RESUMO
BACKGROUND: Nigeria accounts for substantial proportions of global malaria infections and deaths, with children aged younger than 5 years being the most affected group. This suggests that access to lifesaving malaria interventions could be suboptimal, especially at public health facilities where most rural dwellers seek health care. We conducted this study to ascertain if public health facilities have the commodities and the robust supply chain management (SCM) system required to deliver malaria interventions to children younger than 5 years. METHOD: We conducted a cross-sectional survey in 1,858 health facilities across 7 states in Nigeria. Using structured questionnaires, we assessed the availability of selected malaria commodities required by children aged younger than 5 years. We also interviewed health workers to evaluate other core SCM activities. RESULT: More than 50% of health facilities in 5 states were stocked out of malaria rapid diagnostic tests (mRDTs), and stock-out rates for artemisinin-based combination therapies (ACTs) were over 50% for almost all assessed ACTs across all states. The percentage of health facilities that received malaria commodities within the recommended lead time was below average across most states (71%). States with a higher percentage of health workers who were aware of and placed orders following the national reporting timeline and those that delivered commodities to the last mile predominantly through third-party logistics service providers tended to have higher availability of mRDTs and artemether/lumefantrine combinations. The top 2 logistics challenges were insecurity and inadequate funding. CONCLUSION: The availability of lifesaving malaria commodities across the health facilities visited was suboptimal, possibly due to several SCM challenges. The results from this study underscore the urgent need to implement effective interventions to address the observed gaps. This will contribute to reducing malaria morbidity and mortality among children aged younger than 5 years in Nigeria.
Assuntos
Antimaláricos , Artemisininas , Malária , Setor Público , Humanos , Nigéria , Malária/tratamento farmacológico , Estudos Transversais , Antimaláricos/uso terapêutico , Antimaláricos/provisão & distribuição , Pré-Escolar , Artemisininas/provisão & distribuição , Artemisininas/uso terapêutico , Lactente , Acessibilidade aos Serviços de Saúde , Instalações de Saúde , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: The dispensation of medicines in some low- and middle-income countries is often carried out by private vendors operating under constrained conditions. The aim of this study was to understand the challenges reported by employees of dispensaries, specifically, chemical and herbal shops and pharmacies in Accra, Ghana. Our objectives were twofold: (1) to assess challenges faced by medicine vendors related to dispensing antimicrobials (antibiotic and antimalarial medications), and (2) to identify opportunities for improving their stewardship of antimicrobials. METHODS: Data were collected in 79 dispensaries throughout Accra, in 2021, using a survey questionnaire. We used open-ended questions, grounded on an adapted socioecological model of public health, to analyze these data and determine challenges faced by respondents. RESULTS: We identified multiple, interlocking challenges faced by medicine vendors. Many of these relate to challenges of antimicrobial stewardship (following evidence-based practices when dispensing medicines). Overall, medicine vendors frequently reported challenges at the Customer and Community levels. These included strained interactions with customers and the prohibitive costs of medications. The consequences of these challenges reverberated and manifested through all levels of the socioecological model of public health (Entity, Customer, Community, Global). DISCUSSION: The safe and effective distribution of medications was truncated by strained interactions, often related to the cost of medicines and gaps in knowledge. While addressing these challenges requires multifaceted approaches, we identified several areas that, if intervened upon, could unlock the great potential of antimicrobal stewardship. The effective and efficient implementation of key interventions could facilitate efforts spearheaded by medicine vendors and leverage the benefits of their role as health educators and service providers. CONCLUSION: Addressing barriers faced by medicine vendors would provide an opportunity to significantly improve the provision of medications, and ultimately population health. Such efforts will likely expand access to populations who may otherwise be unable to access medications and treatment in formal institutions of care such as hospitals. Our findings also highlight the broad range of care provided by shopkeepers and vendors at dispensaries. These findings suggest that the meaningful engagement of dispensaries as valued conduits of community health is a promising pathway for interventions aiming to improve antimicrobial stewardship.
