Children’s Access to Medicines Saad Alkahtani Postgraduate student Academic Division of Child Health Supervisors Prof. Imti Choonara Dr. Helen Sammons

Outline Introduction & background. Hypotheses. ‘At risk’ groups. Access barriers. Study aims. Research methodology. Results to date. Conclusions to date. Questions.

Access to medicines Children’s access to medicines has been considered to be one of the major concerns for health care professionals. Pneumonia, the leading cause of death in children world-wide, kills an estimated 1.6m every year, but less than 20% have access to affordable treatments.( WHO November 2010) Even in developed countries not all children have the same access to medicines. Children are dependent upon their parents who may not recognise important symptoms.

Hypotheses Children from ‘at risk’ groups receive fewer medicines than other children. Barriers in accessing health care influence the number of medicines children receive. Diversity in parental attitudes towards medical conditions (e.g. epilepsy) influences the number of medicines children receive.

‘At risk’ groups Mobile populations are considered as ethnic minorities in the UK. Asylum seekers. Refugees. Travellers.

Access barriers Socioeconomic. Communication skills (language). Cultural issues. Lack of health insurance. Lack of parental knowledge about health care system in the host country.

Study aims Determine the number of medicines used over i) the last month ii) the last six months. Compare the number of medicines received by the ‘at risk’ and control groups. Explore diversity in attitudes towards receiving treatment for certain medical conditions (asthma, epilepsy).

Research methodology Ethical approval obtained from the University of Nottingham Medical School Research Ethics Committee. Study two groups of children in the East Midlands region in the UK who might experience problems in accessing health care and medical treatments.

Research methodology Interview parents from 50 families of each group regarding their children’s health and retrospectively over i) the last month ii) the last six months. Randomly select a control group (children will have a similar age and sex distribution to the ‘at risk’ groups).

Research methodology Determination Semi-structured interview (parents) Asylum seekers Group & refugees ( A ) Travellers ( B ) Control ( C ) Determination Accessibility to health care Attitudes towards treatment (epilepsy & asthma)

Research methodology Primary endpoint (quantitative) will be to compare the number of medicines received by ‘at risk’ groups with the control group over i) the last month. ii) the last six months. Secondary endpoint (qualitative) will be to explore i) parental attitudes towards treatment ii) whether these attitudes affect the treatment given.

Results to date 50 parents of Asylum seekers and refugees were interviewed regarding their children. 117 children in total (ranging from 1-6 per family, median number 3).

Results to date Ages of the children ranging from 2 months to 18 years (median 5 years).

Results to date All were registered with GPs. All were fully immunised (to date).

Results to date In the last month Of 117 children 35 had an illness. 34 of these children were prescribed a total of 48 medicines (ranging from 1-3 per prescription, median 1).

Results to date In the last six months Of 117 children 105 had an illness. Of these 85 children were prescribed a total of 94 medicines (ranging from 1-4 per prescription, median 2).

Results to date Medicines prescribed (paracetamol, ibuprofen, amoxicillin, digoxin, lisinopril, and salbutamol). 23 parents would give analgesics for earache whereas 27 would not. 37 parents would tell friends and relatives about their child’s epilepsy whereas 13 would not.

Conclusions to date This pilot study suggests: Access to medicines and health care for children of refugees and asylum seekers in the East Midlands is good. Parental knowledge about the health care system is good. Further work is ongoing to complete the study.

Thank you for your time and attention. Questions?