Drug dispensing practices during implementation of artemisinin‐based combination therapy at health facilities in rural Tanzania, 2002–2005
Summary Objective To assess the degree to which policy changes to artemisinin‐based combination therapies (ACTs) as first‐line treatment for uncomplicated malaria translate into effective ACT delivery. Methods Prospective observational study of drug dispensing practices at baseline and during the...
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| Veröffentlicht in: | Tropical medicine & international health 2011-03, Vol.16 (3), p.272-279 |
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| creator | Thwing, J. I. Njau, J. D. Goodman, C. Munkondya, J. Kahigwa, E. Bloland, P. B. Mkikima, S. Mills, A. Abdulla, S. Kachur, S. P. |
| description | Summary
Objective To assess the degree to which policy changes to artemisinin‐based combination therapies (ACTs) as first‐line treatment for uncomplicated malaria translate into effective ACT delivery.
Methods Prospective observational study of drug dispensing practices at baseline and during the 3 years following introduction of ACT with sulfadoxine–pyrimethamine (SP) plus artesunate (AS) in Rufiji District, compared with two neighbouring districts where SP monotherapy remained the first‐line treatment, was carried out. Demographic and dispensing data were collected from all patients at the dispensing units of selected facilities for 1 month per quarter, documenting a total of 271 953 patient encounters in the three districts.
Results In Rufiji, the proportion of patients who received a clinical diagnosis of malaria increased from 47.6% to 57.0%. A majority (75.9%) of these received SP + AS during the intervention period. Of patients who received SP + AS, 94.6% received the correct dose of both. Among patients in Rufiji who received SP, 14.2% received SP monotherapy, and among patients who received AS, 0.3% received AS monotherapy.
Conclusions The uptake of SP + AS in Rufiji was rapid and sustained. Although some SP monotherapy occurred, AS monotherapy was rare, and most received the correct dose of both drugs. These results suggest that implementation of an artemisinin combination therapy, accompanied by training, job aids and assistance in stock management, can rapidly increase access to effective antimalarial treatment.
Objectifs: Evaluer la mesure dans laquelle les changements de politique vers les thérapies de combinaison à base d’artémisinine (ACT) comme traitement de première ligne pour la malaria non compliquée, se traduisent par une délivrance effective de l’ACT.
Méthodes: Étude d’observation prospective sur les pratiques de distribution de médicament au début et durant les 3 années suivant l’introduction de l’ACT avec la sulfadoxine‐pyriméthamine (SP) plus artésunate (AS) dans le district de Rufiji, par rapport aux deux districts voisins où la monothérapie SP est restée le traitement de première ligne. Les données démographiques et de distribution ont été recueillies chez tous les patients dans les unités de distribution de certaines installations sélectionnées, sur un mois par trimestre, représentant un total de 271.953 entretiens avec des patients dans les trois districts.
Résultats: À Rufiji, la proportion de patients ayant reçu un dia |
| doi_str_mv | 10.1111/j.1365-3156.2010.02724.x |
| format | Article |
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Objective To assess the degree to which policy changes to artemisinin‐based combination therapies (ACTs) as first‐line treatment for uncomplicated malaria translate into effective ACT delivery.
Methods Prospective observational study of drug dispensing practices at baseline and during the 3 years following introduction of ACT with sulfadoxine–pyrimethamine (SP) plus artesunate (AS) in Rufiji District, compared with two neighbouring districts where SP monotherapy remained the first‐line treatment, was carried out. Demographic and dispensing data were collected from all patients at the dispensing units of selected facilities for 1 month per quarter, documenting a total of 271 953 patient encounters in the three districts.
Results In Rufiji, the proportion of patients who received a clinical diagnosis of malaria increased from 47.6% to 57.0%. A majority (75.9%) of these received SP + AS during the intervention period. Of patients who received SP + AS, 94.6% received the correct dose of both. Among patients in Rufiji who received SP, 14.2% received SP monotherapy, and among patients who received AS, 0.3% received AS monotherapy.
Conclusions The uptake of SP + AS in Rufiji was rapid and sustained. Although some SP monotherapy occurred, AS monotherapy was rare, and most received the correct dose of both drugs. These results suggest that implementation of an artemisinin combination therapy, accompanied by training, job aids and assistance in stock management, can rapidly increase access to effective antimalarial treatment.
