Improving private drug sellers' practices for managing common health problems in Nepal.

BACKGROUND

In most Asian countries, 50 - 90% of pharmaceutical sales are made in private drug outlets, by personnel with some training in drugs but not for the treatment of common health problems. The objective of the study was to determine effects of focused training for private drug sellers to improve practices in treating acute respiratory infections and diarrhoea in children, and anaemia in pregnancy in Nepal.

METHODS

Randomized controlled, four way nested design study incorporating four interventions for drug retailers in both hill and terai districts. One group received mailed printed educational materials followed by mailed feedback; a second received small group training followed by feedback; a third received small group training only; and a fourth, the control group, received no intervention. Surrogate customer method was used to assess practices. Outcomes were measured using multivariate linear regression.

RESULTS

A significant increase in the asking of key history questions, recommendation ( prescribing by drug retailers) of cotrimoxazole, and advice-giving for pneumonia; a significant increase in ORS recommendation, and advice giving for diarrhoea including the avoidance of antidiarrhoeals; and a significant increase in asking key history questions and recommending appropriate products in pregnancy cases.

CONCLUSIONS

Training intervention as well as training followed by practice feedback was effective in improving the management of common illnesses and pregnancy by private drug sellers.