Effects of daily chlorpromazine administration on behavioural and physiological parameters in the rat.

Chlorpromazine is a classical neuroleptic drug which produces both therapeutic effects as well as unwanted side effects in human such as sedation, autonomic, endocrine and neurological effects. It is thought that blockade of dopamine D-2 receptors caused by chlorpromazine induces these untoward side effects. Pre-clinical studies on catalepsy has been proposed as an animal model for neuroleptic induced extrapyramidal side effects. The drug also blocks certain stereotypic behaviours in animals induced by dopamine agonists such as apomorphine and amphetamine. These stereotypic behaviours are circling, chewing, rearing, grooming and hyperactivity. Daily administration of chlorpromazine (1, 3 and 10 mg/kg, i.p) to rats for 21 days induced catalepsy, tolerance to catalepsy and locomotor sensitization following PCP (10 mg/kg, i.p) challenge. These results suggest that daily chlorpromazine treatment induced DA/NMDA-receptor sensitization to total locomotor activity following PCP challenge. Furthermore, there were no changes in other behavioural parameters assessed. Surprisingly daily chlorpromazine administration in rats also produced no changes in other physiological parameters assessed (body weight, food and water intake).

Assessing the performance, practices and roles of drug sellers/dispensers and mothers'/guardians' behaviour for common childhood conditions in Kibaha district, Tanzania.

In most third world countries, self-medication is common and pharmacies, drug stores and drug shops are important providers of health advice and inexpensive medicines. We used exit interviews to assess drug sellers'/dispensers' roles and consumers' behaviour in Kibaha district, Coast region, Tanzania. Exit interviews with mothers/guardians reported the following childhood conditions treated with or without prescriptions at drug shops: respiratory infections (34%), fever (21%), a combination of diarrhoea, acute respiratory infection (ARI) and fever (14%), diarrhoea alone (13%) and other conditions (17%). The majority of drug sellers/dispensers prescribed or dispensed branded drugs (85%) for most mothers/guardians who visited these drug shops. In addition, antibiotics in total were prescribed for 31% of the mothers/guardians. Of the antibiotics dispensed, 38% were not prescribed by clinicians. In total, oral rehydration salts (ORSs) (3%), antimalarials (sulphadoxine/pyrimethamine) (24%) and antipyretics (11%), were prescribed in 20% but were bought by only 9%; multivitamins (6%), cough mixtures (4%) and other drugs (2%) (antihelminthics, benzylbenzoate emulsions, ear and eye drops) were also purchased from these facilities. Of the diarrhoea case histories presented by simulated clients at the drug shops, only 35% of the bloody diarrhoea scenarios were accurately diagnosed for getting antibiotics as compared with 44% for watery diarrhoea for which the use of antibiotics were wrongly advised (P<0.01). Furthermore, drug sellers/dispensers in these drug shops recommended use of ORS less frequently (3%) for a combination of diarrhoea, ARI and fever, and 2% for ARI alone than for watery (29%) and bloody diarrhoea (32%), respectively, for children under five years of age (P<0.001). Antimicrobial agents were advised for ARI (38%), watery diarrhoea (44%) and bloody diarrhoea (35%), respectively, with no significant difference among the three common childhood conditions. Antipyretics were advised in almost all childhood conditions but were least in watery (2%) and bloody diarrhoea (4%). This study demonstrates that antibiotics are overused in both the urban and rural settings of Kibaha district and that this is due to both clinicians'and drug sellers'prescribing practices in public and private facilities. The use of branded drugs was more common than that of generic drugs in private pharmacies, drug stores and ordinary shops. It is hereby proposed that any intervention should focus on training both facilities in the district on selectively prescribing and rational use of antibiotics for ARI and diarrhoea, and also to prescribe and dispense generic drugs so that it costs patients less when they buy drugs in shops. There is a need to increase awareness in recommending the use of ORS for clients to manage watery and bloody diarrhoea, and ARI in children under five years of age.

Assessing the Impact of Educational Intervention for Improving Management of Malaria and Other Childhood Illness in Kabaha District Tanzania