Assuntos
Farmácias , Gana , Humanos , Farmácias/economia , Inquéritos e Questionários , Gestão de Antimicrobianos/economia , Anti-Infecciosos/uso terapêutico , Anti-Infecciosos/economia , Comércio , Antibacterianos/uso terapêutico , Antibacterianos/economia , Antibacterianos/provisão & distribuição , Antimaláricos/uso terapêutico , Antimaláricos/economia , Antimaláricos/provisão & distribuição , Saúde PúblicaRESUMO
BACKGROUND: Malaria treatment is faced with the challenge of access, affordability, availability, and quality of antimalarial medicines. Affordable medicines facility-malaria (AMFm) program and subsequently Co-payment mechanism were developed to help increase access to quality assured Artemisinin-based combination therapies (ACTs) in seven countries in sub-Saharan Africa. We explored through a qualitative study, experience of healthcare personnel on Co-payment mechanism and the implication on its use in private drug outlets in Uganda. METHOD: Private drug outlets that reported stocking antimalarial agents in moderate-to-high and low malaria transmission settings were purposively selected for inclusion in the study. In each drug outlet, data was collected from a pharmacist/dispenser through key informant interview. The interview was done using a key informant interview guide which covered the following areas, (i) sociodemographic characteristics, ii) awareness of healthcare personnel on the co-payment mechanism, (iii) awareness of healthcare personnel on quality assured artemisinin combination therapies (QAACT), (iv) antimalarial stocking in private drug outlets, (v) antimalarial dispensing prices, (vi) considerations made while stocking, and pricing antimalarial agents, vii) challenges in antimalarial dispensing, and (viii) access to antimalarial agents in private drug outlets. Data was managed using Atlas.ti and analyzed using framework methodology. RESULTS: Data was collected from 25 key informants (12 pharmacists and 13 dispensers). Five themes emerged following data analysis, (i) antimalarial stocking influenced by price and client demand, (ii) access and purchasing behavior of drug outlet clients, (iii) basis of dispensing antimalarial agents in private drug outlets, (iv) awareness of QAACT, and (v) awareness of Co-payment mechanism. None of the study participants was aware of the existence of Co-payment mechanism and QAACT in the private sector. Duocotecin brand of ACTs was the most mentioned and dispensed ACT among the study participants in private drug outlets. Nearly all the pharmacists/dispensers said that many clients who request to purchase ACTs don't come with a prescription and prefer buying cheaper antimalarial agents. Study participants reported stocking and selling both ACTs and non-ACT antimalarial agents in the drug outlets. Pharmacists/dispensers in the drug outlets reported that most clients could not afford buying a full dose of an ACT. None of the study participants considered using Co-payment mechanism while stocking ACTs in the drug outlets. CONCLUSION: There is lack of awareness and utilization of Co-payment mechanism in stocking, pricing, and dispensing of ACTs among pharmacists/dispensers in private drug outlets in Uganda. The antimalarial dispensing in drug outlets was mostly based on prescriptions, clients' preferences, and medicine affordability. The Ministry of Health needs to create demand for Co-payment mechanism through public awareness campaigns, training of healthcare personnel and behavior change communication in the private sector.
