Abstract
Among the strategies being tested to improve prompt and appropriate treatment of febrile illness, especially malaria, in young children is the prepackaging of antimalarial drugs in easy to use daily dosages. A TDR-sponsored study in three rural communities in southern Nigeria tested a delivery system for prepackaged chloroquine and cotrimoxazole for children aged 6 months to 6 years. A variety of distributors were trained including village health workers (VHWs), patent medicine vendors (PMVs), and health clinic staff. These distributors also performed community health education. During a 12-month study period, 3954 units of project medicines were sold. While VHWs accounted for the majority of distributors and as a group sold the largest proportion of drugs overall, health staff sold the highest number on average. A follow-up survey found a 25 percent increase in the use of antimalarials over baseline, almost all of which could be attributed to sales of the project chloroquine. While there was also an increased use of cotrimoxazole over baseline, the contribution of project drugs was less. PMVs remained the most common source of treatment both before and after intervention, and there was a small but significant rise in the proportion who sought care from VHWs. While 93 percent of respondents sought care for their sick child within 24 hours, there was significantly more delay among those whose first choice was a government or private clinic. Factors that were positively associated with use of project drugs included reports that the child had a high temperature and seeking care from a VHW or PMV. The results indicate that it is possible to gain a significant market share for prepackaged drugs using locally available distribution channels. The value lies in using a variety of channels, both ones that are centrally located and others that are accessible to scattered, outlying communities that are poorly served by orthodox medicine.
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