A proposal for an evaluation model of pharmaceutical services for malaria (original) (raw)
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Malaria Journal, 2011
Background: In spite of the fact that pharmaceutical services are an essential component of all malaria programmes, quality of these services has been little explored in the literature. This study presents the first results of the application of an evaluation model of pharmaceutical services in high-risk municipalities of the Amazon region, focusing on indicators regarding organization of services and prescribing according to national guidelines. Methods: A theoretical framework of pharmaceutical services for non-complicated malaria was built based on the Rapid Evaluation Method (WHO). The framework included organization of services and prescribing, among other activities. The study was carried out in 15 primary health facilities in six high-risk municipalities of the Brazilian Amazon. Malaria individuals ≥ 15 years old were approached and data was collected using specific instruments. Data was checked by independent reviewers and fed to a data bank through double-entry. Descriptive variables were analyzed. Results: A copy of the official treatment guideline was found in 80% of the facilities; 67% presented an environment for receiving and prescribing patients. Re-supply of stocks followed a different timeline; no facilities adhered to forecasting methods for stock management. No shortages or expired anti-malarials were observed, but overstock was a common finding. On 86.7% of facilities, the average of good storage practices was 48%. Time between diagnosis and treatment was zero days. Of 601 patients interviewed, 453 were diagnosed for Plasmodium vivax; of these, 99.3% received indications for the first-line scheme. Different therapeutic schemes were given to Plasmodium falciparum patients. Twenty-eight (4.6%) out of 601 were prescribed regimens not listed in the national guideline. Only 5.7% individuals received a prescription or a written instruction of any kind.
The Role of the Pharmaceutical Sector in Malaria Control in Ghana
Publications of the University of Eastern …
Background: Malaria is endemic in Ghana, and contributes significantly to infant and maternal deaths, as well as to loss of disability adjusted life years. The pharmaceutical sector and in particular the medicine outlets has been identified as accessible units in the health system, where public health initiatives could be targeted to facilitate greater access to interventions for prevention and control of malaria. This study was aimed at assessing medicine outlets and their staff in both public and private sector facilities in Ghana, and how their activities conformed to global and national initiatives for malaria control. Materials and Methods: A preliminary study on the appropriateness of self care and health facilities based management of malaria, and the role played by medicine outlets staff in the supply and utilisation of anti-malarials, was done in a well resourced rural hospital and a city based polyclinic in Southern Ghana. After which an indicator-based assessment of the infrastructure and settings for pharmaceutical services, the staff and material resources and practices for malaria control was done, in a cross section of medicine outlets (n=130) selected from hospitals/clinics and community-based retail outlets in Northern and Southern Ghana. The study indicators were based on international and national standards for pharmaceutical services, as well as the roll back malaria and national policy initiatives for malaria control. Results: The preliminary study indicated high prevalence of inappropriate use of anti-malarials among those who attempted self care before visiting the health facilities, consequently resulting in severe and complicated malaria conditions that were managed appropriately in the health facilities. The later study showed that the infrastructure and practice settings assessed were satisfactory, but could be further improved and utilized as supplementary or alternative channels to facilitate access to effective interventions for malaria control. On the availability and supply of medicines for malaria therapy; nonpolicy recommended and mostly ineffective anti-malarials were observed to be highly available and often supplied for malaria therapy, particularly in the retail outlets. The availability of policy-recommended medicines and in particular the artemisinin-based combination products, were rather poor. In addition very few of the outlets (less than 10%) strictly adhered to policy recommendations for the selection and supply of medicines for malaria therapy. On the staff resources; greater than 55% had no professional training as pharmaceutical service providers. The hospitals/clinics had more professional staff per outlet than those in the retail sector. Majority of the staff assessed (over 80%), which included both professionals and non professionals could recognise malaria illness and also advice clients on how to avoid further infections. However, very few (20%) and mainly professionals were adequately skilled to both recognise and manage the malaria cases as recommended by national guidelines. Conclusions: The infrastructure and settings in most of the outlets were satisfactory for pharmaceutical services. However, there were significant shortfalls, regarding the availability and supply of effective medicines for malaria control. Also majority of the staff assessed were inadequately skilled to appropriately manage malaria cases. Pragmatic education and regulatory interventions should be directed CONTENTS 1 INTRODUCTION 2 BACKGROUND 2.1 Health and health care challenges in sub-Saharan Africa 2.2 Pharmaceutical services and health in Societies in sub-Saharan Africa 2.3 Health policy of Ghana 2.4 Health systems in Ghana and organisation of health services 2.5 Regulation of health and pharmaceutical services 2.6 The pharmaceutical sector and services in medicine outlets 2.7 Medicines supply management chain 2.8 Pharmacy education and manpower issues 3 MALARIA AS A PUBLIC HEALTH PROBLEM 