Assuntos
Antimaláricos , Pessoal de Saúde , Malária , Uganda , Humanos , Antimaláricos/economia , Antimaláricos/provisão & distribuição , Antimaláricos/uso terapêutico , Malária/tratamento farmacológico , Malária/economia , Pessoal de Saúde/economia , Artemisininas/economia , Artemisininas/provisão & distribuição , Setor Privado/economia , Feminino , Acessibilidade aos Serviços de Saúde/economia , MasculinoRESUMO
BACKGROUND: The World Health Organization (WHO) recommends prompt malaria diagnosis with either microscopy or malaria rapid diagnostic tests (RDTs) and treatment with an effective anti-malarial, as key interventions to control malaria. However, in sub-Saharan Africa, malaria diagnosis is still often influenced by clinical symptoms, with patients and care providers often interpreting all fevers as malaria. The Ministry of Health in Uganda defines suspected malaria cases as those with a fever. A target of conducting testing for at least 75% of those suspected to have malaria was established by the National Malaria Reduction Strategic Plan 2014-2020. METHODS: This study investigated factors that affect malaria testing at health facilities in Uganda using data collected in March/April 2017 in a cross-sectional survey of health facilities from the 52 districts that are supported by the US President's Malaria Initiative (PMI). The study assessed health facility capacity to provide quality malaria care and treatment. Data were collected from all 1085 public and private health facilities in the 52 districts. Factors assessed included supportive supervision, availability of malaria management guidelines, laboratory infrastructure, and training health workers in the use of malaria rapid diagnostic test (RDT). Survey data were matched with routinely collected health facility malaria data obtained from the district health information system Version-2 (DHIS2). Associations between testing at least 75% of suspect malaria cases with several factors were examined using multivariate logistic regression. RESULTS: Key malaria commodities were widely available; 92% and 85% of the health facilities reported availability of RDTs and artemether-lumefantrine, respectively. Overall, 933 (86%) of the facilities tested over 75% of patients suspected to have malaria. Predictors of meeting the testing target were: supervision in the last 6 months (OR: 1.72, 95% CI 1.04-2.85) and a health facility having at least one health worker trained in the use of RDTs (OR: 1.62, 95% CI 1.04-2.55). CONCLUSION: The study findings underscore the need for malaria control programmes to provide regular supportive supervision to health facilities and train health workers in the use of RDTs.
Assuntos
Antimaláricos/provisão & distribuição , Combinação Arteméter e Lumefantrina/provisão & distribuição , Testes Diagnósticos de Rotina/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Malária/diagnóstico , Estudos Transversais , Humanos , UgandaRESUMO
Since the announcement of the coronavirus disease (COVID-19) pandemic in January 30th 2020, 68 countries reported to the World Health Organization that they were experiencing disruptions in malaria diagnosis and treatment. This situation had the potential to lead to delays in diagnosis and treatment, which could result in an increase in severe cases and deaths. This analysis was based on findings from a field visit, carried out between June 30th and July 1st, 2020, to a warehouse, to two health facilities, and a meeting with a community health worker, and an descriptive epidemiologic data analysis of health information system (HIS) to evaluate trends of the number of people tested for malaria and number of malaria cases reported, by comparing data from 2018, 2019 and 2020 for the period between January and May. The two health facilities and the warehouse had about two months of stock of antimalarial drugs, and patients with malaria symptoms were being tested for malaria at the COVID-19 screening site. The HIS data showed that the number of reported malaria cases decreased by 3.0% (177.646/172.246) in April, and 7.0% (173.188/161.812) in May, when comparing 2019 and 2020 data. People tested for malaria in community increased by 39.0% (190.370/264.730), between 2019 and 2020. The COVID-19 may have had a negative impact on the diagnosis and treatment of malaria in health facility (HF). The decrease in people tested for malaria in the health facilities may have overwhelmed the activities of the community.
Assuntos
COVID-19 , Malária/epidemiologia , Vigilância da População/métodos , Antimaláricos/administração & dosagem , Antimaláricos/provisão & distribuição , Humanos , Malária/diagnóstico , Malária/tratamento farmacológico , Programas de Rastreamento/métodos , Moçambique/epidemiologiaRESUMO
The COVID-19 pandemic has brought concurrent challenges. The increased incidence of fake and falsified product distribution is one of these problems with tremendous impact, especially in low- and middle-income countries. Up to a tenth of medicines including antibiotics and antimalarial drugs in the African market are considered falsified. Pandemics make this worse by creating an ecosystem of confusion, distraction, and vulnerability stemming from the pandemic as health systems become more stressed and the workload of individuals increased. These environments create opportunities for substandard and falsified medicines to be more easily introduced into the marketplace by unscrupulous operators. In this work we discuss some of the challenges with fake or falsified product distribution in the context of COVID-19 and proposed strategies to best manage this problem.
