Abstract
ObjectiveThe dearth of age-appropriate formulations of many medicines for children poses a major challenge to pediatric therapeutic practice, adherence, and health care delivery worldwide. We provide information on current administration practices of pediatric medicines and describe key stakeholder preferences for new formulation characteristics.Patients and MethodsWe surveyed children aged 6–12 years, parents/caregivers over age 18 with children under age 12, and healthcare workers in 10 regions of Tanzania to determine current pediatric medicine prescription and administration practices as well as preferences for new formulations. Analyses were stratified by setting, pediatric age group, parent/caregiver education, and healthcare worker cadre.ResultsComplete data were available for 206 children, 202 parents/caregivers, and 202 healthcare workers. Swallowing oral solid dosage forms whole or crushing/dissolving them and mixing with water were the two most frequently reported methods of administration. Children frequently reported disliking medication taste, and many had vomited doses. Healthcare workers reported medicine availability most significantly influences prescribing practices. Most parents/caregivers and children prefer sweet-tasting medicine. Parents/caregivers and healthcare workers prefer oral liquid dosage forms for young children, and had similar thresholds for the maximum number of oral solid dosage forms children at different ages can take.ConclusionsThere are many impediments to acceptable and accurate administration of medicines to children. Current practices are associated with poor tolerability and the potential for under- or over-dosing. Children, parents/caregivers, and healthcare workers in Tanzania have clear preferences for tastes and formulations, which should inform the development, manufacturing, and marketing of pediatric medications for resource-limited settings.
Highlights
Seven million children under the age of five die every year, many from treatable conditions for which we lack adequate pediatric medicine formulations. [1] As a result, healthcare workers often report using adult formulations for the treatment of children with diseases such as HIV/AIDS, tuberculosis, and malaria [2], which can lead to reduced efficacy and/or toxicity [3]
Complete data were available for 206 children, 202 parents/caregivers, and 202 healthcare workers
We interviewed a random sample of parents/caregivers of children under age 12 who themselves were aged 18 years or older; healthcare workers who were medical officers, clinical officers, nurses or pharmacists registered with the Ministry of Health; and children between the ages of 6 and 12 years
Summary
Seven million children under the age of five die every year, many from treatable conditions for which we lack adequate pediatric medicine formulations. [1] As a result, healthcare workers often report using adult formulations for the treatment of children with diseases such as HIV/AIDS, tuberculosis, and malaria [2], which can lead to reduced efficacy (due to underdosing) and/or toxicity (due to over-dosing) [3]. Key drivers of the proper formulation of pediatric medications include parent/caregiver, healthcare worker, and patient preferences for medicine appearance, form, and basic taste (i.e., sweet, sour, bitter) as well as refrigeration requirements, ease of transport, and flavors that correspond to culturally appropriate and recognized food or drink. These factors remain under-studied, especially in resource-limited settings [10,11,12,13,14]. Given the critical role that home administration habits, medicine palatability and formulation preferences play in pediatric medication adherence, it is important to understand the practices of parents/caregivers and to engage them in efforts to promote rational use and to improve administration options. [15]
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