3.1 Life cycle of malaria infection 3.2 Symptoms of malaria 3.3 Global burden of malaria and malaria in sub-Saharan Africa 3.4 Impact of malaria on well-being and socioeconomic development 3.5 Global strategies for prevention and control of malaria 3.6 Malaria control in Ghana and the role of medicine outlet practitioners 4 AIMS AND OBJECTIVES OF THE STUDY 5 MATERIALS AND METHODS 5.1 Context of the study 5.2 Overview of methods used and study design 5.3 Self care and health facilities-based management of malaria (I) 5.3.1 Study setting and participants 5.3.2 Data collection and analysis 5.4 Assessments of the pharmaceutical settings and practices for malaria control (IIIV) 5.4.1 Sampling of facilities 5.4.2 Indicators for assessments of the pharmaceutical settings and malaria control practices 5.5 Data collection (II-IV) 5.5.1 Infrastructure and settings for pharmaceutical services 5.5.2 Availability and supply of medicines for chemotherapy and malaria prevention in pregnancy (IPTp) 5.5.3 Human resources in the outlets, their knowledge, skills and practices for malaria control 5.6 Coding of data and data analysis 6 RESULTS 6.1 Self care and the health facilities-based management of malaria (I) 6.1.1 Self-care for malaria and appropriateness of use of anti-malarials 6.1.2 Malaria therapy at the health facilities and therapeutic outcomes 6.2 Assessment of the infrastructure and settings for pharmaceutical services (IV) 6.2.1 Diagnostics, dispensing tools and packaging of anti-malarials 6.2.2 Medicine outlet records, tools for communication and reference literature 6.3 The availability of medicines for malaria chemotherapy and IPTp (II) 6.3.1 Non policy recommended medicines and anti-malarials not registered with FDB 6.3.2 Policy recommended medicines 6.3.3 Other commodities stocked for mosquito control in the outlets 6.3.4 Adherence to policy recommendations when supplying medicines 6.4 The staff resources, their knowledge and practices for malaria therapy (III) 6.4.1 Staff resources in the outlets and their professional status 6.4.2 Knowledge, skills and practices of staff for malaria therapy 7 DISCUSSION 7.1 Appropriateness of self-care and the role of medicine outlets 7.2 Infrastructure and the settings for pharmaceutical services (IV) 7.2.1 Packaging and dispensing of anti-malarials 7.2.2 Tools to aid the identification of malaria cases and optimization of anti-malaria therapy 7.2.3 Records maintained in medicine outlets and tools for communication 7.2.4 Reference materials and its relevance to pharmaceutical services 7.3 Availability and accessibility of medicines and other commodities 87 7.3.1 Malaria prevention 7.3.2 Malaria treatment 7.3.3 Adherence to policy when choosing anti-malarials for chemotherapy or IPTp 7.4 Staff resources and their training as pharmaceutical service providers 7.4.1 Knowledge, skills and practices of staff for malaria control 7.5 Methodological considerations and limitations 8 CONCLUSIONS 8.1 Policy implications and applicability of study findings 9 RECOMMENDATIONS FOR FURTHER RESEARCH 100
Brazilian Journal of Pharmaceutical Sciences, 2013
Malaria is one of the most important global public health problems threatening the health of the population owing to prevailing socio-economic conditions and epidemiological reasons in Pakistan. This qualitative study has focused on the perspectives held towards the rational use of medicine intervention among malaria control program officials. Eight semi-structured interviews with all officials working for the malaria control program in Islamabad were conducted. The interviews, which were audio-taped and transcribed verbatim, were evaluated by thematic content analysis and by all authors. All respondents agreed on successful implementation of the malaria control program in Pakistan for controlling malaria by improving diagnostic and treatment facilities and promoting rational case management through training of prescribers. However, funding is still the major challenge faced by the program for its future implementation.
Combating poor-quality anti-malarial medicines: a call to action
The circulation of poor-quality medicines continues to undermine the fight against many life-threatening diseases. Anti-malarial medicines appear to have been particularly compromised and present a major public health threat in malaria-endemic countries, negatively affecting individuals and their communities. Concerted collaborative efforts are required from global, regional and national organizations, involving the public and private sectors, to address the problem. While many initiatives are underway, a number of unmet needs deserve urgent and increased multisector attention. At the global level, there is a need for an international public health legal framework or treaty on poor-quality medicines, with statutes suitable for integration into national laws. In addition, increased international efforts are required to strengthen the governance of global supply chains and enhance cooperation between national medicine regulation authorities and law enforcement bodies. Increased investment is needed in innovative technologies that will enable healthcare teams to detect poor-quality medicines at all levels of the supply chain. At the regional level, a number of initiatives would be beneficial—key areas are standardization, simplification, and reciprocal recognition of registration processes and development of quality control capacity in regional centres of excellence that are better aligned with public health needs; improved surveillance methods and creation of a framework for compulsory and transparent reporting of poor-quality medicines; additional support for national medicine regulation authorities and other national partner authorities; and an increase in support for regional laboratories to boost their capabilities in detecting poor-quality medicines. It is vital that all stakeholders involved in efforts against poor-quality anti-malarial medicines extend and strengthen their actions in these critical areas and thus effectively support global health development and malaria elimination programmes.
