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Bethesda, Maryland, Center for Human Services, Quality Assurance Project, 2002 Feb. 16 p. (Operations Research Results; USAID Contract No. HRN-C-00-96-90013)Private drug outlets have grown increasingly important as the main source of malaria treatment for residents of malaria endemic areas. Unfortunately, the quality of information and the quantity and quality of drugs provided is often deficient. The World Health Organization has included the private sector in its Roll Back Malaria strategy, but has noted that it is notoriously difficult to change private sector practices without burdening the governments of developing countries. In the Bungoma district of Kenya, the Quality Assurance Project (USA) teamed up with the Bungoma District Health Management Team and African Medical and Research Foundation to test an innovative, low-cost approach for improving the prescribing practices of private drug outlets. The intervention, called Vendor-to-Vendor Education, involved training and equipping wholesale counter attendants and mobile vendors with customized job aids for distribution to small rural and peri-urban retailers. The job aids consisted of: (a) a shopkeeper poster that described the new malaria guidelines, provided a treatment schedule, and gave advice on the appropriate actions to take in various scenarios; and (b) a client poster that depicted the five approved malaria drugs and advised clients to ask for them. The training of wholesalers began in April 2000. (author's)
[Unpublished] . 27 p. (USAID Contract No. DPE-5927-C-00-5068-00)Health personnel in Niger report that malaria is the leading diagnosis in health facilities (1980-1984), about 380,000 cases/year), but just 19% of the population live within a 5 km radius of a health facility. A 1985 household survey reveals that 31.4% of children had a febrile illness (presumptive malaria) within the last 2 weeks and 22.1% of all child deaths were presumptive malaria related. The Government of Niger began developing a national malaria program in 1985 to reduce malaria-related deaths rather than morbidity reduction, because available data indicated that morbidity reduction was not feasible. There is no standard treatment regimen for presumptive malaria, however. Some studies indicate that an effective dose regimen is 10 mg chloroquine/kg body weight in a single dose. Some health workers use other antimalarial arbitrarily. Lack of uniformity can increase the risk of chloroquine and Fansidar resistant falciparum. Government officials are thinking about having only chloroquine available at first level facilities. It plans to set up national surveillance for chloroquine resistance. Niger has just 1 trained malariologist, indicating a need for training of more staff. To keep government costs to a minimum, it wants to set chloroquine at all points in the distribution network. The program's plan of action also includes chemoprophylaxis for pregnant women, limited vector control in Niamey, and health education stressing reducing breeding sites. A REACH consultant believes that it is possible for the program to reach its coverage targets within 5 years. Obstacles include limited access to health care, unavailable chloroquine in warehouses, and lack of untrained personnel (the main obstacle). The consultant suggests various interventions to help Niger meet its targets, e.g., periodic coverage surveys. The World Bank, WHO, the Belgian Cooperation, and USAID are either providing or planning to provide support to the malaria control programs.