Assuntos
Benchmarking/legislação & jurisprudência , Betacoronavirus/patogenicidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Medicamentos Falsificados/provisão & distribuição , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , África/epidemiologia , Antibacterianos/provisão & distribuição , Antimaláricos/provisão & distribuição , Antivirais/provisão & distribuição , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Medicamentos Falsificados/análise , Regulamentação Governamental , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Saúde Pública/ética , SARS-CoV-2RESUMO
BACKGROUND: Many countries are striving to become malaria-free, but global reduction in case estimates has stagnated in recent years. Substandard and falsified medicines may contribute to this lack of progress. Zambia aims to eliminate their annual burden of 1.2 million pediatric malaria cases and 2500 child deaths due to malaria. We examined the health and economic impact of poor-quality antimalarials in Zambia. METHODS: An agent-based model, Substandard and Falsified Antimalarial Research Impact (SAFARI), was modified and applied to Zambia. The model was developed to simulate population characteristics, malaria incidence, patient care-seeking, disease progression, treatment outcomes, and associated costs of malaria for children under age five. Zambia-specific demographic, epidemiological, and cost inputs were extracted from the literature. Simulations were run to estimate the health and economic impact of poor-quality antimalarials, the effect of potential artemisinin resistance, and six additional malaria focused policy interventions. RESULTS: We simulated annual malaria cases among Zambian children under five. At baseline, we found 2610 deaths resulting in $141.5 million in annual economic burden of malaria. We estimated that elimination of substandard and falsified antimalarials would result in an 8.1% (n = 213) reduction in under-five deaths, prevent 937 hospitalizations, and realize $8.5 million in economic savings, annually. Potential artemisinin resistance could further increase deaths by 6.3% (n = 166) and cost an additional $9.7 million every year. CONCLUSIONS: Eliminating substandard and falsified antimalarials is an important step towards a malaria-free Zambia. Beyond the dissemination of insecticide-treated bed nets, indoor residual spraying, and other malaria control measures, attention must also be paid to assure the quality of antimalarial treatments.
Assuntos
Antimaláricos/normas , Antimaláricos/uso terapêutico , Medicamentos Falsificados/provisão & distribuição , Malária/tratamento farmacológico , Malária/epidemiologia , Antimaláricos/provisão & distribuição , Artemisininas , Criança , Pré-Escolar , Simulação por Computador , Medicamentos Falsificados/economia , Humanos , Renda , Lactente , Malária/mortalidade , Modelos Econômicos , Modelos Teóricos , Aceitação pelo Paciente de Cuidados de Saúde , ZâmbiaRESUMO
BACKGROUND: Support supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for Class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers. Without support supervision, inappropriate treatment of malaria, pneumonia and diarrhoea among children under 5 years of age continues unabated. This study assessed experiences of drug sellers and peer supervisors at the end of a peer supervision intervention in Luuka District in East Central Uganda. METHODS: Eight in-depth interviews (IDIs) were held with peer supervisors while five focus group discussions (FGDs) were conducted among registered drug sellers at the end of the peer supervision intervention. The study assessed experiences and challenges of peer supervisors and drug sellers regarding peer supervision. Transcripts were imported into Atlas.ti 7 qualitative data management software where they were analysed using thematic content analysis. RESULTS: Initially, peer supervisors were disliked and regarded by drug sellers as another extension of drug inspectors. However, with time a good relationship was established between drug sellers and peer supervisors leading to regular, predictable and supportive peer supervision. This increased confidence of drug sellers in using respiratory timers and rapid diagnostic tests in diagnosing pneumonia symptoms and uncomplicated malaria, respectively, among children under 5 years. There was also an improvement in completing the sick child register which was used for self-assessment by drug sellers. The drug shop association was mentioned as a place where peer supervision should be anchored since it was a one-stop centre for sharing experiences and continuous professional development. Drug sellers proposed including community health workers in monthly drug shop association meetings so that they may also gain from the associated benefits. Untimely completion of the sick child registers by drug sellers and inadequate financial resources were the main peer supervision challenges mentioned. CONCLUSION: Drug sellers benefitted from peer supervision by developing a good relationship with peer supervisors. This relationship guaranteed reliable and predictable supervision ultimately leading to improved treatment practices. There is need to explore the minimum resources needed for peer supervision of drug sellers to further inform practice and policy.