Objectifs: Evaluer la mesure dans laquelle les changements de politique vers les thérapies de combinaison à base d’artémisinine (ACT) comme traitement de première ligne pour la malaria non compliquée, se traduisent par une délivrance effective de l’ACT.
Méthodes: Étude d’observation prospective sur les pratiques de distribution de médicament au début et durant les 3 années suivant l’introduction de l’ACT avec la sulfadoxine‐pyriméthamine (SP) plus artésunate (AS) dans le district de Rufiji, par rapport aux deux districts voisins où la monothérapie SP est restée le traitement de première ligne. Les données démographiques et de distribution ont été recueillies chez tous les patients dans les unités de distribution de certaines installations sélectionnées, sur un mois par trimestre, représentant un total de 271.953 entretiens avec des patients dans les trois districts.
Résultats: À Rufiji, la proportion de patients ayant reçu un diagnostic clinique de malaria est passée de 47,6%à 57,0%. Une majorité (75,9%) de ceux‐ci a reçu SP+AS au cours de la période d’intervention. Parmi les patients qui ont reçu SP+AS, 94,6% ont reçu la dose correcte pour les deux régimes. Parmi les patients à Rufiji qui ont reçu SP, 14,2% ont reçu une monothérapie SP et parmi les patients qui ont reçu AS, 0,3% l’ont reçu en monothérapie.
Conclusions: L’adoption de SP+AS à Rufiji a été rapide et maintenue. Bien que certaines monothérapies SP aient été observées, la monothérapie était rare et la plupart des patients ont reçu la dose correcte des deux médicaments. Ces résultats suggèrent que l’implémentation d’une thérapie à base d’artémisinine, accompagnée par la formation, des outils de travail et l’aide à la gestion des stocks, peut rapidement accroître l’accès à un traitement antimalarique efficace.
Objetivos: Evaluar hasta donde los cambios en la política de las terapias de combinación basadas en la artemisinina (TCAs) como primera línea de tratamiento para la malaria no complicada pueden trasladarse a una entrega efectiva de la TCAs.
Métodos: Estudio prospectivo y observacional de las prácticas de dispensación de medicamentos al comienzo y durante los 3 años posteriores a la introducción de la TCA con sulfadoxina‐pirimetamina (SP) más artesunato (AS) en el distrito de Rufiji, en comparación con dos distritos vecinos en los que la monoterapia con SP continuaba siendo la primera línea de tratamiento. Los datos demográficos y de dispensación de los pacientes se recolectaron en las unidades de dispensación de centros sanitarios escogidos, durante un mes por trimestre, documentando un total de 271,953 encuentros con pacientes en tres distritos.
Resultados: En Rufiji, la proporción de pacientes que recibieron un diagnóstico clínico de malaria aumentó del 47.6% al 57.0%. La mayoría (75.9%) de ellos recibieron SP+AS durante el periodo de intervención. De los pacientes que recibieron SP+AS, un 94.6% recibió una dosis correcta de ambos. Entre los pacientes en Rufiji que recibieron SP, un 14.2% recibió monoterapia con SP, y entre los pacientes que recibieron AS, un 0.3% recibió una monoterapia con AS.
