Transcript Oral Presentation 1

IMPROVING ADHERENCE TO MALARIA
TREATMENT FOR CHILDREN:
THE USE OF PRE-PACKAGED
CHLOROQUINE TABLETS VRS. SYRUP
EVELYN K. ANSAH, IRENE A. AGYEPONG,
JOHN O. GYAPONG, DAVID B. EVANS
Order of Presentation


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



Background
Study setting
Methods
Results
Key lessons learnt
Policy and Program Implications
Conclusion
Background
 Follow-on to initial study on adherence in the
Dangme West District
 Adherence to Rx schedule was found to be
very poor especially for chn (Agyepong et
al,2002; Social Science & Medicine 2002 Dec ;
55(12): 2215-2226)
 Syrup mainstay of antimalarial Rx among chn
<5 yrs
 Pre-packaged tablets for adults shown to
improve adherence remarkably (Yeboah-Antwi
et al, 2001,Quingjun et al, 1995)
Study Setting
 Cape Coast municipality in the
Central Region of Ghana
 Population: 120,000
 2 H/Centers 2 MCH Centers
 Malaria is highly endemic; there is
transmission all year round
Research Questions
 Would prescribing pre-packaged
tablets improve adherence to
antimalarial Rx for children <5yrs?
 Would tablets be acceptable to
mothers as an alternative
formulation for children?
Methods
 144 clients randomly assigned to
receive syrup, 155 to receive prepackaged tablets at OPD
1
2
3
 Day 4 home visit. (The first day of
visit to the clinic was counted as
day 1)
Methods
 Caregivers were interviewed to find
out how medication was administered
and their perceptions of the
formulation received
 Volume of spoons/other home
implements used to administer syrup
measured using a calibrated
measuring syringe
Definition of Adherence used
 Doing exactly as the provider
prescribed no matter the volume and
type of implement used
e.g Mother gives exactly “one teaspoon”
daily even if her idea of a teaspoon is
a tablespoon.
Results
 42% of 144 clients who received syrup c/f
91% of 155 who received pre-packaged
tablets adhered to Rx schedule
 80% used spoons whilst 20% used a small
cup to measure the dose
(Syrups were/still are dispensed at the clinic
without a standard measure)
 Only 19.4% used an accurate 5 ml measure.
68% used measuring implements <5ml. The
rest used implements >5ml in volume
Results
 The volume of spoons/cups used to
represent 5 mls varied from 1 ml to 9 mls.
 Some used teaspoons whilst others used
dessertspoons and tablespoons.
Apparently to most of the caregivers/
mothers, “a spoon is a tablespoon is a
desertspoon is a teaspoon”
 4 caregivers used two different measures at
different times or on a different days.
Results
 Only 8.6% of caregivers had given a
total dose of 25mg/kg by day 4
> 25mg/kg - 44.3%
< 25mg/kg - 47.1%
 Cost to the caregiver when syrup was
dispensed was about 4x that of tablets
GHC750(US$0.36) vrs GHC168
(US$0.08)
Perceptions of Caregivers
/Mothers
 “Tablets are easier to administer than
the syrup. I just put it in thick ‘koko’
(fermented maize porridge).”
 “It is easier for me to remember how
much to give. As for 1,2,3 anybody
can read it”
 “The tablets work faster than syrups.”
 About 62% of caregivers/mothers who
received pre-packaged tabs preferred
it to the syrup
Key Lessons
 Pre-packaged tabs for children are a
viable alternative for home
management of malaria.
 Improves adherence remarkably &
reduces over & under dosage --->Toxicity or resistance
 Also improves the administration of
the correct dose
Key Lessons
 Eliminates problem of variations in
home measures and the mother’s
dilemma of
“HOW MUCH?’
“HOW OFTEN?”
“HOW LONG?”
 Reduces cost to caregiver/mother
 Caregivers/ mothers are willing to use
them
Policy/Program Implications
 Policy makers must consider using
pre-packaged tabs for children.
 Manufacturers must be encouraged to
produce already packaged, lower
strength, sweeter tabs for children
 Where syrup MUST necessarily be
dispensed, standard 5ml measures
must be provided with the medication
 In that case, just enough syrup with
allowance for spillage must be
supplied
Future Research Agenda
 Would adherence to dosage schedule of
co-packaged tablets be the same as for
single drug tablets? (Current move to
combination therapy for malaria)
 Addition of standard measures to syrups:
by how much would adherence be
improved?
 How do we ensure that prescribers and
chemical sellers/Pharmacies do dispense
adequate doses of antimalarials
Thank you for your attention!!!