Assuntos
Antimaláricos/provisão & distribuição , Agentes Comunitários de Saúde/estatística & dados numéricos , Testes Diagnósticos de Rotina/estatística & dados numéricos , Preparações Farmacêuticas/provisão & distribuição , Farmácias/organização & administração , Grupos Focais , Preparações Farmacêuticas/normas , População Rural , UgandaAssuntos
Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Hidroxicloroquina/provisão & distribuição , Pandemias , Pneumonia Viral/tratamento farmacológico , Dermatopatias/epidemiologia , Antimaláricos/provisão & distribuição , COVID-19 , Comorbidade , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Dermatopatias/tratamento farmacológico , Tratamento Farmacológico da COVID-19Assuntos
Antimaláricos/efeitos adversos , Cloroquina/efeitos adversos , Infecções por Coronavirus/tratamento farmacológico , Aprovação de Drogas/legislação & jurisprudência , Hidroxicloroquina/efeitos adversos , Pneumonia Viral/tratamento farmacológico , Antimaláricos/provisão & distribuição , Antimaláricos/uso terapêutico , Betacoronavirus , COVID-19 , Cloroquina/provisão & distribuição , Cloroquina/uso terapêutico , Infecções por Coronavirus/epidemiologia , Aprovação de Drogas/organização & administração , União Europeia , Humanos , Hidroxicloroquina/provisão & distribuição , Hidroxicloroquina/uso terapêutico , Pandemias/legislação & jurisprudência , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Estados Unidos/epidemiologiaRESUMO
Effective case management is central for malaria control, but not all of those affected by malaria have access to prompt, effective treatment. In Kenya, free malaria treatment has been implemented since 2006. However, questions remain regarding effective treatment. We conducted cross-sectional epidemiological and questionnaire surveys in four counties in western Kenya in 2004, 2010, and 2016, and antimalarial availability surveys in 2016. We found a significant decline in self-reported malaria cases and an improvement in knowledge of malaria prevention and treatment since 2004. Parasite prevalence declined significantly from 2004 to 2010; however, it has remained unchanged since then. Artemisinin-based combination therapies (ACTs) and sulfadoxine-pyrimethamine (SP) drugs were widely available everywhere. The proportion of ACT usage increased from none in 2004 to 48% and 69%, respectively, in 2010 and 2016, whereas SP drug usage declined from 88% in 2004 to 39% in 2010 and 27% in 2016. During the 2016 survey, non-intermittent preventive treatment in pregnancy use of SP was common (20.9% of all surveyed individual treatments). In 2004, 27.2% (168/617) of households sought hospital treatment alone, and this number increased to 50.6% in 2016. The key factors affecting treatment-seeking behavior were education level, wealth index, household size, and distance to hospitals. Our results indicated that gaps in malaria case management remain and out-of-policy treatment is still a concern.