Objective: The study was carried out to evaluate short term effects of one to one educational intervention approach; conducted with 40 drug sellers in order to improve the private sector's practices; compliance and performance in using the national treatment guidelines for malaria and other common childhood (diarrhoea; acute respiratory tract infection-ARI) illnesses in Kibaha district-Tanzania. Methods: The training took place one month after baseline data collection. Data collection was undertaken eight months after training and the effects of training was evaluated. The 40 drug stores were divided into 20 intervention and 20 control facilities. Trained nurses were used as clients who posed as caretakers of sick under-five children needing medication. The drug dispensers/sellers knowledge of anti-malarials and other drugs and their dispensing practices was assessed. Results: The intervention seemed to have had a significant impact on knowledge pattern for prescribing and dispensing practices of drug stores for some common childhood illnesses but not in other control drug stores/shops. About 90 (n = 18) of shops prescribed to clients; the approved first-line anti-malarial drug for uncomplicated malaria (sulfadoxine-pyrimethamine); as compared to only 55 (n = 11) of the control shops. Conclusion: Changing the private sectors' knowledge; behaviour and practices/performance may be a slow and difficult process. The intervention approach applied in this study seems to be feasible at district-level. This strategy can be applied in all districts of Tanzania with the aim of achieving significant improvements in knowledge; behaviour; compliance; improving performance and practices of drug sellers in drug stores/shops. However; other alternative strategies are needed to influence drug sellers'/dispensers' compliance and performance. Thus; the overall impact on performance and practices in these facilities will remain at moderate level for quite sometime unless national policies; other programs and stakeholders are involved actively

Self-medication with chloroquine in a rural district of Tanzania: a therapeutic challenge for any future malaria treatment policy change in the country.

BACKGROUND: Malaria continues to be a leading cause of morbidity and mortality in children aged 5 years or younger in Tanzania. Children who develop mild disease can rapidly progress to severe malaria (cerebral malaria with convulsions) and even death, because of mismanagement, delays and inappropriate drug therapy in the remote areas where primary health care facilities are inaccessible or unavailable. The threat is particularly severe in those who are unable to take oral medications. OBJECTIVE: To identify treatment strategies adopted by mothers or guardians of children under five for malaria. METHOD: A cross-sectional descriptive study using a questionnaire and blood sampling was carried in Kibaha district primary health care facilities. Over 500 mothers/guardians of sick children aged up to 5 years who visited the public facilities seeking care were interviewed in order to assess what management they offered to their sick children in their homes prior to coming to the public health facilities. RESULTS: Seventy-four per cent of the mothers/guardians stated that they had given some medication to their children prior to visiting the public health facilities: mostly analgesics (asprin, paracetamol) and chloroquine. Eighty-five per cent of the sick children given chloroquine had whole blood chloroquine levels above 500 nmol/L and 33% of the sick children with whole blood chloroquine levels above 1,000 nmol/L had malaria parasites in their blood. Of the sick children given chloroquine at the health facilities, 63% had no malaria parasites in their blood. CONCLUSION: There is a need to educate both rural communities, and health care providers about rational prescribing, dispensing and use of antimalarials.

Assessing prescribing practice in church-owned primary healthcare (PHC) institutions in Tanzania: a pilot study.

A retrospective survey of prescribing patterns in 10 church-owned primary healthcare (PHC) institutions in Dar es Salaam region, Tanzania, was carried out by trained research assistants in order to assess the prescribing practices of healthcare providers in these institutions. From a total of 15,000 prescriptions, 600 were recorded randomly from patient registers retrospectively. This work was carried out between April to September 1996. Each prescription was recorded using World Health Organization Action Programme on Essential Drugs (WHO/DAP) forms and analysed manually. The average number of drugs per prescription was 2.9; the percentage encounters for injections and antibiotics was 38 and 71, respectively. Ninety-four per cent of all drugs were prescribed according to the essential drug list of Tanzania.

Local understanding, perceptions and reported practices of mothers/guardians and health workers on childhood malaria in a Tanzanian district--implications for malaria control.

Knowledge on local understanding, perceptions and practices of care providers regarding management of childhood malaria are needed for better malaria control in urban, peri-urban and rural communities. Mothers of under five children attending five purposively selected public health facilities in the Kibaha district, Tanzania, were invited to participate in 10 focus group discussions (FGDs). The health workers of these facilities were included in six other FGDs to elicit their professional views. Analysis was done using interpretative and qualitative approaches. Both health workers and all mothers were clear about the signs and symptoms of homa ya malaria, a description consistent with the biomedical definition of mild malaria. Although most of the mothers related this to mosquito bites, some did not. Mothers also described a severe childhood illness called degedege, consistent with convulsions. Most of the mothers failed to associate this condition with malaria, believing it is caused by evil spirits. Urinating on or fuming the child suffering from degedege with elephant dung were perceived to be effective remedies while injections were considered fatal for such condition. Traditional healers were seen as the primary source of treatment outside homes for this condition and grandmothers and mother in-laws are the key decision makers in the management. Our findings revealed major gaps in managing severe malaria in the study communities. Interventions addressing these gaps and targeting mothers/guardians, mother in-laws, grandmothers and traditional healers are needed.