Medical abortion drug dispensing practices among private pharmacy workers in Nepal: A mystery client study.

BACKGROUND: Pharmacies are the first point of contact for women seeking medical abortion (MA) and act as important sources of information and referral in Nepal. Over the counter sale of MA drugs is not currently allowed in Nepal. This study aimed to assess the MA drug dispensing practices of pharmacy workers using mystery clients in Nepal. METHODS: A cross-sectional study using the mystery client approach was conducted in 266 pharmacies in September-October 2019. These pharmacies had either received harm reduction training or medical detailing visits. A total of 532 visits were conducted by six male and six female mystery clients. Mystery clients without prescription approached the sample pharmacy and filled out a standard digital survey questionnaire using the SurveyCTO application immediately after each interaction. RESULTS: Pharmacy workers dispensed MA drugs in 35.7% of the visits while they refused to provide MA drugs to the mystery clients in 39.3% of visits. Lack of evidence of prior consultation with a physician (27.5%), referral to other health facilities (21.8%), unavailability of MA drugs in the pharmacy (21.3%) and lack of prescription (16.4%) were the main reasons for refusal. Seventy percent of the pharmacy workers inquired clients about last menstrual period/months of pregnancy while 38.1% asked whether the pregnancy status was confirmed. During 65.1% of the visits, mystery clients were told about when to take the MA drugs while in 66.4% of visits, they were told about the route of drug administration. Similarly, mystery clients were briefed about what to expect during the abortion process in half of the visits, and information about the possible side effects of the MA drug was provided in 55.9% of the visits. Pharmacy workers provided correct information on taking MA drugs to mystery clients in 70.7% of visits. CONCLUSION: Despite legal provision of sale of MA drugs only on prescription, pharmacy workers dispensed MA drug in one out of three visits. As pharmacies are the initial contacts of women for abortion services in Nepal, correct supplementary information through pharmacy workers can be an effective strategy to expand access to quality safe abortion services.

Isolation and Characterization of Potential Antibiotic-Producing Actinomycetes from Water and Soil Sediments of Different Regions of Nepal.

INTRODUCTION: The actinomycetes are diversely distributed microorganisms in nature. The geographical diversity of Nepal is suitable for adaptation of various species of actinomycetes. The distribution of the actinomycetes is dependent upon the altitude and nature of the soil and water. METHODS: A total of 22 water and soil samples were collected from different regions of Nepal and were processed. Different isolates were characterized by observing colony characteristics and microscopic characteristics. Screening of the antimicrobial property was based upon perpendicular line streaking and submerged-state fermentation for antibiotic production. RESULTS: From the identification tool used, 12 were found to be Micromonospora, 9 were Nocardia, and 7 were Streptomyces. Out of total samples, 8 isolates of actinomycetes were tested effective against the tested bacteria by primary screening using the well diffusion method. Among the primarily screened, all isolates were subjected to submerged-state fermentation methods to produce crude extracts and 4 were found to be effective against the tested bacterial group. The actinomycetes identified from a water source showed better antimicrobial property towards the tested bacteria than the soil sample. Most isolates were found to be Micromonospora followed by Nocardia and Streptomyces with higher antimicrobial activities. CONCLUSION: The water source and soil sediments of Nepal provide suitable environments for actinomycetes towards obtaining a novel antimicrobial agent. The study of actinomycetes from various unexploited areas of Nepal is necessary. Thus, exploitation of various regions of Nepal for the discovery of an effective antimicrobial agent is helpful in providing a solution to the cost-effective therapy and action against antibiotic resistance.