Conclusiones: La aceptación del SP+AS en Rufiji fue rápida y sostenida. Aunque había alguna monoterapia con SP, la monoterapia con AS era rara, y la mayoría recibió la dosis correcta de ambos medicamentos. Estos resultados sugieren que la implementación de una terapia de combinación con artemisinina, acompañada con el entrenamiento, ayudas en el trabajo y asistencia en el manejo de las existencias, puede aumentar de forma rápida el acceso al tratamiento efectivo con antimaláricos.</description><identifier>ISSN: 1360-2276</identifier><identifier>EISSN: 1365-3156</identifier><identifier>DOI: 10.1111/j.1365-3156.2010.02724.x</identifier><identifier>PMID: 21226795</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Age Factors ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antimalarials - economics ; Antimalarials - therapeutic use ; Antiparasitic agents ; Artemisinins - economics ; Artemisinins - therapeutic use ; artemisinin‐based combination therapy ; Biological and medical sciences ; case management ; Case Management - organization & administration ; Child ; Child, Preschool ; Drug Combinations ; Drug Costs - statistics & numerical data ; Drug Prescriptions - standards ; Drug Prescriptions - statistics & numerical data ; Drug therapy ; Drug Therapy, Combination ; General aspects ; Health care delivery ; Human protozoal diseases ; Humans ; Infant ; Infectious diseases ; Malaria ; Malaria - drug therapy ; Malaria - epidemiology ; manejo de casos ; Medical sciences ; Parasitic diseases ; Pharmacology. Drug treatments ; Practice Patterns, Physicians' - standards ; Practice Patterns, Physicians' - statistics & numerical data ; prise en charge des cas ; Prospective Studies ; Protozoal diseases ; Pyrimethamine - economics ; Pyrimethamine - therapeutic use ; Rural Health Services - standards ; Rural Health Services - statistics & numerical data ; Sulfadoxine - economics ; Sulfadoxine - therapeutic use ; Tanzania ; Tanzania - epidemiology ; Tanzanie ; terapia de combinación basada en la artemisinina ; terapéutica ; therapeutics ; thérapies ; traitement de combinaison à base d’artémisinine</subject><ispartof>Tropical medicine & international health, 2011-03, Vol.16 (3), p.272-279</ispartof><rights>2011 Blackwell Publishing Ltd</rights><rights>2015 INIST-CNRS</rights><rights>2011 Blackwell Publishing Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4754-93ce1255de343cf3d09f899a1a7ce7d514258e8f866a61699b4e48ae3af9d7d03</citedby><cites>FETCH-LOGICAL-c4754-93ce1255de343cf3d09f899a1a7ce7d514258e8f866a61699b4e48ae3af9d7d03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1411,1427,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23835461$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21226795$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thwing, J. I.</creatorcontrib><creatorcontrib>Njau, J. D.</creatorcontrib><creatorcontrib>Goodman, C.</creatorcontrib><creatorcontrib>Munkondya, J.</creatorcontrib><creatorcontrib>Kahigwa, E.</creatorcontrib><creatorcontrib>Bloland, P. B.</creatorcontrib><creatorcontrib>Mkikima, S.</creatorcontrib><creatorcontrib>Mills, A.</creatorcontrib><creatorcontrib>Abdulla, S.</creatorcontrib><creatorcontrib>Kachur, S. P.</creatorcontrib><title>Drug dispensing practices during implementation of artemisinin‐based combination therapy at health facilities in rural Tanzania, 2002–2005</title><title>Tropical medicine & international health</title><addtitle>Trop Med Int Health</addtitle><description>Summary
Objective To assess the degree to which policy changes to artemisinin‐based combination therapies (ACTs) as first‐line treatment for uncomplicated malaria translate into effective ACT delivery.
Methods Prospective observational study of drug dispensing practices at baseline and during the 3 years following introduction of ACT with sulfadoxine–pyrimethamine (SP) plus artesunate (AS) in Rufiji District, compared with two neighbouring districts where SP monotherapy remained the first‐line treatment, was carried out. Demographic and dispensing data were collected from all patients at the dispensing units of selected facilities for 1 month per quarter, documenting a total of 271 953 patient encounters in the three districts.
Results In Rufiji, the proportion of patients who received a clinical diagnosis of malaria increased from 47.6% to 57.0%. A majority (75.9%) of these received SP + AS during the intervention period. Of patients who received SP + AS, 94.6% received the correct dose of both. Among patients in Rufiji who received SP, 14.2% received SP monotherapy, and among patients who received AS, 0.3% received AS monotherapy.
Conclusions The uptake of SP + AS in Rufiji was rapid and sustained. Although some SP monotherapy occurred, AS monotherapy was rare, and most received the correct dose of both drugs. These results suggest that implementation of an artemisinin combination therapy, accompanied by training, job aids and assistance in stock management, can rapidly increase access to effective antimalarial treatment.
Objectifs: Evaluer la mesure dans laquelle les changements de politique vers les thérapies de combinaison à base d’artémisinine (ACT) comme traitement de première ligne pour la malaria non compliquée, se traduisent par une délivrance effective de l’ACT.
Méthodes: Étude d’observation prospective sur les pratiques de distribution de médicament au début et durant les 3 années suivant l’introduction de l’ACT avec la sulfadoxine‐pyriméthamine (SP) plus artésunate (AS) dans le district de Rufiji, par rapport aux deux districts voisins où la monothérapie SP est restée le traitement de première ligne. Les données démographiques et de distribution ont été recueillies chez tous les patients dans les unités de distribution de certaines installations sélectionnées, sur un mois par trimestre, représentant un total de 271.953 entretiens avec des patients dans les trois districts.
