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Abstract ID: MA026

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The three major languages; English, Pidgin and Motu were separately employed in ... Pidgin Lang. 77 (49.4) 57 (37.7) 57 (44.2) English. p 0.05. 65 (41.7) 73 ... – PowerPoint PPT presentation

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Title: Abstract ID: MA026


1
Abstract ID MA026
2
Background Settings
  • Malaria is a major health problem in the world,
    and it is the second cause of morbidity and
    mortality in Papua New Guinea (PNG) . The PNG
    Health Plan 2001- 2010
  • Resistance of P. falciparum to chloroquine
    amodiaquine, led to new Standard Treatments
    Guidelines (STGs) for malaria in PNG PNG DOH New
    STGs, 2000
  • Patients frequently fail to adhere to the correct
    3-day dosage regimen recommended by PNG Adult
    STGs

3
Study Objectives
  • To contribute to the improvement of malaria
    treatment at Port Moresby General Hospital (PMGH)
    Outpatient Department (OPD) through intervention
    by pre-packaged regimens with clearly delineated
    daily doses and special counselling instructions.
  • To examine acceptability of the pre-package by
    prescribing and dispensing health workers.

4
Methods
  • Setting Port Moresby General Hospital
  • (PMGH), PNGs referral hospital.
  • Study patients Consenting Adult
  • outpatients with uncomplicated malaria.
  • Intervention An appropriately labelled
  • pre-package with partitioned, coloured
  • sectors, each containing medications for
  • each of the 3-days specified in the STGs.
  • Design of pre-package packaging
  • A transparent polyethylene bag was partitioned
    into three sectors and names of the drugs, and
    instructions for use were clearly printed on a
    card under each sector of the bag, which was also
    differently colour coded. The three major
    languages English, Pidgin and Motu were
    separately employed in the instructions. The
    Figure below shows a pre-package with English
    instructions.

5
CHLOROQUINE TABLETS
Figure 1. Design of the Pre-package and
Packaging
6
Methods (Continued)
  • Documentation from Interviews Patient cards
  • Each patient was interviewed a questionnaire
  • was completed including the following
  • Patient characteristics Gender, language spoken,
    diagnosis and drug treatment given.
  • Other medicines prescribed
  • Whether the patient was informed (instructed)
    about malaria.
  • The patients understanding of instructions about
    antimalarial drug use.
  • Data Analysis
  • Tabulations of specific characteristics and
    responses of intervention and control groups were
    made with the help of Excel spreadsheets.
    Chi-square analysis was performed, and the level
    of significance was set at p lt 0.05

7
Special counseling Instructions
  • Special instructions explained to the
  • patient
  • the need for early treatment of
  • uncomplicated malaria,
  • Possible side effects of antimalarials
  • The need to report serious side effects
  • of the antimalarial drugs
  • The Intervention group was compared
  • with two Control Groups A and B.
  • Control Group A Standard package with
    special instructions.
  • Control Group B Standard package
    without special instructions

8
Methods (Continued)
  • Patient Review on the Fourth Day
  • Follow-up reviews on the fourth day were to
  • elicit whether the patient
  • was cured
  • took all drugs as prescribed
  • could recall information about the disease and
    instructions on malaria drug usage as given in
    the first visit.
  • A separate questionnaire sought the
  • views of Prescribing and Dispensing
  • Health Workers on their acceptability of
  • the prepackage and whether they thought
  • it would
  • improve patient compliance
  • improve Patient drug management
  • improve Clarity of directions to patients
  • reduce waiting time and treatment costs
  • be suitable to present other standard treatments.

9
Results ( Tables 1 4)
Table 1. Number of patients enrolled in
intervention and control groups and their basic
characteristics.
Figures in parenthesis are percentages
10
Table 2. Patients understanding about malaria
and instructions on drug usage as compared among
Intervention and Control Groups A and B.
Figures in parenthesis are percentages 1.
Intervention vs. Control Group A p gt 0.05
Intervention vs. Control Group B p lt 0.001 2.
Intervention vs. Control Group A p gt 0.05
Intervention vs. Control Group B p lt 0.001
11
Table 3. Number of patients reviewed, and their
compliance ratings () among all groups.
Intervention vs. Control Group A p gt
0.05 Intervention vs. Control Group B p lt
0.001 Control Group A vs.
Control Group B p lt 0.001 Good Patients
ability to remember instructions, and to
complete regimen as directed Poor
Inability to recall instructions, and non
adherence to prescribers directions.
Table 4. Views Of Prescribing Dispensing
Health Workers on the New Pre-package.
Figures in parenthesis represent percentages of
(N 40)
12
Discussion
  • This study demonstrated an 18 increase in
    compliance when an intervention prepackage linked
    with special instructions were applied, compared
    to control group B that was neither given a
    prepackage nor additional special instructions.
  • Increase in compliance was comparable to findings
    of similar studies elsewhere.
  • In Ghana, pre-packaging of antimalarial tablets
    and syrups increased compliance by 21.5 22.1
    resp. (Yeboah-Antwi. K et al., 2001)
  • In China, organized blister prepackaging improved
    patient compliance by 20 (Quinjun L et al.,
    1998)
  • verbal information about the disease, and
    instructions pertinent to the effects of drug(s)
    used showed impact on compliance.
  • Majority (70) of health workers interviewed
    supported the introduction of the new
    pre-package, while 30 were doubtful or
    undecided.

13
Conclusion and Recommendations
  • The pre-package linked with clear printed and
  • verbal instructions significantly improved
    patient
  • compliance in taking antimalarial drugs.
  • Pre-packaging could eliminate contaminations of
  • the products inherent in the existing
    extempo-
  • raneous repacking of patient regimens from
    bulk
  • products.
  • Product stability may also be enhanced by the
    pre- package system.
  • Blister packaging should be employed in its final
  • design.
  • We recommend to the appropriate health
  • authorities in Papua New Guinea to consider
    the
  • implementation of the new antimalarials
    pre-
  • packaging system.
  • References
  • Papua New Guinea National Health Plan 2001
    2010, Vol III 1999. Department of Health, Papua
    New Guinea.
  • Department of Health. Announcement of new
    combination treatments for all malaria in Papua
    New Guinea. August 2000.
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