Taking stock: provider prescribing practices in the presence and absence of ACT stock

Malaria Journal

Review

Rima Shretta¹  Bernadette Hensen²  Jayne Webster³  Lucy Smith Paintain³  Caroline Jones³  Jane Bruce³ 

[1] Center for Pharmaceutical Management, Management Sciences for Health, Arlington, VA, USA;Clinical Research Department, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK;Department of Disease Control, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK;

关键词: Malaria;    Health Facility;    Uncomplicated Malaria;    Public Health Facility;    Febrile Patient;   

DOI  :  10.1186/1475-2875-10-218

 received in 2011-05-06, accepted in 2011-08-03,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundGlobally, the monitoring of prompt and effective treatment for malaria with artemisinin combination therapy (ACT) is conducted largely through household surveys. This measure; however, provides no information on case management processes at the health facility level. The aim of this review was to assess evidence from health facility surveys on malaria prescribing practices using ACT, in the presence and absence of ACT stock, at time and place where treatment was sought.MethodsA systematic search of published literature was conducted. Findings were collated and data extracted on proportion of patients prescribed ACT and alternative anti-malarials in the presence and absence of ACT stock.ResultsOf the 14 studies identified in which ACT prescription for uncomplicated malaria in the public sector was evaluated, just six, from three countries (Kenya, Uganda and Zambia), reported this in the context of ACT stock. Comparing facilities with ACT stock to facilities without stock (i) ACT prescribing was significantly higher in all six studies, increasing by a range of 21.3% in children < 5 yrs weighing ≥ 5 kg (p < 0.001; Kenya 2006) to 51.7% in children ≥ 10 kg (p < 0.001; Zambia 2006); (ii) SP prescribing decreased significantly in five studies, by a range of 14.4% (p < 0.001; Kenya 2006), to 46.3% (p < 0.001; Zambia 2006); (iii) Where quinine was a reported alternative, prescriptions decreased in five of the six studies by 0.1% (p = 1.0, Kenya 2010) to 10.2% (p < 0.001; Zambia 2006). At facilities with no ACT stock on the survey day, the proportion of febrile patients prescribed ACT was < 10% in five of the nine target groups included in the six studies, with the proportion prescribed ACT ranging from 0 to 28.4% (Uganda 2007).ConclusionsPrescriber practices vary based on ACT availability. Although ACT prescriptions increased and alternative anti-malarials prescriptions decreased in the presence of ACT stock, ACT was prescribed in the absence, and alternative anti-malarials were prescribed in the presence of, ACT. Presence of stock alone does not ensure that treatment guidelines are followed. More health facility surveys, together with qualitative research, are needed to understand the role of ACT stock-outs on provider prescribing behaviours and preferences.

【 授权许可】

CC BY   
© Hensen et al; licensee BioMed Central Ltd. 2011