Soundappan Kathirvel1, Jaya Prasad Tripathy2, Zaw Myo Tun3, Binod Kumar Patro4, Tarundeep Singh1, Ashish Bhalla5, Mahesh Devnani6, Ewan Wilkinson7. 1. Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India. 2. International Union Against Tuberculosis and Lung Disease (The Union), South-east Asia Region, New Delhi, India. 3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore. 4. Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India. 5. Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India. 6. Department of Hospital Administration, Post Graduate Institute of Medical Education & Research, Chandigarh, India. 7. Department of Global Public Health, Institute of Medicine, University of Chester, UK.
Abstract
Background: National drug policies are formulated to encourage rational use of drugs and to reduce drug resistance. This study assessed physicians' compliance with the National Drug Policy on Malaria at a tertiary care hospital in north India. Methods: This mixed method study extracted data from adult malaria inpatient records of the hospital from 2010-2015, and assessed drug supply at pharmacies. Physicians' practices and perspectives were explored by in-depth interviews. Compliance was assessed by severity, type of species and pregnancy status. Thematic analysis was done for the qualitative data. Results: A total of 247 case files were reviewed. Vivax malaria (41.0%) was more common than falciparum malaria (37.2%). The majority (90.8%) of cases were severe malaria. Overall compliance for use of schizonticidal drug was 73.0% in severe malaria and was only 9.5% in uncomplicated malaria. Compliance for use of gametocidal drug (primaquine) was 15.3%. Schizonticidal drugs were available in all pharmacies except the public one. Primaquine was available in only one. The main themes emerging in the thematic network analysis were physicians' misconceptions, physician-related factors, and hospital-related and drug access factors. Conclusions: The degree of compliance for severe malaria treatment was reasonably good but low for radical cure. Raising knowledge and awareness among health care providers, by using written treatment protocols and continuing medical education would improve compliance.
Background: National drug policies are formulated to encourage rational use of drugs and to reduce drug resistance. This study assessed physicians' compliance with the National Drug Policy on Malaria at a tertiary care hospital in north India. Methods: This mixed method study extracted data from adult malaria inpatient records of the hospital from 2010-2015, and assessed drug supply at pharmacies. Physicians' practices and perspectives were explored by in-depth interviews. Compliance was assessed by severity, type of species and pregnancy status. Thematic analysis was done for the qualitative data. Results: A total of 247 case files were reviewed. Vivax malaria (41.0%) was more common than falciparum malaria (37.2%). The majority (90.8%) of cases were severe malaria. Overall compliance for use of schizonticidal drug was 73.0% in severe malaria and was only 9.5% in uncomplicated malaria. Compliance for use of gametocidal drug (primaquine) was 15.3%. Schizonticidal drugs were available in all pharmacies except the public one. Primaquine was available in only one. The main themes emerging in the thematic network analysis were physicians' misconceptions, physician-related factors, and hospital-related and drug access factors. Conclusions: The degree of compliance for severe malaria treatment was reasonably good but low for radical cure. Raising knowledge and awareness among health care providers, by using written treatment protocols and continuing medical education would improve compliance.