Insights following change in drug policy: a descriptive study for antimalarial prescription practices in children of public sector health facilities in Jharkhand state of India.
OBJECTIVE
Widespread resistance to chloroquine was the mainstay to implement artemisinin-based combination therapy (ACT) in the year 2007 in few malaria endemic states in India including Jharkhand as the first line of treatment for uncomplicated Plasmodium falciparum malaria. This study was conducted in Jharkhand state of the country just after the implementation of ACT to assess the prevailing antimalarial drug prescribing practices, availability of antimalarial drugs and the acceptability of the new policy by the health professionals for the treatment of uncomplicated P. falciparum malaria patients particularly in children ≤ 15 yr of age.


METHODS
This is a cross-sectional study in children aged ≤ 15 yr with malaria or to whom antimalarial drug was prescribed. Main outcome measure was prescription of recommended ACT in children aged ≤ 15 yr with malaria in the selected areas of Jharkhand.


RESULTS
In the year 2008, artemisinin-based combination therapy (ACT) was implemented in 12 districts of the studied state; however, the availability of ACT was confirmed only in five districts. Antimalarial prescription was prevalent amongst the undiagnosed (8.4%), malaria negative (64.3%) and unknown blood test result (1.2%) suggesting the prevalence of irrational treatment practices. ACT prescription was very low with only 3.2% of confirmed falciparum malaria patients receiving it while others received either non-artesunate (NA) treatment (88.1%) including chloroquine (CQ) alone, CQ + Primaquine (PQ)/other drugs, sulphadoxine-pyrimethamine (SP) alone, SP + other drugs or artemisinin monotherapy (AM) treatment (6.3%). Still others were given non-antimalarial treatment (NM) in both malaria positive (0.3%) and malaria negative (2.1%) cases.


CONCLUSIONS
Despite the change in drug policy in the studied state the availability and implementation of ACT was a major concern. Nevertheless, the non-availability of blister packs for children aged ≤ 15 yr was the main hindrance in the implementation of the recommended antimalarial. Availability, training and participation of health professionals in decision-making are the key elements to improve adherence to new treatment guidelines. This study provided evidence for the requirement of age-specific blister packs in the country and the national programme has introduced age-specific blister packs in the country in 2010. This baseline information will be useful to monitor the progress in ACT implementation in the country.
ECR Division, National Institute of Malaria Research, New Delhi, India.
Neelima
N
Mishra
Ruchi
R
Gupta
Sagya
S
Singh
Roma
R
Rana
Bhartendu
B
Shahi
Manoj Kumar
MK
Das
Anupkumar R
AR
Anvikar
Neena
N
Valecha
D000293:Adolescent; D000962:Antimalarials / Q000600:supply & distribution* / Q000627:therapeutic use; D037621:Artemisinins / Q000600:supply & distribution / Q000627:therapeutic use; D000077332:Artesunate; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000600:supply & distribution / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data; D007194:India / Q000453:epidemiology; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data; D011446:Prospective Studies; D017150:Public Sector / Q000706:statistics & numerical data*; D011739:Pyrimethamine / Q000600:supply & distribution / Q000627:therapeutic use; D012189:Retrospective Studies; D013413:Sulfadoxine / Q000600:supply & distribution / Q000627:therapeutic use
D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D000077332:Artesunate; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine