Medicines use in children under 5 years primary care in developing and transitional countries Results from studies reported between 1990-2009 Kathleen.

Slides:



Advertisements
Similar presentations
UNDP RBA Workshop on MDG-Based National Development Strategies Module 4: Health Strategies UN Millennium Project February 27-March 3, 2006.
Advertisements

Chronic disease self management – a systematic review of proactive telephone applications Carly Muller Dean Schillinger Division of General Internal Medicine.
New Challenges in M&E Lets go. Scaling Up Monitoring & Evaluation Strategic Information PROGRAM GUIDANCE RESULT NEEDS OPPORTUNITIES Resources New directions.
Improving Use of Medicines - Where are we today? Kathleen A Holloway Regional Advisor Essential Drugs and Other Medicines World Health Organisation, South.
Yudatiningsih I.1,Sunartono H.1,SuryawatiS.2
RATIONAL USE OF INJECTION: An Integrated Tool For Monitoring Injection Prescription in the Kingdom of CAMBODIA Dr Sok Srun Department of Hospitals, MoH.
New Performance-Based Reward Strategy to Improve Pharmacy Practices, Financial Management, and Appropriate Medicines Use in the Public Sector in Uganda.
Presentation to the 2014 International AIDS Conference
QUASI-EXPERIMENTAL STUDY DESIGNS IN EVALUATING MEDICINES USE INTERVENTIONS 1 Lloyd Matowe 2 Craig Ramsay 1 Faculty of Pharmacy, Kuwait University 2 HSRU,
Medication among Children in Africa South of Sahara: Qualitative Systematic Review Professor Ebba Holme Hansen and Professor Susan R. Whyte
How can operational research be used to strengthen health information systems? PHIN Annual meeting Fiji June 7, 2013 Damian Hoy, Sione Hufanga, and Adam.
Monitoring and Evaluation: A Review of Terms. Goals To provide better treatment for people with tuberculosis in Country X To achieve a treatment success.
Active Pharmaceutical Management Strategies of Health Insurance Systems to Improve Cost-Effective Use of Medicines in Low- and Middle-Income Countries:
Drug and Therapeutics Committee Session 7A. Identifying Problems with Medicine Use: Indicator Studies.
Ministry of Health Syed Anwar Mahmood Federal Secretary (Health) Government of Pakistan Saving Children’s lives through Community based Interventions.
EDM STRATEGY FOR WORKING WITH COUNTRIES-TANZANIA Rose Shija EDM NPO TANZANIA.
Generating evidence for change: Implementing the post-ICIUM research agenda Dennis Ross-Degnan, ScD Harvard Medical School and Harvard Pilgrim Health Care.
Impact on prescribing patterns of a fee per drug unit versus a fee per drug item Kathleen Holloway 1, Karkee SB 2, Tamang AL 2, Gurung YB 2, Pradhan R.
WHO local pilot projects to contain AMR ICIUM 2004 K.A.Holloway and T.L.Sorensen Essential Drugs and Medicines Policy WHO Geneva.
Impact of a public education program on promoting rational use of medicines: a household survey in south district of Tehran, Darbooy SH, Hosseini.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 12 Undertaking Research for Specific Purposes.
MDG Needs Assessment Training Workshop May 9-12, 2005 Health Module.
Unit 10. Monitoring and evaluation
Cultivating Demand Within USAID for Impact Evaluations of Democracy and Governance Assistance Mark Billera USAID Office of Democracy and Governance Perspectives.
Surveillance of antimicrobial use in resource-constrained community settings Kathleen Holloway, Elizabeth Mathai and Andy Gray on behalf of on behalf of:
Experiences in Impact Evaluation: The PEMA Perspective.
Summary of ICIUM Chronic Care Track Prepared by: Ricardo Perez-Cuevas Veronika Wirtz David Beran.
WHAT CAN YOUR NURSING TEAM DO FOR YOU?. Over the last few years General Practice has changed. Nurses now undertake a more responsible role other than.
Margarit MELIKYAN Drug Utilization Research Group PO, Armenia, National Institute of Health Access to and Use of Medicines by Households in Armenia: Impact.
Problem Statement: In Kenya, despite the development of national standard treatment guidelines (STGs) for the management of acute respiratory infections.
Improving Uncomplicated Malaria Case Management by Drug Shops through Accreditation and Regulation AZIZ MAIJA, MSH.
Plymouth Health Community NICE Guidance Implementation Group Workshop Two: Debriding agents and specialist wound care clinics. Pressure ulcer risk assessment.
