Abstract
ObjectivesTo explore the availability and utilization of the World Health Organization (WHO) recommended priority life-saving medicines for children under five in public health facilities in Uganda.MethodsWe conducted a cross sectional survey in 32 lower level public facilities in Jinja district of Uganda. A proportionate number of facilities were randomly selected in each stratum following a hierarchy of Health Centers (HC) defined according to the level of care they provide: 17 HC IIs, 10 HC IIIs and 5 HC IVs. In the facilities, we verified the availability of the WHO recommended priority medicines for diarrhea, sepsis, pneumonia and malaria. 81 health workers from the facilities reported what they prescribed for children with the above diseases.ResultsOral rehydration salt (ORS) and zinc sulphate dispersible tablets for diarrhea were available in all HC IIs and IIIs and in only 60% of HC IVs. Procaine benzyl penicillin injection powder for treatment of sepsis was available in the majority of all HCs with: 100% of HC of IVs, 83% of HC IIIs and 82% of HC IIs. Medicines for pneumonia were limited across all the HCs with: Amoxicillin dispersible tablets in only 30% of the HC IIs and 40% of the HC IVs. The most uncommon were child-friendly priority medicines for malaria with: Artesunate injection in only 6% of HC IIs, 14% of HC IIIs and 20% of HC IVs; Artemether lumefantrine dispersible tablets and rectal artesunate were missing in all the 32 HCs. Less than a third of the health workers reported prescribing zinc sulphate and ORS for diarrhea, 86% reported procaine benzyl penicillin injection powder for sepsis, and 57% reported amoxicillin dispersible tablets for pneumonia. None reported prescribing Artemether lumefantrine dispersible tablets and rectal artesunate for malaria.ConclusionsThere is low availability and utilization of life-saving priority medicines for pneumonia and malaria in public health facilities in Uganda. However, the priority medicines for diarrhea and sepsis are available and highly prescribed by the health workers.
Highlights
An estimated 8.1 million children under five die every year due to conditions that could be prevented or treated with evidence-based medicines [1]
Priority medicines for diarrhea and sepsis Oral rehydration salt (ORS) and zinc sulphate dispersible tablets for treatment of diarrhea were available in all the Health Centers (HC) IIs and IIIs but present in only 60% of the HC IVs
Procaine benzyl penicillin injection powder for treatment of sepsis was available in the majority all HCs; 100% of the HC IVs, 83% HC IIIs and 82% of the HC IIs (Table 2)
Summary
An estimated 8.1 million children under five die every year due to conditions that could be prevented or treated with evidence-based medicines [1]. A study by Robertson and colleagues showed poor availability and accessibility of children’s medicines and in order to achieve substantial progress towards Millennium Development Goals (MDGs), a major effort to improve access to medicines for children will be required [3]. The need for countries to have essential medicines list for children [6]. Studies have shown that child appropriate medicines do not reach the children who need them [5]. The World Health Organization (WHO) and partners launched the Make Medicines Child Size Campaign to increase children’s access to appropriate dosage formulations [9]. The need to access appropriate medicines for children is recognized as an essential step in achieving the Millennium Development Goals 4 and 6 [3,10]
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