Bayero Journal of Pure and Applied Sciences, 2010
The best way to analyze drug utilization and evaluate impact of an intervention in health care institutions is to study the universal indicators, which are not dependent either on investigator or time of measurement. The aim of this study was to characterize the prescription pattern of public health institutions in Kano, Nigeria and evaluate the rational use of anti-malarial drugs with a view to intervening where necessary. Values of drug utilization indicators were measured prospectively and areas that required intervention identified. Intervention; consisting of free pictorial handbills given to patients, discussions held with health care personnel and pieces of advice were given to health administrators. The impact of the intervention was assessed using pre and post comparison of appropriate indicators. The study revealed a significant decline (P < 0.01) in percentage of encounters with injections and increase utilization of oral chloroquine (P < 0.05). Significant increase (P < 0.05) in dispensing time was also observed in the study group. The results of this study suggest the need for further intervention.
Malaria Journal, 2011
Background: Artemisinin-based combination therapy (ACT) is the first-line malaria treatment throughout most of the malaria-endemic world. Data on ACT availability, price and market share are needed to provide a firm evidence base from which to assess the current situation concerning quality-assured ACT supply. This paper presents supply side data from ACTwatch outlet surveys in Benin, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and Zambia. Methods: Between March 2009 and June 2010, nationally representative surveys of outlets providing anti-malarials to consumers were conducted. A census of all outlets with the potential to provide anti-malarials was conducted in clusters sampled randomly.
PLoS ONE, 2012
Background: Patent medicine vendors (PMV) provide antimalarial treatment and care throughout Sub-Saharan Africa, and can play an important role in the fight against malaria. Their close-to-client infrastructure could enable lifesaving artemisinin-based combination therapy (ACT) to reach patients in time. However, systematic assessments of drug sellers' performance quality are crucial if their role is to be managed within the health system. Lot quality assurance sampling (LQAS) could be an efficient method to monitor and evaluate PMV practice, but has so far never been used for this purpose.
What determines providers' stated preference for the treatment of uncomplicated malaria?
Social Science & Medicine, 2014
As agents for their patients, providers often make treatment decisions on behalf of patients, and their choices can affect health outcomes. However, providers operate within a network of relationships and are agents not only for their patients, but also other health sector actors, such as their employer, the Ministry of Health, and pharmaceutical suppliers. Providers' stated preferences for the treatment of uncomplicated malaria were examined to determine what factors predict their choice of treatment in the absence of information and institutional constraints, such as the stock of medicines or the patient's ability to pay.
Malaria Journal
Background: Despite recent strides made towards reducing the emergence of artemisinin resistance, inappropriate dispensing practices for anti-malarials in both private and public sectors affect treatment outcomes negatively. In Ghana, private retail pharmacies are the most accessible health facilities for managing diseases of common occurrence. However, there is growing concern about the number of patients harmed by dispensing errors in the management of malaria in retail pharmacies. Although considerable work has been done in this area, several questions regarding dispensing practices remain unanswered. This study, therefore, sought to investigate the predictors of appropriate dispensing practices for anti-malarials in community pharmacies in the La Nkwantanang-Madina municipality of Greater Accra, Ghana. Methods: A cross-sectional analytic study was conducted in sixty-one randomly selected community pharmacies in the La Nkwantanang-Madina. Data from 230 clients and 106 dispensers were analysed. It was checked for internal consistency and completeness then entered and analysed using STATA I/C version 14.0. Frequencies, Chi square tests, and logistic regression analyses were conducted, accounting for clustering. Results and discussion: Of the 106 dispensers interviewed, 71.4% were medicine counter assistants. The mean age of dispensers was 30.4 years (SD 8.8). Over 88.0% of clients were advised to complete the full course of their antimalarials. However, the 8-h loading dose principle for artemether-lumefantrine was not explained to 88.3% of the clients. More than half of the clients (52.2%) were given appropriate dispensing information on anti-malarial use. Most clients (66.1%), were dispensed anti-malarials without malaria tests. Dispensers with more than a 10-years experience were less likely to dispense artemisinin-based combinations appropriately relative to dispensers with less than 2 years experience (AOR = 0.04, 95% CI 0.002-0.802 p-value = 0.036) while pharmacy interns were about 19 times more likely (AOR = 18.5, 95% CI 1.40-245.6 p-value = 0.03) to dispense artemisinin-based combinations appropriately compared to pharmacists. Conclusion: Dispensing practices for anti-malarials is unsatisfactory. There is a need to enforce existing legislation with educational programmes directed towards dispensers especially those with more than 10 years experience. Specific adherence to the World Health Organization Test, Treat and Track initiative should be encouraged to ensure effective use of anti-malarials.