Academic journal article Bulletin of the World Health Organization

Impact of Prepackaging Antimalarial Drugs on Cost to Patients and Compliance with Treatment

Academic journal article Bulletin of the World Health Organization

Impact of Prepackaging Antimalarial Drugs on Cost to Patients and Compliance with Treatment

Article excerpt

Objective To examine the extent to which district health teams could reduce the burden of malaria, a continuing major cause of mortality and morbidity, in a situation where severe resource constraints existed and integrated care was provided.

Methods Antimalarial drugs were prepackaged into unit doses in an attempt to improve compliance with full courses of chemotherapy.

Findings Compliance improved by approximately 20% in both adults and children. There were 50% reductions in cost to patients, waiting time at dispensaries and drug wastage at facilities. The intervention, which tended to improve both case and drug management at facilities, was well accepted by health staff and did not involve them in additional working time.

Conclusion The prepackaging of antimalarials at the district level offers the prospect of improved compliance and a reduction in the spread of resistance.

Keywords Antimalarials/administration and dosage; Drug packaging; Patient compliance; Drug costs; Prescriptions, Drug; Ghana (source: MeSH).

Mots cles Antipaludique/administration et posologie; Emballage medicaments; Observance prescription; Cout medicament; Ordonnance medicale medicament; Ghana (source:INSERM).

Palabras clave Antimalaricos/administracion y dosificacion; Embalaje de medicamentos; Cooperacion del paciente; Costos en drogas; Prescripcion de medicamentos; Ghana (fuente: BIREME).

Bulletin of the World Health Organization, 2001, 79:394-399.

Voir page 398 le resume en francais. En la pagina 399 figura un resumen en espanol.

Introduction

Malaria is a public health problem in more than 90 countries inhabited by 40% of the world's population. It is responsible for up to 500 million clinical episodes and 2.7 million deaths a year, predominantly among young children in sub-Saharan Africa (1). In tropical Africa the total cost of malaria in terms of health care, treatment and lost productivity is estimated to be over US$ 1800 million a year (2). In Ghana, malaria is the principal cause of lost days of healthy life (3). Chloroquine is still effective against the disease and remains the first-line drug of choice for treatment (4).

As in many other countries of sub-Saharan Africa, Ghana has a decentralization policy allowing districts to decide how to organize their health services. Vertical programmes no longer exist and districts are required to provide integrated health care. District health management teams are expected to plan and implement health services on the basis of perceived needs and to explore financing mechanisms with a view to supplementing the resources received from central government. They also have to explore innovations and carry out operational research in order to ensure that the services are acceptable and affordable to the people (5).

In 1995 a meeting of district officers in Ghana considered the problems posed by malaria. The officers each undertook preliminary situation analyses of the status of malaria and its control, and it emerged that the cost of treatment to patients was high, largely because of the dispensing of excessive volumes of chloroquine and the prescribing of chloroquine injections for uncomplicated malaria. Attention was also drawn to long waiting times at dispensaries and poor compliance with recommended treatment regimens (6). The district health management teams decided to implement their own interventions with a view to improving matters. The present paper describes a study conducted in Wenchi District, which was designed primarily to assess the effect of prepackaging antimalarials on compliance. It also examined the efficiency of malarial management at the facility level, costs to patients, waiting times and acceptance by district health staff. Approval for the study was given by the Ethics Committee of the Ministry of Health through its Health Research Unit, and by the Brong Ahafo Regional Health Administration and the Wenchi District Assembly. …

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