")
TOTAL
N
412
17
23
9
4
210
675
%
61%
3%
3%
1%
1%
31%
100%
Since 2001 the Maternal Mortality Rate in Urugway due to
unsafe abortion among women in Public Hospitals
decreased by 87%
80
70
60
Cases
50
40
30
20
10
0
2001
2002
2003
Year
2004
2005
Cases
Since 2001, the number of women arriving at the Emergency Room
of the Public Hospital who had to be referred to the Intensive Care
Unit decreased by 79%
16
14
12
10
8
6
4
2
0
2001
2002
2003
Year
2004
2005
Legal Challenges
 Abortion still generally restricted in most of Africa.
 Anglophone countries have similar laws- inherited from the
British.
 Sections of abortion law may impact on community use of
MA for termination of pregnancy.
Legal Challenges
 A person is not criminally responsible for performing in
good faith and with reasonable care and skill a surgical
operation upon any person for his benefit, or upon an
unborn child for the preservation of the mother’s life, if
the performance of the operation is reasonable, having
regard to the patient’s state at the time and to all the
circumstances of the case.
 MA is not a surgical procedure but the principle
of good faith and reasonable care and skill still
applies.
Legal Challenges
 Any person who unlawfully supplies to, or procures for any person any
thing whatever, knowing that it is intended to be unlawfully used to
procure the miscarriage of a woman whether she is or not with a
child, is guilty of a felony and is liable to imprisonment for three
years
 The community supplier of MA drugs should have
certification by MOH or other agencies
 Broad interpretation of the law is necessary so as to spell out
legal indications for abortion.
Legal Challenges
 Any woman who, being with child, with intent to procure her own
miscarriage, unlawfully administers to her self any poison or any
noxious things, or uses any force of any kind or uses any other means
whatever, or permits any such a thing or means to be administered or
used on her is guilty of felony and is liable to imprisonment for seven
years
 Countries need to compile adequate evidence to support the
scientific use of MA.
 National standards and guidelines are needed for guidance on
MA use both at facility and community levels.
Conclusion
• Misoprostol is easily available in pharmacies
• This is a window of opportunity for saving women from
crude forms of abortion
• Women have been accessing Misoprostol to terminate
pregnancies
• Information given to women by pharmacy workers is not
always accurate.
• Wrong advise on usage of the drug is worrying.
Recomendations
• There is need to train pharmacy workers on pharmacological
agents for termination of pregnancy.
• Use of pharmacies as a channel for Misoprostol could
potentially reduce complications of unsafe abortion and
should be encouraged.
• Laws and policies to protect the pharmacist and the woman
needed.