测绘在莫桑比克马普托获得药物流产的情况。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2025-04-16 DOI:10.1016/j.contraception.2025.110911

Christine M. Zachek , Santos Guilherme M. Santos , Maimuna Marenah , Nafissa Bique Osman , Sierra Washington

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引用次数: 0

摘要

目的：了解莫桑比克马普托地区药物流产中米非司酮和米索前列醇共包装（“复合包装”）的可及性。研究设计：2022年6月至9月期间，在马普托的药店进行了一项横断面秘密购物者研究。学生们被训练成寻求堕胎的病人。购物者访问了马普托的所有商业药店，以获取有关组合包装的可用性、管理和副作用的信息。药店有两名购物者；一个有处方，一个没有。根据社区社会经济状况评估成本和可得性。结果：共对155家药店进行了250次访问。80.6%的药房提供组合包装；只有8.4%的人需要处方。成本中位数为1000梅蒂卡尔（15.65美元）（350-1700公吨，5.48-26.60美元）。药房工作人员对联合包装给药的说明完全准确的比例仅为3.8%，46.2%的人给出了部分正确的说明，48.4%的人根本没有给出说明。分别有49.2%和22.9%的患者讨论了药物的副作用和医院预防措施。与高收入社区相比，低收入社区更有可能分发组合包（94.9%对68.9%,p=0.001）。然而，与高收入社区相比，低收入社区的联合包装成本要高得多（中位数成本为1300吨（20.35美元）对950吨（14.87美元））。结论：总体而言，联合包装在马普托广泛使用，但在分配做法和成本方面存在显著差异。需要采取干预措施，改善以药物为基础的咨询，特别是针对低收入社区，以增加获得安全堕胎服务的机会。意义：同包装米非司酮-米索前列醇在莫桑比克马普托的商业药店广泛销售。大多数药店在没有处方的情况下提供药物流产，并且提供的药物管理和潜在副作用的信息有限，特别是在低收入社区。改善药师咨询和重点干预低收入社区可促进药物流产的安全性。

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Mapping access to medication abortion in Maputo, Mozambique

Objective

To characterize access to co-packaged mifepristone and misoprostol (“combi-pack”) for medication abortion in Maputo, Mozambique.

Study design

A cross-sectional, secret shopper study was conducted among pharmacies in Maputo between June and September 2022. Students were trained to act as patients seeking abortion. Shoppers visited all commercial pharmacies in Maputo to obtain information about combi-pack availability, administration, and side effects. Pharmacies were visited by two shoppers; one with a prescription and one without. Cost and availability were evaluated according to neighborhood socioeconomic status.

Results

We conducted 250 visits among 155 pharmacies. Combi-pack was available at 80.6% of pharmacies; only 8.4% required a prescription. Median cost was 1000 meticais ($15.65 USD) (range 350–1700 MT, $5.48–26.60 USD). Pharmacy worker instructions on combi-pack administration were fully accurate at only 3.7% of visits, while 45.2% gave partially correct instructions and 47.9% gave no instructions at all. Side effects and hospital precautions were discussed at 48.9% and 22.9% of pharmacy visits, respectively. Low-income neighborhoods were more likely to dispense combi-pack compared to high-income neighborhoods (94.9% vs. 68.9%, p = 0.001). Yet, combi-pack cost significantly more in low-income compared to high-income neighborhoods (median cost 1300 MT [$20.35 USD] vs. 950 MT [$14.87 USD], p < 0.001). Dispensing combi-pack with or without a prescription was not significantly correlated with neighborhood income level.

Conclusions

Overall, combi-pack is widely available in Maputo with significant variations in dispensing practices and cost by neighborhood income level. Interventions to improve pharmacy-based counseling, specifically targeted towards low-income neighborhoods, are needed to increase access to safe abortion services.

Implications

Co-packaged mifepristone-misoprostol was widely available at commercial pharmacies in Maputo, Mozambique. Most pharmacies dispensed medication abortion without a prescription and provided limited information on medication administration and potential side effects, particularly in lower income neighborhoods. Improving pharmacist counseling and focusing interventions in low-income neighborhoods can promote safety of medication abortion.

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来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.