Résultats: À Rufiji, la proportion de patients ayant reçu un diagnostic clinique de malaria est passée de 47,6%à 57,0%. Une majorité (75,9%) de ceux‐ci a reçu SP+AS au cours de la période d’intervention. Parmi les patients qui ont reçu SP+AS, 94,6% ont reçu la dose correcte pour les deux régimes. Parmi les patients à Rufiji qui ont reçu SP, 14,2% ont reçu une monothérapie SP et parmi les patients qui ont reçu AS, 0,3% l’ont reçu en monothérapie.
Conclusions: L’adoption de SP+AS à Rufiji a été rapide et maintenue. Bien que certaines monothérapies SP aient été observées, la monothérapie était rare et la plupart des patients ont reçu la dose correcte des deux médicaments. Ces résultats suggèrent que l’implémentation d’une thérapie à base d’artémisinine, accompagnée par la formation, des outils de travail et l’aide à la gestion des stocks, peut rapidement accroître l’accès à un traitement antimalarique efficace.
Objetivos: Evaluar hasta donde los cambios en la política de las terapias de combinación basadas en la artemisinina (TCAs) como primera línea de tratamiento para la malaria no complicada pueden trasladarse a una entrega efectiva de la TCAs.
Métodos: Estudio prospectivo y observacional de las prácticas de dispensación de medicamentos al comienzo y durante los 3 años posteriores a la introducción de la TCA con sulfadoxina‐pirimetamina (SP) más artesunato (AS) en el distrito de Rufiji, en comparación con dos distritos vecinos en los que la monoterapia con SP continuaba siendo la primera línea de tratamiento. Los datos demográficos y de dispensación de los pacientes se recolectaron en las unidades de dispensación de centros sanitarios escogidos, durante un mes por trimestre, documentando un total de 271,953 encuentros con pacientes en tres distritos.
Resultados: En Rufiji, la proporción de pacientes que recibieron un diagnóstico clínico de malaria aumentó del 47.6% al 57.0%. La mayoría (75.9%) de ellos recibieron SP+AS durante el periodo de intervención. De los pacientes que recibieron SP+AS, un 94.6% recibió una dosis correcta de ambos. Entre los pacientes en Rufiji que recibieron SP, un 14.2% recibió monoterapia con SP, y entre los pacientes que recibieron AS, un 0.3% recibió una monoterapia con AS.
Conclusiones: La aceptación del SP+AS en Rufiji fue rápida y sostenida. Aunque había alguna monoterapia con SP, la monoterapia con AS era rara, y la mayoría recibió la dosis correcta de ambos medicamentos. Estos resultados sugieren que la implementación de una terapia de combinación con artemisinina, acompañada con el entrenamiento, ayudas en el trabajo y asistencia en el manejo de las existencias, puede aumentar de forma rápida el acceso al tratamiento efectivo con antimaláricos.</description><subject>Adolescent</subject><subject>Age Factors</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antimalarials - economics</subject><subject>Antimalarials - therapeutic use</subject><subject>Antiparasitic agents</subject><subject>Artemisinins - economics</subject><subject>Artemisinins - therapeutic use</subject><subject>artemisinin‐based combination therapy</subject><subject>Biological and medical sciences</subject><subject>case management</subject><subject>Case Management - organization & administration</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Drug Combinations</subject><subject>Drug Costs - statistics & numerical data</subject><subject>Drug Prescriptions - standards</subject><subject>Drug Prescriptions - statistics & numerical data</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>General aspects</subject><subject>Health care delivery</subject><subject>Human protozoal diseases</subject><subject>Humans</subject><subject>Infant</subject><subject>Infectious diseases</subject><subject>Malaria</subject><subject>Malaria - drug therapy</subject><subject>Malaria - epidemiology</subject><subject>manejo de casos</subject><subject>Medical sciences</subject><subject>Parasitic diseases</subject><subject>Pharmacology. Drug treatments</subject><subject>Practice Patterns, Physicians' - standards</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>prise en charge des cas</subject><subject>Prospective