Community Pharmacists in Maternal and Child Health Services Provisions in Ethiopia

Abstract

<p>Maternal and child mortalities are the top global health issues within the United Nations (UN) Sustainable Development Goals (SDGs). Although remarkable reduction of global maternal and child mortalities has been recorded in the past two decades, still the numbers of mortalities are unequivocally high in many resources limited countries such as Ethiopia. Achieving universal Maternal and Child Health (MCH) service is a fundamental strategy to lower mortality and to achieve SDG targets. Resource limited countries are facing a shortage of skilled health professionals to improve access to MCH services. Given their easier and wider availability than other healthcare providers such as doctors and nurses, community pharmacists have great potential to deliver various types of MCH services which could assist countries with high maternal and child mortalities. However, little is known about the involvement and practice of community pharmacists in MCH service globally and, more specifically, in resource limited settings including Ethiopia. The overarching aim of this thesis work was to assess and evaluate community pharmacy professionals' involvement and practice in providing MCH services in the Ethiopian context. In addition to a systematic review, four empirical studies employing a combination of self-reported survey and simulated client visits methods were conducted to address the objectives of the thesis.</p> <p>Chapter 1 introduces the overall thesis work with background information from global and local contexts and the significance of the thesis. It also highlights the thesis structure and describes the overall methodological approach.</p> <p>Chapter 2 presents the findings of a systematic review of studies focusing on involvement and practice of community pharmacists in MCH services. In this chapter, it was identified that community pharmacists have been involved in different types of maternal health services, mainly guidance on breastfeeding, vitamin supplementation during pregnancy, provision of emergency contraceptives and responding to minor symptoms experienced by pregnant women. The findings of the systematic review also revealed that community pharmacists have been involved in the management of minor symptoms and medication use review and counselling for children. Further, the systematic review identified practice gaps among community pharmacists in providing MCH services particularly regarding management of minor symptoms in children.</p> <p>Insights from the systematic review (chapter 2) suggested that evidence is lacking from the perspective of resource limited settings. </p> <p>Chapter 3 and 4 presented the findings from studies conducted on the involvement of community pharmacy professionals in maternal (chapter 3) and child (chapter 4) health service provision in the Ethiopian context. The findings in chapter 3 identified that most community pharmacy professionals are either 'involved' in advising about vitamins (53.4%), 'provision of contraceptives' (52.9%), 'advising about lifestyle changes' (46.2%), 'responding to minor symptoms' (47.5%), 'nutritional advice during pregnancy' (45.0%) and 'breastfeeding guidance' or 'very involved' in advising about 'screening for chronic disease' (41.6%). Similarly, the study findings in chapter 4 identified that most community pharmacy professionals in Ethiopia are 'involved' in providing different types of child health services mainly 'responding to minor symptoms' (50.8%), 'advice about infant milk/formulas' (47.1%) and 'advice about vitamins/supplements' (46.6%). </p> <p>The papers presented in chapters 5 and 6 evaluated the practice of community pharmacy professionals in MCH service provision focusing on management of minor symptoms/ailments for pregnant women (chapter 5) and children (chapter 6). The papers in chapters 5 and 6 employed a combined self-reported survey and simulated client visit methods. The self-reported survey showed that, most community pharmacy professionals 'always' gather most symptom-related information and provide most medication-related information. However, the simulated client visits demonstrated that most community pharmacy professionals did not gather symptom-related information nor provide medicationrelated information to the extent indicated in the self-reported survey. Overall, the findings in chapters 5 and 6 identified that community pharmacy professionals' practice in provision of MCH service was poor.</p> <p>Chapter 7 links the chapters together and highlights the contribution of the thesis work with implications for policy, practice, and future research.</p> <p>Overall, this thesis aimed to assess and evaluate the involvement and practice of community pharmacy professionals in providing MCH services in Ethiopia. The findings from the systematic review and the four empirical papers suggest that community pharmacists have potential to play a significant role in providing various types of MCH services. Further, the findings demonstrate that there are practice gaps in providing MCH services, particularly in regard to the management of minor symptoms/aliments among pregnant women and children. These findings have implications for policymakers, practitioners, and future research in optimising the involvement and practice of community pharmacists in MCH service provision, particularly in resource limited settings such as Ethiopia.</p>