Pharmacists at the Muhimbili University of Health and Allied Health Sciences (Muhas) have established that most of the community pharmacies in Dar es Salaam dispense emergency contraception medicines poorly.
Emergency contraceptives (ECs) are used to prevent unwanted pregnancy in situations such as after having an unprotected sexual intercourse, concerns about possible contraceptive failure or incorrect use of the contraceptives and following a sexual assault.
Muhas pharmacists say they have found widespread cases of poor dispensing practices in Dar es Salaam; such as not giving adequate information to clients.
They warn that this contributes significantly to the burden of unwanted or mistimed pregnancies in the city and possibly across the country.
Unwanted pregnancies are known to pose significant public health concerns especially in low and middle-income countries due to their association with adverse health, social, and economic outcomes.
However, the World Health Organisation (WHO) recommends the use of EC as the last choice in preventing unwanted pregnancies.
In recent times, data has shown that there is an increasing trend of unwanted pregnancies despite the efforts by the government and stakeholders to control them.
In Tanzania, about a quarter of girls aged 15-24 years conceive unintentionally, data from the Ministry of Health, Community Development, Gender, Elderly and Children show.
The pharmacists who carried out the survey wanted to explore all forms of contraceptives used in Dar es Salaam. Before they went on to carry out the survey, their assumption was that unwanted pregnancies are likely to be on the increase, partly because there is a problem during dispensing.
They also initially suspected that substandard medicine was being dispensed or inadequate instructions were being given to clients—and now, one of the pharmacists, Mr Nelson Masota says, “[the problem] was both in dispensing and giving instructions.”
The WHO says that ECs can prevent up to over 95 per cent of pregnancies when taken within 5 days after intercourse.
But in Tanzania, there is a growing need for mass education on how the ECs should be dispensed by pharmacies and used by members of the public, says Mr Nelson Masota, from Muhas’ Department of Medicinal Chemistry.
During an 8-month survey carried out in 100 pharmacy outlets in the city in 2016/17, it was found out that no pharmacy gave counseling to the clients about the use of ECs, the experts said.
“We targeted emergency contraceptives found at pharmacies by posing as clients,’’ said Mr Masota during an interview with The Citizen.
The revelations came at a time the Muhas School of Pharmacy was showcasing various findings from studies carried out at the varsity this year.
Findings show that 54 per cent of the surveyed pharmacies in the city had poor dispensing practices, whereas 22 per cent of these were following the recommended ways of dispensing the contraceptives. The level of practice was found to be moderate in 24 per cent of these outlets.
The researchers said the latest findings show that relevant information concerning the use of ECs is rarely given and sometimes not given to clients who want to access them. “The dispensers fail to relay useful instruction and information to the client,’’ says the survey, titled: ‘Assessment of Dispensing Practice of Emergency Contraceptives in Community Pharmacies in Dar es Salaam’.
Mr Masota urged authorities to ensure that policies which were established to regulate dispensing practices are reinforced, for all drugs, including the emergency contraceptives. The experts believe that lack of adequate information from dispensers is to blame for cases where people fail to use the contraceptives correctly, leading to unwanted pregnancy.
Mr Adam Kiganja from Muhas School of Pharmacy says he has come across cases of women and girls who complain that certain contraceptives do not work.
But, he says, “I came to realise that they did not know the right procedures on how to use the contraceptives.”
Mr Kiganja, one of the researchers in the latest survey says further,“You see, there are certain contraceptives which cannot work well in a person who is taking certain anti-fungal drugs.”
He adds, “Those who don’t know this may end up complaining that the contraceptives were perhaps fake. But the fact could be that they applied the contraceptives wrongly.”
Previous studies carried out in Dar es Salaam have also shown that there is lack of adequate knowledge regarding the use of emergency contraceptives.
One of the studies—titled: ‘Availability, Awareness, Attitude and Knowledge of Emergency Contraceptives in Dar Es Salaam’, showed that university students lacked basic knowledge on ECs.
The researchers said that unwanted pregnancies pose a major public health problem among higher learning students, especially in developing countries.
This, they added, was associated with far-reaching consequences such as jeopardizing students’ educational progress and future careers.
They say proper use of contraceptives could help reduce unwanted pregnancies and unsafe abortions.
In the same year, a study in the Journal of Family Planning and Reproductive Health Care showed that lower educational level, not being married, not knowing where to access condoms, were among the risk factors for the unwanted pregnancies.