Studies</subject><subject>Protozoal diseases</subject><subject>Pyrimethamine - economics</subject><subject>Pyrimethamine - therapeutic use</subject><subject>Rural Health Services - standards</subject><subject>Rural Health Services - statistics & numerical data</subject><subject>Sulfadoxine - economics</subject><subject>Sulfadoxine - therapeutic use</subject><subject>Tanzania</subject><subject>Tanzania - epidemiology</subject><subject>Tanzanie</subject><subject>terapia de combinación basada en la artemisinina</subject><subject>terapéutica</subject><subject>therapeutics</subject><subject>thérapies</subject><subject>traitement de combinaison à base d’artémisinine</subject><issn>1360-2276</issn><issn>1365-3156</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkctu1DAUhiMEohd4BWQhITbM4HviBQtUbpWK2Axr64xz0vEocYKdiA6rPgGqxBv2SXA6Q5FY4c2xjr_z61hfURBGlyyf19slE1otBFN6yWnuUl5yubx6UBzfPzy8u9MF56U-Kk5S2lJKpVT6cXHEGee6NOq4-PkuTpek9mnAkHy4JEMEN3qHidRTnBu-G1rsMIww-j6QviEQR-x8pn24vb5ZQ8KauL5b-7BHxg1GGHYERrJBaMcNacD51o8-p_pA4hShJSsIPyB4eEU4pfz2-lcu6knxqIE24dNDPS2-fni_Ovu0uPjy8fzs7cXCyVLJhREOGVeqRiGFa0RNTVMZAwxKh2WtmOSqwqqptAbNtDFribICFNCYuqypOC1e7nOH2H-bMI02f8hh20LAfkq2UspQzbjJ5PN_yG0_xZCXyxDXXGgxx1V7yMU-pYiNHaLvIO4so3Y2Zrd2FmNnMXY2Zu-M2as8-uyQP607rO8H_yjKwIsDAMlB20QIzqe_nKiEkppl7s2e--5b3P33Anb1-Xy-id-RBLQK</recordid><startdate>201103</startdate><enddate>201103</enddate><creator>Thwing, J. I.</creator><creator>Njau, J. D.</creator><creator>Goodman, C.</creator><creator>Munkondya, J.</creator><creator>Kahigwa, E.</creator><creator>Bloland, P. B.</creator><creator>Mkikima, S.</creator><creator>Mills, A.</creator><creator>Abdulla, S.</creator><creator>Kachur, S. P.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>7X8</scope></search><sort><creationdate>201103</creationdate><title>Drug dispensing practices during implementation of artemisinin‐based combination therapy at health facilities in rural Tanzania, 2002–2005</title><author>Thwing, J. I. ; Njau, J. D. ; Goodman, C. ; Munkondya, J. ; Kahigwa, E. ; Bloland, P. B. ; Mkikima, S. ; Mills, A. ; Abdulla, S. ; Kachur, S. P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4754-93ce1255de343cf3d09f899a1a7ce7d514258e8f866a61699b4e48ae3af9d7d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Age Factors</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antimalarials - economics</topic><topic>Antimalarials - therapeutic use</topic><topic>Antiparasitic agents</topic><topic>Artemisinins - economics</topic><topic>Artemisinins - therapeutic use</topic><topic>artemisinin‐based combination therapy</topic><topic>Biological and medical sciences</topic><topic>case management</topic><topic>Case Management - organization & administration</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Drug Combinations</topic><topic>Drug Costs - statistics & numerical data</topic><topic>Drug Prescriptions - standards</topic><topic>Drug Prescriptions - statistics & numerical data</topic><topic>Drug therapy</topic><topic>Drug Therapy, Combination</topic><topic>General aspects</topic><topic>Health care delivery</topic><topic>Human protozoal diseases</topic><topic>Humans</topic><topic>Infant</topic><topic>Infectious diseases</topic><topic>Malaria</topic><topic>Malaria - drug therapy</topic><topic>Malaria - epidemiology</topic><topic>manejo de casos</topic><topic>Medical sciences</topic><topic>Parasitic diseases</topic><topic>Pharmacology. Drug treatments</topic><topic>Practice Patterns, Physicians' - standards</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>prise en charge des cas</topic><topic>Prospective Studies</topic><topic>Protozoal diseases</topic><topic>Pyrimethamine - economics</topic><topic>Pyrimethamine - therapeutic use</topic><topic>Rural Health Services - standards</topic><topic>Rural Health Services - statistics & numerical data</topic><topic>Sulfadoxine - economics</topic><topic>Sulfadoxine - therapeutic use</topic><topic>Tanzania</topic><topic>Tanzania - epidemiology</topic><topic>Tanzanie</topic><topic>terapia de combinación basada en la artemisinina</topic><topic>terapéutica</topic><topic>therapeutics</topic><topic>thérapies</topic><topic>traitement de combinaison à base d’artémisinine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thwing, J. I.