Measuring Medicine Use in Children under 5years: Methodological issues and analysis of progress 1990-2009

Ivanovska, Verica and Holloway, Kathleen and Ross-Degnan, Dennis (2012) Measuring Medicine Use in Children under 5years: Methodological issues and analysis of progress 1990-2009. In: Utrecht WHO Winter meeting 2012, 5-6 Jan 2012, Utrecht University, the Netherlands. (Unpublished)

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Background: Many low- and middle-income countries (LMIC) have tried to improve treatment of child acute illnesses, but scant evidence exists about progress. Objectives: To undertake a systematic review of studies in order to provide an overview of medicine use in children under 5 years in LMIC and identify effective interventions. Search strategy and methods: Quantitative data was systematically extracted from published and unpublished studies from 1990 to 2009 on medicine use in children under 5 years in primary health care in LMIC. Pertinent data was entered in WHO database providing details on study setting, methodology, interventions, and outcomes based on standard indicators of medicines use. To estimate trends over time, the average of each indicator was calculated (limited to baseline data for interventions) by study year, region, facility ownership and prescriber type. To estimate intervention impacts, summary effect sizes was calculated for studies meeting accepted design criteria. The indicator with the greatest effect size (GES) and the median effect size (MES) over all indicators were examined. Results: Data was extracted for 394 studies conducted in 78 countries; 75% reported data from the public sector and 25% from the private-for-profit sector. From 1992 to 2009, we observed no improvements in percentage of pneumonia cases treated appropriately with antibiotics and non-pneumonia cases receiving inappropriate antibiotics. Treatment of childhood diarrhoea remains poor in regards to diarrhea cases treated with ORS and diarrhea cases treated inappropriately with antibiotics, and only use of antidiarrheals shows improvement. Public sector practices tended to be better than private sector. Interventions were reported in 57% of studies, but of those only 20% used adequate study design. Multi-component interventions tended to have larger effects than single-component ones. Conclusions: Treatment of child illness remains suboptimal in LMIC. Although many well-designed interventions reported positive effects, there has been no observable improvement in practice.

Item Type: Conference or Workshop Item (Lecture)
Subjects: Medical and Health Sciences > Health sciences
Divisions: Faculty of Medical Science
Depositing User: Verica Ivanovska
Date Deposited: 10 Apr 2017 10:09
Last Modified: 10 Apr 2017 10:09

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