Medication among Children in Africa South of Sahara: Qualitative Systematic Review Professor Ebba Holme Hansen and Professor Susan R. Whyte University of Copenhagen, Denmark Copenhagen University’s Global Health Cluster temporary fund provided partial funding

Problem statement The use of medicines is an important aspect of child health Children are not just “small adults” However, this topic has been sparsely dealt with in international research, not least in low-income societies. Objective To provide an overview of empirical evidence on children and medication in Africa south of Sahara

Systematic searches conducted without restrictions in Medline Embase Psychinfo Structured by using the same search terms in similar combinations in all databases In all searches: “children” “Africa, south of Sahara” “Children” defined as 0-18 years “Medicines” defined by 80 different search terms

Flow chart of included/excluded studies Duplicates Purely economic studies - Diagnostic tools - Drug abuse - Purely clinical studies - Studies where children and adults are mixed 830 potentially relevant articles 1530 potentially relevant references 132 included studies

Data handling and extraction Titles and abstracts assessed for eligibility Full text papers Extraction on data sheets

Illnesses – in 132 studies

Main points 132 studies from 24 countries Most studies dealt with children under 5 years  In many studies age group was not specified Very few studies on prescribing and use Most studies recognised the multiple sources of treatment (popular, professional, folk sectors)

Main points (contd.) Doses, dispensing, dosage forms barely mentioned Few studies on perceptions No reviews of the field of children and medicines in Africa

Implications This study shows that medicine use in children is a neglected topic –except medication treatment of malaria/fever and diarrhoea in small children As medicine use behaviours may track from childhood and adolescence into adulthood, knowledge about this topic also have implications for the improvement of medicine use in future adult populations The study indicates a lack of research interest in, particularly, older children as autonomous beings This little research only provides hints about proper interventions and policies to improve use of medicines among children Research to lay the foundation for future interventions should be high on the agenda

Research gaps Studies on medicine use for chronic conditions and acute conditions other than malaria/fever and diarrhoea Characterisation of issues specific to children over 5 The meaning and implications of (lack of) dosage forms for children Analyses of policies of relevance to children’s medicine use Children’s own experiences and the meaning of medicines in their daily lives.