Contraceptive Injections in Rural Drug Shops in Uganda

Background: Small private drug shops are ubiquitous in many African countries, and, at the community level, are often the first stop for rural dwellers seeking health care. They are also controversial: drug shop operators are notorious in some countries for selling controlled, counterfeit or tainted drugs, and for providing health services for which they are not qualified. In Uganda, most rural drug shops illegally sell and inject Depo Provera.

Methodology: In August 2007, we visited 139 drug shops in three rural districts of Uganda and interviewed the operators, collecting data on provider qualifications, injection practices, and contraceptive knowledge and attitudes. Subsequently, we trained many of the drug shop operators as community-based distributors of Depo Provera, and then re-interviewed the operators in subsequent months to evaluate the impact of training on safe provision of injectable contraception.

Results: Baseline data showed that nearly 90% of drug shops both sold and injected Depo Provera. We also present data on drug shop operator qualifications, and pre-post changes in injection practices and contraceptive knowledge and attitudes.

Conclusions: Provision of Depo Provera by rural drug shop operators in Uganda remains illegal and ubiquitous. The relative innocuousness of DMPA and the pre-packed autodisable syringes in the socially-marketed product likely make these injections the safest offered in drug shops, yet there is a need to better regulate this sector and to insure safe injections.