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International Journal for Quality in Health Care Advance Access published online on October 27, 2005
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzi086
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© The Author 2005. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved
Accepted September 24, 2005

Article

Post-training quality of syndromic management of sexually transmitted infections by chemists and druggists in Pokhara, Nepal: is it satisfactory?

M. M. H. Khan 1*, S. Wolter 2, and Mitsuru Mori 3

1 Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido, Japan; Department of Statistics, Jahangirnagar University, Dhaka, Bangladesh
2 Department of Tropical Hygiene and Public Health, Heidelberg University, Heidelberg, Germany
3 Department of Public Health, Sapporo Medical University, Sapporo, Hokkaido, Japan

* To whom correspondence should be addressed.
M. M. H. Khan, E-mail: khan{at}sapmed.ac.jp


  Abstract

Objective. Using simulated client and provider interview methods, this study assessed chemists and druggists’ post-training management quality of syndromic sexually transmitted infections focusing on the areas of privacy maintaining, encouraging, history taking, counseling, referral practice, partner notification, and drug prescribing and then compared the findings of two methods.

Design. Forty-five pharmacies from a list of 75 in Pokhara, who collected sexually transmitted infections data during 1999, were selected randomly. First simulated client successfully presented either urethral or vaginal discharge syndrome at 37 pharmacies and recorded the events of whole encounter into an observation form within 20 minutes. Later 39 chemists and druggists were interviewed by a pre-tested semi-structured questionnaire.

Main measures. Results were reported mainly by numbers and corresponding percentages. For comparative purpose, P values were also shown.

Results. Overall, interview method revealed satisfactory knowledge of chemists and druggists for management of sexually transmitted infections except drug prescribing but their actual behaviors, revealed by simulated client method, indicated lower quality and differed significantly in the areas of encouraging, history taking, counseling, referral practice, and partner notification. Both methods indicated very poor qualities of drug prescribing.

Conclusion. Retained knowledge of chemists and druggists for syndromic management of sexually transmitted infections were not applied to simulated client in actual practice. They should not prescribe drugs for patients of sexually transmitted infections, except referring to the doctors/hospitals. Continuous monitoring and further motivations for them may improve syndromic management quality of sexually transmitted infections. Moreover, depending on the purpose of study, various methods should be applied simultaneously to reach a better conclusion.

Keywords: interview method, private drug sellers, sexually transmitted infections, simulated client method, syndromic management.
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