Intervention study to improve the misuse of artemisinin and its derivatives at a township in Myanmar

ABSTRACT

Intervention study to remove the misuse of Artemisinin and its derivatives was conducted in Myeik township. Workshops to use Artemisinin compound together with Mefloquine was conducted for doctors, basic health workers and drug dealers separately. Mefloquine tablets that are to be used together with Artemisinin compounds were made available with low price at hospital cost sharing shop, meditrade government clinic and rural health centres. Assessment was done on doctors, basic health workers and drug dealers on how they improve their knowledge on the use of Artemisinin compounds before and 6 months after intervention. Assessment was also done on 100 consecutive patients who had been treated in hospital and another 100 who had been treated outside the hospital before and after intervention. After intervention all doctors and basic health workers, had improved the knowledge of Artemisinin and 90 percent and 36.5 percent of them can give proper dosage of these drugs. All the doctors change their attitude and use combined therapy on all of their patients. Among the general practitioners all 100 percent did use combined therapy, but the patients did not come regularly for 3 day treatment as the cost of first visit is high and patients get better after 24 hours. These are the main reasons for the failure. Ninety-four percent of the drug dealers cannot keep simple records for the sale of these compounds. Only 3.6 percent of the Artemisinin compound bought from the drug dealers continue to buy Mefloquine. This include 46 percent of the patients who bought from the drug store and received referral tickets with necessary instruction to use combined drug therapy. This findings is also supported from the study on ex-patients. We conclude that special strip tablets are required so that all Artemisinin compounds are sold with Mefloquine all in one packet. It is also necessary to enforce the existing Food and Drug Act so that we can give more rigid training to drug dealers.