Assuntos
Antimaláricos/provisão & distribuição , Antimaláricos/uso terapêutico , Malária/epidemiologia , Malária/prevenção & controle , Controle de Mosquitos/métodos , Adolescente , Criança , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Mosquiteiros Tratados com Inseticida , Quênia/epidemiologia , Gravidez , Complicações Parasitárias na Gravidez/prevenção & controle , Fatores de TempoRESUMO
OBJECTIVE: To determine whether the administration of rectal artesunate by trained community health volunteers before referral to a health-care facility reduces the case fatality rate of severe malaria in young children in hard-to-reach communities in Zambia. METHODS: We implemented a pilot project in Serenje District between July 2017 and July 2018. The project involved: (i) training community health volunteers to administer rectal artesunate to children with suspected severe malaria and refer them to a health facility; (ii) ensuring emergency transport with bicycle ambulances was available; (iii) ensuring adequate drug supplies; and (iv) ensuring health-care workers could treat severe malaria with injectable artesunate. Surveys of health facilities, volunteers and bicycle ambulance riders were performed near the beginning and end of the intervention period. In addition, data on severe malaria cases and associated deaths were obtained from health facilities and a community monitoring system. FINDINGS: In the year before the intervention, 18 deaths occurred in 224 cases of confirmed severe malaria among children younger than 5 years seen at intervention health facilities (case fatality rate: 8%); during the intervention, 3 of 619 comparable children with severe malaria died (case fatality rate: 0.5%). CONCLUSION: The administration of pre-referral rectal artesunate treatment to young children with severe malaria by community health volunteers was feasible, safe and effective in hard-to-reach communities in Zambia and was associated with a substantial decrease in the case fatality rate. The project's approach is highly adaptable and could be used in other countries with a high malaria burden.
Assuntos
Antimaláricos/uso terapêutico , Artesunato/uso terapêutico , Agentes Comunitários de Saúde/organização & administração , Malária/tratamento farmacológico , Administração Retal , Antimaláricos/administração & dosagem , Antimaláricos/provisão & distribuição , Artesunato/administração & dosagem , Artesunato/provisão & distribuição , Pré-Escolar , Agentes Comunitários de Saúde/educação , Estudos Transversais , Humanos , Lactente , Área Carente de Assistência Médica , Projetos Piloto , Índice de Gravidade de Doença , Meios de Transporte , ZâmbiaRESUMO
Substandard and falsified medications are a major threat to public health, directly increasing the risk of treatment failure, antimicrobial resistance, morbidity, mortality and health expenditures. While antimalarial medicines are one of the most common to be of poor quality in low- and middle-income countries, their distributional impact has not been examined. This study assessed the health equity impact of substandard and falsified antimalarials among children under five in Uganda. Using a probabilistic agent-based model of paediatric malaria infection (Substandard and Falsified Antimalarial Research Impact, SAFARI model), we examine the present day distribution of the burden of poor-quality antimalarials by socio-economic status and urban/rural settings, and simulate supply chain, policy and patient education interventions. Patients incur US$26.1 million (7.8%) of the estimated total annual economic burden of substandard and falsified antimalarials, including $2.3 million (9.1%) in direct costs and $23.8 million (7.7%) in productivity losses due to early death. Poor-quality antimalarials annually cost $2.9 million to the government. The burden of the health and economic impact of malaria and poor-quality antimalarials predominantly rests on the poor (concentration index -0.28) and rural populations (98%). The number of deaths among the poorest wealth quintile due to substandard and falsified antimalarials was 12.7 times that of the wealthiest quintile, and the poor paid 12.1 times as much per person in out-of-pocket payments. Rural populations experienced 97.9% of the deaths due to poor-quality antimalarials, and paid 10.7 times as much annually in out-of-pocket expenses compared with urban populations. Our simulations demonstrated that interventions to improve medicine quality could have the greatest impact at reducing inequities, and improving adherence to antimalarials could have the largest economic impact. Substandard and falsified antimalarials have a significant health and economic impact, with greater burden of deaths, disability and costs on poor and rural populations, contributing to health inequities in Uganda.