Gender and Access to Medicines in 15 Low- and Middle-Income Countries: Does Physician Prescribing for Men and Women Differ? Stephens, Peter (1); Ross-Degnan,
Promoting Drug and Therapeutics Committees in the Developing World
Impact of a NGO-supported supervisory programme on the quality of care in private shops in rural E.Nepal Kathleen Holloway Bharat Raj Gautam Britain Nepal.
Community Approaches to Child Health. Why Community Approaches? To reach unreached families To mobilize additional resources and partners (including communities.
Do Village Revolving Funds Improve Access and Rational Use of Drugs in Laos? Bigdeli M 1 Ketsouvannasane B 2 Shuey DA 1 1.WHO, Laos 2.Ministry of Health,
A BASELINE SURVEY OF THE PHARMACEUTICAL SECTOR IN TANZANIA
Promoting Rational Use of ARVs in HIV/AIDS Clinics in Tanzania Presented by Salama Mwakisu -MSH.
Intervention Strategy in Improving ART Adherence In Tanzania Salama Mwakisu-MSH, Dr D Sando-NACP, Dr R. Malele-MUHAS, Bernard Rabiel- NACP, Dr G. Somi-NACP,
HIV/AIDS Track Session. Key Points Application of international reference price list during a national tender is a valuable tool for achieving optimal.
Monitoring and Evaluation in MCH Programs and Projects MCH in Developing Countries Feb 24, 2009.
CAMBODIA EXPERIENCE ON MTP TO REDUCE INAPPROPRIATE MEDICINE USE IN HOSPITALS Sok Srun & Chroeng Sokhan Ministry of Health, Kingdom of Cambodia.
Multifaceted intervention to improve health worker adherence to Integrated Management of Childhood Illness (IMCI) guidelines in Benin* * Published in American.
A COMPARISON OF PRESCRIBING PRACTICES BETWEEN PUBLIC AND PRIVATE SECTOR PHYSICIANS IN UGANDA Obua C, Ogwal-Okeng JW, WaakoP, Aupont O, Ross-Degnan D International.
MONITORING MEDICINE AVAILABILITY AND PRICES IN UGANDA By Denis Kibira HEPS Uganda.
Indicators for monitoring and assessing pharmaceutical situation in countries Dr. Edelisa D. Carandang Drug Action Program (DAP) Essential Drugs and Medicines.
WHO, Dept. Essential Drugs and Medicines Policy Measuring use of medicines: progress in the last decade Kathleen Holloway and Verica Ivanovska Dept. Essential.
A Multifaceted Continuing Medical Education Intervention to Improve Primary Care Physicians’ Performance In Mexico Hortensia Reyes, Ricardo Perez-Cuevas,
Medicines use in primary care in developing and transitional countries Results from studies reported between Kathleen Holloway, Verica Ivanovska,
MONITORING THE PHARMACEUTICAL SECTOR IN A DEVELOPING COUNTRY - THE GHANA EXAMPLE Gyansa-Lutterodt M. 1,7, Andrews E 2, Arhinful D 3,7, Addo-Atuah J 4,7,
DOES DRUG USE EVALUATION (DUE) REQUIRED BY NATIONAL POLICY IMPROVE USE OF MEDICINES?
Summary of potential priority actions for CMWG Case Management Working Group Meeting 8-9 July 2009.
RECENT ADVANCES IN PROVISION OF PRIMARY HEALTH CARE BY MISSION ORGANIZATIONS THE EFFECT OF AN EDUCATIONAL INTERVENTION ON USE OF ANTIBIOTICS IN THE TREATMENT.
REDUCING ANTIBIOTIC OVERUSE for ARIs with SMALL- GROUP EDUCATIONAL INTERVENTION Munawaroh S 1, Sunartono H 2, Suryawati S 3 1 INRUD Yogya/Indonesia; 2.
Learning About Drug Use1 An Overview of the Process of Changing Drug Use 1. EXAMINE Measure Existing Practices (Descriptive Quantitative Studies) 2. DIAGNOSE.
SMALL GROUP DISCUSSION AMONG PARAMEDICS AT HEALTH CENTER LEVEL TO IMPROVE ADHERENCE TO STANDARD TREATMENT GUIDELINES OF ACUTE RESPIRATORY TRACT INFECTIONS.
CONSTRAINTS TO PRIMARY HEALTH CARE DELIVERY THE GOVERNMENT OBJECTIVES FOR DELIVERING PHC SERVICES To increase accessibility to quality health care services.
Evaluation of P.H.C. services by Prof.Dr. Sabry Ahmed Salem. Prof. of community, Environmental and occupational medicine.
Available measurement tools and methods Current efforts, priorities Available measurement tools and methods Current efforts, priorities.
International Conference on Improving Use of Medicines
Do Village Revolving Funds Improve Access and Rational Use of Drugs in Laos?
Zambia iCCM Experience
Principles of Persuasive Face-to-Face Education
Sri Hidayati, Siti Munawaroh INRUD Yogya/INDONESIA
A Multifaceted Continuing Medical Education Intervention to Improve Primary Care Physicians’ Performance In Mexico Hortensia Reyes, Ricardo Perez-Cuevas,
Toktobaeva B, Karymbaeva S Drug Information Centre Kyrgyzstan
Sabaydee.
Evaluating International Drug and Therapeutics Committees Courses in the Developing World
International Conference on Improving Use of Medicines
Presentation transcript:

