Can licensed drug sellers contribute to safe motherhood? A survey of the treatment of pregnancy-related anaemia in Nepal

Iron-deficiency anaemia is a major cause of maternal mortality worldwide, contributing to perhaps one in five maternal deaths. According to the World Health Organization (WHO), maternal anaemia is most severe in southern Asia. Drug retail shops frequently serve as the public's first point of contact for medical care, even though many drug sellers have no training in the treatment of illness. In western Nepal, drug retailer treatment of anaemia in pregnancy was investigated using interviews, focus groups and simulated clients ('surrogates'). Research assistants posing as the husbands of anaemic pregnant women asked retailers for advice. In 112 retail shops studied, 71% of the study surrogates were recommended iron supplements for purchase. Drug recommendations often included vitamins, minerals and other ingredients not therapeutic for pregnancy-related anaemia. Retailers were found to take little case history. Fifty-seven per cent of retailers asked about the duration of the pregnancy; 40% asked no relevant questions. Advice about the drugs sold was infrequent and 59% of the surrogates received no advice of any kind other than a product recommendation. Knowledge of important referral criteria was also especially low. Although 66% of the retailers had some sort of formal training for work with pharmaceuticals, current training levels were not found to be associated with better knowledge or practice. A focused training intervention to improve retailer treatment of anaemia in pregnant women is recommended.