Assuntos
Antimaláricos/economia , Antimaláricos/normas , Medicamentos Falsificados/uso terapêutico , Malária/tratamento farmacológico , Antimaláricos/provisão & distribuição , Pré-Escolar , Medicamentos Falsificados/economia , Gastos em Saúde , Humanos , Malária/economia , Malária/mortalidade , População Rural , Fatores Socioeconômicos , UgandaRESUMO
BACKGROUND: Tanzania adopted the revised World Health Organization policy in 2013 recommending a minimum of ≥3 doses of Intermittent Preventive Treatment during pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP) to protect against malaria. A study in Tanzania in 2014 reported low (9%) uptake. We investigated health workers knowledge about IPTp-SP and factors that influenced uptake of > 3 doses of IPTp-SP among pregnant women. METHODS: We conducted a cross-sectional study in 2017 among post-delivery women and health care workers from nine randomly-selected public health facilities in three Districts of Arusha Region. Probability proportional to size methodology was used to determine number of participants per facility. We used a structured questionnaire to collect socio-demographic and obstetric data, information on doses of SP received, and knowledge of SP for IPTp. Health care workers were interviewed about their knowledge for IPTp- SP and challenges encountered in its uptake and use. RESULTS: We interviewed 556 persons (median age 26 years, range 16-42 years) with the response rate of 99.3%. Of these, 484 (87.1%) had > 3 Antenatal Care (ANC) visits. A total of 402 (72.3%) were multigravida with 362 (65.1%) having given birth at least once. Of the 556 participants, 219 (39.4%) made their first ANC booking at < 17 weeks of pregnancy and 269 (48.4%) had received > 3 doses of SP-IPTp. Factors associated with uptake of > 3 doses of IPTp-SP included having secondary or higher education [Adjusted Odds Ratio (AOR) =1.6, 95%CI 1.1-2.4], attending ≥4 ANC visits [AOR = 3.1, 95%CI 2.1-4.6], having first antenatal booking at < 17 weeks [AOR = 1.8, 95%CI 1.4-2.3], and adequate knowledge on IPTp-SP [AOR = 2.7, 95%CI 1.9-3.9]. Among 36 health care workers interviewed, 29(80.6%) had adequate knowledge about IPTp-SP. SP was available in seven (87.5%) of the visited health facilities and was administered under Direct Observed Therapy (DOT) in six (75%) facilities. Health care workers reported that stock outs of SP was a challenge. CONCLUSIONS: Fewer than half of the women interviewed reported uptake of > 3 doses of IPTp-SP. That is below the Tanzania national target of 80%. Making > 4 ANC visits, having secondary or higher education, making an early first ANC visit and having adequate knowledge on IPTp-SP promoted uptake of > 3 doses. Further qualitative studies are needed to explore factors that might contribute to low uptake of SP.
Assuntos
Antimaláricos/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Complicações Parasitárias na Gravidez/prevenção & controle , Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Pirimetamina/administração & dosagem , Sulfadoxina/administração & dosagem , Adolescente , Adulto , Antimaláricos/provisão & distribuição , Estudos Transversais , Terapia Diretamente Observada/estatística & dados numéricos , Combinação de Medicamentos , Escolaridade , Feminino , Instalações de Saúde , Pessoal de Saúde/psicologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Primeiro Trimestre da Gravidez , Pirimetamina/provisão & distribuição , Sulfadoxina/provisão & distribuição , Inquéritos e Questionários , Tanzânia , Adulto JovemRESUMO
Malaria in pregnancy (MiP) contributes to devastating maternal and neonatal outcomes. Coverage of intermittent preventive treatment during pregnancy (IPTp) remains alarmingly low. Data was compiled from MiP programme reviews and performed a literature search on access to and determinants of IPTp. National malaria control and reproductive health (RH) policies may be discordant. Integration may improve coverage. Medication stock-outs are a persistent problem. Quality improvement programmes are often not standardized. Capacity building varies across countries. Community engagement efforts primarily focus on promotion of services. The majority of challenges can be addressed at country level to improve IPTp coverage.