</creatorcontrib><creatorcontrib>Njau, J. D.</creatorcontrib><creatorcontrib>Goodman, C.</creatorcontrib><creatorcontrib>Munkondya, J.</creatorcontrib><creatorcontrib>Kahigwa, E.</creatorcontrib><creatorcontrib>Bloland, P. B.</creatorcontrib><creatorcontrib>Mkikima, S.</creatorcontrib><creatorcontrib>Mills, A.</creatorcontrib><creatorcontrib>Abdulla, S.</creatorcontrib><creatorcontrib>Kachur, S. P.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Tropical medicine & international health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thwing, J. I.</au><au>Njau, J. D.</au><au>Goodman, C.</au><au>Munkondya, J.</au><au>Kahigwa, E.</au><au>Bloland, P. B.</au><au>Mkikima, S.</au><au>Mills, A.</au><au>Abdulla, S.</au><au>Kachur, S. P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Drug dispensing practices during implementation of artemisinin‐based combination therapy at health facilities in rural Tanzania, 2002–2005</atitle><jtitle>Tropical medicine & international health</jtitle><addtitle>Trop Med Int Health</addtitle><date>2011-03</date><risdate>2011</risdate><volume>16</volume><issue>3</issue><spage>272</spage><epage>279</epage><pages>272-279</pages><issn>1360-2276</issn><eissn>1365-3156</eissn><abstract>Summary
Objective To assess the degree to which policy changes to artemisinin‐based combination therapies (ACTs) as first‐line treatment for uncomplicated malaria translate into effective ACT delivery.
Methods Prospective observational study of drug dispensing practices at baseline and during the 3 years following introduction of ACT with sulfadoxine–pyrimethamine (SP) plus artesunate (AS) in Rufiji District, compared with two neighbouring districts where SP monotherapy remained the first‐line treatment, was carried out. Demographic and dispensing data were collected from all patients at the dispensing units of selected facilities for 1 month per quarter, documenting a total of 271 953 patient encounters in the three districts.
Results In Rufiji, the proportion of patients who received a clinical diagnosis of malaria increased from 47.6% to 57.0%. A majority (75.9%) of these received SP + AS during the intervention period. Of patients who received SP + AS, 94.6% received the correct dose of both. Among patients in Rufiji who received SP, 14.2% received SP monotherapy, and among patients who received AS, 0.3% received AS monotherapy.
Conclusions The uptake of SP + AS in Rufiji was rapid and sustained. Although some SP monotherapy occurred, AS monotherapy was rare, and most received the correct dose of both drugs. These results suggest that implementation of an artemisinin combination therapy, accompanied by training, job aids and assistance in stock management, can rapidly increase access to effective antimalarial treatment.
Objectifs: Evaluer la mesure dans laquelle les changements de politique vers les thérapies de combinaison à base d’artémisinine (ACT) comme traitement de première ligne pour la malaria non compliquée, se traduisent par une délivrance effective de l’ACT.
Méthodes: Étude d’observation prospective sur les pratiques de distribution de médicament au début et durant les 3 années suivant l’introduction de l’ACT avec la sulfadoxine‐pyriméthamine (SP) plus artésunate (AS) dans le district de Rufiji, par rapport aux deux districts voisins où la monothérapie SP est restée le traitement de première ligne. Les données démographiques et de distribution ont été recueillies chez tous les patients dans les unités de distribution de certaines installations sélectionnées, sur un mois par trimestre, représentant un total de 271.953 entretiens avec des patients dans les trois districts.
Résultats: À Rufiji, la proportion de patients ayant reçu un diagnostic clinique de malaria est passée de 47,6%à 57,0%. Une majorité (75,9%) de ceux‐ci a reçu SP+AS au cours de la période d’intervention. Parmi les patients qui ont reçu SP+AS, 94,6% ont reçu la dose correcte pour les deux régimes. Parmi les patients à Rufiji qui ont reçu SP, 14,2% ont reçu une monothérapie SP et parmi les patients qui ont reçu AS, 0,3% l’ont reçu en monothérapie.
