Saving Lives, Buying Time Economics of Malaria Drugs in an Age of Resistance (2004) / Chapter Skim
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11 Maximizing the Effective Use of Antimalarial Drugs
11 Maximizing the Effective Use of Antimalarial Drugs
Pages 312-328
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From page 312... ...
Even the most highly efficacious treatment, if not used correctly, can fail to cure the illness, and may facilitate the development of drug resistance. In real life, many human factors thwart access and use of curative medications in resource-poor settings, including traditional beliefs, illiteracy, mistrust and fatalistic attitudes.
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. This chapter reviews specific barriers to access and use of antimalarial drugs in falciparum-endemic areas, as well as promising strategies to enhance appropriate drug use in the future.
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From page 314... ...
This more holistic view of malaria therapy, i.e., one that takes into account all of the factors that determine treatment success in practice, underlies the concept of "programmatic effectiveness." Programmatic effectiveness recognizes that even the most highly efficacious treatment, if not used correctly, can fail to cure the illness, and possibly contribute to the development of resistance. In one of the few studies that have tried to measure programmatic effective ness of malaria therapy, the authors identified a series of 7 critical factors leading to successful treatment (Krause and Sauerborn, 2000)
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From page 315... ...
Even when drugs are free through public-sector sources, they are not necessarily accessible. Patients and their families may seek malaria treatment outside the public sector because private outlets are easier to reach, and their products are perceived to be of higher quality.
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A recent qualitative study among urban and rural women in western Uganda found prepacked, unit-dosed malaria treatment for children widely accepted by mothers (Kilian et al., 2003)
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. These findings validate consumers' concerns about antimalarial drug quality in many malaria-endemic countries.
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From page 318... ...
Close-to-Home Treatment At the Abuja Summit in April 2000, African heads of state agreed that, by 2005, 60 percent of malaria sufferers should have prompt access to affordable, appropriate treatment within 24 hours of the onset of symptoms (WHO, 2000)
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From page 319... ...
. In addition, presumptive treatment of febrile episodes at home is likely to result in overuse of antimalarial drugs and the attendant risk of escalating drug resistance.
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From page 320... ...
The Tanzanian health service responded by creating health education messages to counter the belief that SP is ineffective because it lacks chloroquine's immediate antipyretic plus anti-inflammatory effects. Other messages in Tanzania and elsewhere have focused on malaria's symptoms and complications, correct dosing of antimalarial drugs, the use of oral versus injectable antimalarials, and persistent or recurrent symptoms following treatment (Ruebush et al., 1995; Foster, 1995)
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From page 321... ...
The authors argue for an increased awareness of the sociocultural context of antimalarial drug use when designing educational programs for health providers and patients. Targeting Family Decision Makers and Traditional Healers Understanding local knowledge, perceptions, and practices of malaria management has become an increasing focus of research during the last decade.
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From page 322... ...
Educating traditional healers about febrile convulsions and severe malaria is a particularly important means of rerouting children with seizures and impaired consciousness to effective antimalarials. Another ethnographic study conducted in Tanzania found parents and traditional healers unanimous in their belief that febrile seizures require traditional treatments, at least initially, and that these treatments are effective (Makemba et al., 1996)
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Similarly, school health education can have a significant yield in terms of community-wide understanding of malaria control and treatment. It has been suggested that school-based teaching of medicine could start
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. IPTi is a new program for infants designed to reduce malaria-related morbidity and mortality by the use of periodic antimalarial treatment doses of antimalarial drugs during infancy.
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1989. Home treatment of febrile children with antimalarial drugs in Togo.
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1999. Changing home treatment of childhood fevers by training shop keepers in rural Kenya.
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From page 327... ...
Use of antimalarial drugs for children's fevers in district medical units, drug shops and homes in eastern Uganda. Tropical Medicine and International Health 7(4)
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2003. Early treatment of childhood fevers with pre-packaged antimalarial drugs in the home reduces severe ma laria morbidity in Burkina Faso.
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