Quality of male urethritis case management at pharmacies and health facilities in Mtwapa and Shanzu, Kenya, 2011
| Quality elements assessed | Simulated visits | Interviews | ||
|---|---|---|---|---|
| Pharmacies (N=20) | Pharmacies (n=20) | Private health facilities (N=20) | Government health facilities (N=4) | |
| N (%) or mean (SD) | N (%) or mean (SD) | |||
| History of present illness (HPI) | ||||
| Nature and duration of symptoms | 20 (100%) | 18 (90%) | 16 (80%) | 4 (100%) |
| Recent sexual exposure | 15 (75%) | 9 (45%) | 17 (85%) | 1 (25%)* |
| Previous care-seeking for current illness | 1 (5%) | 6 (30%) | 10 (50%) | 3 (75%) |
| Summary HPI score (maximum 3) | 2 (0.5) | 1.65 (0.6) | 2.2 (0.8) | 2.0 (0.8) |
| Medication regimens compliance†‡§ | ||||
| Compliant regimen for gonorrhoea (right dosage and duration) | 9 (45%) | 10 (56%) | 7 (39%) | 1 (25%) |
| Compliant regimen for Chlamydia (right dosage and duration) | 2 (10%) | 5 (28%) | 5 (28%) | 2 (50%) |
| Compliant regimens for both gonorrhoea and Chlamydia (right dosage and duration) | 2 (10%) | 5 (28%) | 5 (28%) | 1 (25%) |
| Potential treatment efficacy for both gonorrhoea and Chlamydia† | 0 | 0 | 2 (11%) | 0 |
| Provision of counselling messages | ||||
| Get an HIV test | 2 (10%) | 4 (20%) | 3 (15%) | 3 (75%)* |
| Use condoms consistently | 12 (60%) | 9 (45%) | 13 (65%) | 3 (75%) |
| Get partner treated | 13 (65%) | 17 (85%) | 16 (80%) | 4 (100%) |
| Adhere to the full course of treatment | 19 (95%) | 5 (25%) | 10 (50%) | 1 (25%) |
| Summary counselling score (maximum 4) | 2.3 (1.3) | 1.8 (0.9) | 2.1 (0.9) | 2.8 (1.0) |
*Significant difference (p<0.05) between private and government health facilities.
†For interviews, two pharmacies that said they would only refer were excluded (n=18). Similarly, two health facilities that said they would wait for laboratory results were excluded (n=22).
‡During simulated visits the median (range) number of medicines dispensed was 2 (2–6), of which 2 (1–5) were antibiotics. During interviews the median (range) number of medicines that would be dispensed by pharmacies was 3 (2–5), of which 2 (2–3) would be antibiotics. The median (range) number of medicines that would be prescribed by health facilities was 3 (1–4), of which 2 (1–4) would be antibiotics.
§Other antimicrobials suggested were: fluconazole, tinidazole, secnidazole, metronidazole, gentamicin and ofloxacin.
SD, standard deviation