Conclusions: L’adoption de SP+AS à Rufiji a été rapide et maintenue. Bien que certaines monothérapies SP aient été observées, la monothérapie était rare et la plupart des patients ont reçu la dose correcte des deux médicaments. Ces résultats suggèrent que l’implémentation d’une thérapie à base d’artémisinine, accompagnée par la formation, des outils de travail et l’aide à la gestion des stocks, peut rapidement accroître l’accès à un traitement antimalarique efficace.
Objetivos: Evaluar hasta donde los cambios en la política de las terapias de combinación basadas en la artemisinina (TCAs) como primera línea de tratamiento para la malaria no complicada pueden trasladarse a una entrega efectiva de la TCAs.
Métodos: Estudio prospectivo y observacional de las prácticas de dispensación de medicamentos al comienzo y durante los 3 años posteriores a la introducción de la TCA con sulfadoxina‐pirimetamina (SP) más artesunato (AS) en el distrito de Rufiji, en comparación con dos distritos vecinos en los que la monoterapia con SP continuaba siendo la primera línea de tratamiento. Los datos demográficos y de dispensación de los pacientes se recolectaron en las unidades de dispensación de centros sanitarios escogidos, durante un mes por trimestre, documentando un total de 271,953 encuentros con pacientes en tres distritos.
Resultados: En Rufiji, la proporción de pacientes que recibieron un diagnóstico clínico de malaria aumentó del 47.6% al 57.0%. La mayoría (75.9%) de ellos recibieron SP+AS durante el periodo de intervención. De los pacientes que recibieron SP+AS, un 94.6% recibió una dosis correcta de ambos. Entre los pacientes en Rufiji que recibieron SP, un 14.2% recibió monoterapia con SP, y entre los pacientes que recibieron AS, un 0.3% recibió una monoterapia con AS.
Conclusiones: La aceptación del SP+AS en Rufiji fue rápida y sostenida. Aunque había alguna monoterapia con SP, la monoterapia con AS era rara, y la mayoría recibió la dosis correcta de ambos medicamentos. Estos resultados sugieren que la implementación de una terapia de combinación con artemisinina, acompañada con el entrenamiento, ayudas en el trabajo y asistencia en el manejo de las existencias, puede aumentar de forma rápida el acceso al tratamiento efectivo con antimaláricos.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>21226795</pmid><doi>10.1111/j.1365-3156.2010.02724.x</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1360-2276 |
| ispartof | Tropical medicine & international health, 2011-03, Vol.16 (3), p.272-279 |
| issn | 1360-2276 1365-3156 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_855906129 |
| source | MEDLINE; IngentaConnect Free/Open Access Journals; Wiley Online Library Journals Frontfile Complete; Wiley Online Library Free Content; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adolescent Age Factors Antibiotics. Antiinfectious agents. Antiparasitic agents Antimalarials - economics Antimalarials - therapeutic use Antiparasitic agents Artemisinins - economics Artemisinins - therapeutic use artemisinin‐based combination therapy Biological and medical sciences case management Case Management - organization & administration Child Child, Preschool Drug Combinations Drug Costs - statistics & numerical data Drug Prescriptions - standards Drug Prescriptions - statistics & numerical data Drug therapy Drug Therapy, Combination General aspects Health care delivery Human protozoal diseases Humans Infant Infectious diseases Malaria Malaria - drug therapy Malaria - epidemiology manejo de casos Medical sciences Parasitic diseases Pharmacology. Drug treatments Practice Patterns, Physicians' - standards Practice Patterns, Physicians' - statistics & numerical data prise en charge des cas Prospective Studies Protozoal diseases Pyrimethamine - economics Pyrimethamine - therapeutic use Rural Health Services - standards Rural Health Services - statistics & numerical data Sulfadoxine - economics Sulfadoxine - therapeutic use Tanzania Tanzania - epidemiology Tanzanie terapia de combinación basada en la artemisinina terapéutica therapeutics thérapies traitement de combinaison à base d’artémisinine |
| title | Drug dispensing practices during implementation of artemisinin‐based combination therapy at health facilities in rural Tanzania, 2002–2005 |
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