Assuntos
Antimaláricos/uso terapêutico , Malária/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Complicações Parasitárias na Gravidez/prevenção & controle , Adolescente , Adulto , Antimaláricos/provisão & distribuição , Fortalecimento Institucional/estatística & dados numéricos , Controle de Doenças Transmissíveis/legislação & jurisprudência , Participação da Comunidade/estatística & dados numéricos , Feminino , Política de Saúde/legislação & jurisprudência , Humanos , Gravidez , Melhoria de Qualidade/estatística & dados numéricos , Saúde Reprodutiva/legislação & jurisprudência , Adulto JovemAssuntos
Antimaláricos/provisão & distribuição , Antimaláricos/uso terapêutico , Malária Falciparum/tratamento farmacológico , Quinidina/análogos & derivados , Artesunato/uso terapêutico , Aprovação de Drogas , Humanos , Malária Falciparum/diagnóstico , Masculino , Planejamento de Assistência ao Paciente , Quinidina/provisão & distribuição , Quinidina/uso terapêutico , Índice de Gravidade de Doença , Estados Unidos , United States Food and Drug Administration , Adulto JovemRESUMO
There is currently a hazardous debate between the rational use of antimalarial drugs based on artemisinin derivatives and the antimalarial efficacy of plant extracts of Artemisia spp. This article recall some fundamental rules guiding progresses in malaria treatment and use of artemisinin, with the aim to provide discussion elements to identify the safest place responding to health situations for drugs and phytotherapy.
Assuntos
Antimaláricos/farmacologia , Artemisia annua , Preparações de Plantas/farmacologia , Antimaláricos/provisão & distribuição , Acessibilidade aos Serviços de Saúde , Humanos , Preparações de Plantas/provisão & distribuição , Plantas MedicinaisAssuntos
Antimaláricos/provisão & distribuição , Artesunato/provisão & distribuição , Aprovação de Drogas , Malária Falciparum/tratamento farmacológico , Administração Intravenosa , Antimaláricos/uso terapêutico , Artesunato/uso terapêutico , Centers for Disease Control and Prevention, U.S./legislação & jurisprudência , Esquema de Medicação , Humanos , Malária Falciparum/epidemiologia , Quinidina/uso terapêutico , Quinina/uso terapêutico , Estados Unidos/epidemiologia , United States Food and Drug Administration/legislação & jurisprudênciaRESUMO
OBJECTIVE: To evaluate the effectiveness of a program of antimalarial interventions implemented in 2010-2013 in Niger State, Nigeria. DATA SOURCES: Utilization reports from 99 intervention and 51 non-intervention health facilities from the Niger State Malaria Elimination Program, supplemented by data on facility-level characteristics from the Niger State Primary Health Care Development Agency and Local Government Malaria Control units. STUDY DESIGN: Estimated with mixed-effects negative binomial modeling, a difference-in-differences method was used to quantify the impact of the program on the number of febrile illness cases and confirmed malaria cases. Potential confounding factors, non-stationarity, seasonality, and autocorrelation were explicitly accounted for. DATA EXTRACTION METHODS: Data were retrieved from hard copies of utilization reports and manually inputted to create a panel of 5550 facility-month observations. PRINCIPAL FINDINGS: The program was implemented in two phases. The first phase (August 2010-June 2012) involved the provision of free artemisinin-based combination therapies, long-lasting insecticidal nets, and intermittent preventive treatments. In the second phase (July 2012-March 2013), the program introduced an additional intervention: free parasite-based rapid diagnostic tests. Compared to the pre-intervention period, the average number of monthly febrile illness and malaria cases increased by 20.876 (P < 0.01) and 22.835 (P < 0.01) in the first phase, and by 19.007 (P < 0.05) and 19.681 (P < 0.05) in the second phase, respectively. The results are consistent across different evaluation methods. CONCLUSIONS: This study suggests that user-fee removal leads to increased utilization of antimalarial services. It motivates future studies to cautiously select their investigative methods.