Medicines use in children under 5 years primary care in developing and transitional countries Results from studies reported between Kathleen Holloway, Verica Ivanovska, Dennis Ross-Degnan Medicines use in children under 5: Twenty years of practice patterns and intervention effects

Background Common childhood infections still a major avoidable cause of under 5 mortality Many efforts made to improve the treatment of common childhood infections –ARI/Diarrhoea control, Integrated Management of Childhood Illness Little evidence of progress Objectives To undertake a systematic quantitative review of studies published between 1990 and 2009 about medicine use in children < 5 years in primary care in developing and transitional countries in order to assess progress and the impact of interventions undertaken to improve use

Methods Database (MS Access) created of studies on use of medicines in primary care in developing and transitional countries All studies published during 1990 – 2009 reporting quantitative data eligible for inclusion This study uses a subset of studies in children <5 years Data on commonly used medicine use indicators measured in these studies plus details of study setting and methodology extracted from the reports/articles & entered into the database Studies identified from INRUD bibliography, PubMed, WHO archives (EMP, CAH), MSH archives As far as possible, extracted data from one study was entered as one database record All data-entry checked by 2 persons (KAH, VI) Analysis done using excel To estimate trends and patterns of use, medians of medicine use indicators (limited to baseline data for intervention studies) estimated by study year, region, facility ownership, and prescriber type were calculated

Results 394 surveys conducted in 78 countries – identified 82% surveys included > 2 health facilities &/or > 599 patient encounters Facility type –% surveys done in the public sector 74.5%, private-for-profit sector 25% and private not-for-profit sector 0.5% –% of surveys done in pharmacy shops 13%, non-licensed shops 3%, households 7%, hospitals 7%, PHC 41%, hospitals+PHC 29% Prescriber type –% surveys examining prescribing by doctors 26%, nurses or paramedics 56%, CHW 10%, pharmacist/assts 3%, layperson 5% Disease type –% surveys examining treatment of diarrhoea 60%, ARI 58%, malaria 32%

Treatment of childhood infections over time

Treatment of childhood infections by region

Public vs Private treatment of childhood infections doctors, nurses & paramedics only

Intervention impact 226 surveys were associated with an intervention to improve medicines use –45 interventions were adequately evaluated, using RCT, pre- post with control or time series study design Effect size of interventions –Pre-post change (intervention group) – pre-post change (control) calculated for each outcome measured in each study –2 measures of effect for each intervention study: largest % change in any outcome measured median % change across all outcomes measured –Median of the above 2 measures calculated across all studies by intervention type

Intervention impact: largest % change in any medicines use outcome measured in each study Intervention typeNo. studiesMedian impact25,75 th centiles Printed materials 2 -5% -12%, 2% National policy 1 19% Economic strategies 1 15% Provider education10 15% 11%, 22% Consumer education 2 13% 7%, 20% Provider+consumer ed 8 21% 17%, 24% Provider group process 2 21% 13%, 28% Provider supervision 6 31% 22%, 36% Provider+consumer educ & supervision 4 18% 16%, 25% Community case mgt 8 30% 23%, 39% IMCI -mix of interv type 7 16% 15%, 27%

Intervention impact: median % change over all medicines use outcomes measured in each study (av.4/study) Intervention typeNo. studiesMedian impact25,75 th centiles Printed materials 2 -2%-7%, 2% National policy 1 19% Economic strategies 1 6% Provider education10 9% 5%, 16% Consumer education 2 13% 6%, 19% Provider+consumer ed 8 19% 4%, 21% Provider group process 2 16%11%, 22% Provider supervision 6 13%10%, 26% Provider+consumer educ & supervision 4 18%16%, 22% Community case mgt 8 28%19%, 39% IMCI -mix of interv type 7 16%15%, 25%

Conclusions Key Lessons Learnt –Treatment of childhood infections remains poor in all regions over the past 25 years and is worse in the private compared to the public sector –Effective interventions are those with multiple components e.g. provider & consumer education with supervision, community case management, IMCI –Medicines use database can be used to monitor treatment of childhood infections in developing & transitional countries, where there is little data and methodological limitations Policy implications –Implement more multi-faceted interventions to improve treatment of childhood infections & evaluate the impact using adequate study design Future research agenda –Identify how to build effective interventions & monitoring into the health care systems in a sustainable way –How to expand/maintain the drug use database and put it in the public domain (requires funds)