Change in malaria treatment policy: A study of its immediate effects on hospital malaria drug manage

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Change in malaria treatment policy A study of
its immediate effects on hospital malaria drug
management, utilization of hospital facilities
and prescription behavior in District Hospitals
of Uganda

• Waako P., Ogwal-Okeng JW., Aupont O. ,
  Ross-Degnan D.
• International Conference on Improving
• Use of Medicines
• Chiang Mia, Thailand
• March 31, 2004
• INRUD Uganda and Makerere University
• Project supported as part of the Joint
  Initiative on Improving Use of Medicines under a
  grant from RPM Plus

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Acknowledgements

• Applied Research for Child Health
• Management Sciences for Health/RPM Plus
• Makerere University, Kampala, Uganda
• INRUD-Uganda
• Uganda National Council of Science and Technology
• Mulago Hospital, Kampala, Uganda
• Mbale Hospital, Uganda
• Kamuli Mission Hospital, Uganda
• Nkozi Mission Hospital, Uganda
• Bugolobi Hospital, Kampala
• Mayanja Memorial Hospital, Mbarara, Uganda

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Background

• Malaria is a leading health problem worldwide
  Over 100 million people are affected annually.
• Major burden in Uganda Leading cause of death,
  High levels of hospital admission (nearly 25)
  and outpatient attendance (25-40).
• Parasite resistance and limited access to
  effective treatment are major constraints to
  malaria control.
• Treatment failure ? change in treatment policy
  (from chloroquine to chloroquine SP)
• Problems with implementation and adoption of the
  new treatment policy

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Objectives

• To explore the effects of the policy change
  on the utilization of services, drug management
  and treatment practices for malaria at the
  hospitals over a three year transitional period.
• Specific Objectives
• To assess awareness and knowledge of hospital
  administrators and prescribers of the existence
  of the policy change
• To assess the variations in hospital utilization
  over time during the transition of the policy
• To analyze the adjustment of hospital drug
  management to the new policy
• To determine the effect of the policy on the
  prescription practices for malaria patients
  during the transition

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Methods

• Retrospective study using a survey research
  design combined with longitudinal data analysis.
• Setting 6 Hospitals (mission, public , private)
• Survey of 38 hospital administrators and
  providers
• Analysis of monthly hospital records (attendance,
  drug stocks and malaria prescriptions) over 36
  months.
• Time periods
• 12 months before policy proposal
• 12 months of transition / debates
• 12 months after pronouncement
• --------------- I --------------- I
  ---------------

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Results

• Awareness and Knowledge
• Of all administrators and prescribers surveyed,
  only one did not know about the change in malaria
  treatment policy
• Prescription practices
• Improvement in prescribing of new treatment
  regimen observed in the public hospitals
• Smaller improvement in prescribing of new
  treatment regimen observed in Mission Hospitals,
  with increased use of SP alone over the study
  period
• No changes in level of CQSP prescriptions noted
  for Private Hospitals. Rather steady increases in
  prescriptions of Artemisinin derivatives can be
  observed

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Results
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Results (continued)

• Drug availability
• - Steady decrease in availability of CQ and SP in
  Public Hospitals
• - Increase in SP stocks in Mission facilities (CQ
  availability decreased)
• - Increased stock of Artemisinin derivatives in
  the Private Sector (CQ and SP stocks remain
  stable)
• Facility Utilization
• - No variation in admissions despite increased
  out-patient attendance in the 3 hospital types

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Results (continued)
Variations in drug availability at the hospitals
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Results (continued)
Variations in malaria attendance and admissions
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Summary and conclusion

• Prescribers in the public sector were more
  compliant to the policy change
• Drug stock adjustment were inadequate in all
  hospital setting despite the level of policy
  awareness and knowledge
• There is increased prescriptions of SP alone in
  mission hospitals in preference to the
  recommended treatment
• There is increased stocking and prescription of
  Artemisinin derivatives in the private sector in
  lieu of the recommended treatment
• Mission hospitals that used SP alone were able to
  control hospital admissions against the
  increasing outpatient attendance
• The public sector that had a high rate of
  compliance to the new policy did not contain the
  increasing rate of admissions possibly due to
  inadequate stock adjustments
• Source of funding, administrative structures and
  style of administration of health facilities
  affect compliance to national policy