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Catherine Vialle-Valentin, Robert LeCates, Fang Zhang, Dennis Ross-Degnan

Treating Acute Fever with Artemisinin-Based Combination Therapy: Prevalence and Predictors in Five African Household Surveys. Catherine Vialle-Valentin, Robert LeCates, Fang Zhang, Dennis Ross-Degnan

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Catherine Vialle-Valentin, Robert LeCates, Fang Zhang, Dennis Ross-Degnan

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  1. Treating Acute Fever with Artemisinin-Based Combination Therapy: Prevalence and Predictors in Five African Household Surveys Catherine Vialle-Valentin, Robert LeCates, Fang Zhang, Dennis Ross-Degnan Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute Presented by Dr. Catherine Vialle-Valentin ICIUM2011 Malaria Session 1f - 16th November, 2011

  2. Background Little evidence exists about the behaviors and perceptions of care givers and patients with regard to national recommendations to switch from well-established practices to new malaria treatment paradigms Medicines household surveys can measure the actual utilization of ACT in the community.

  3. Study Objectives To describe the early impact on households of national policies recommending ACT as first-line therapy to treat cases of suspected malaria To identify predictors of ACT use in communities at high risk of malaria

  4. Methods – WHO Survey Methodology • Standardized rapid cluster sample household surveys • Clusters in proximity to reference public health care facilities (<5km, 5-10km, >10km) • Structured questionnaire collecting • Opinions on medicines and socio-economic data • Name, prescriber, source, cost of medicines taken by sick individuals

  5. Methods - Analysis Open source software EpiData Entry v.2.0 Proportion estimates using Survey commands of StataSE V11.2 Multivariate logistic regression analysis with SAS V9.2

  6. Overall Survey Findings • Of the 2000 individuals reporting a recent episode of acute fever: • 91.8% sought care outside home, • 96.0% took medicines, • 67.0 % received antimalarials, • 16.2% received ACT.

  7. Differences Between Regions

  8. Differences Across Countries

  9. Artemisinin Combinations in the Community

  10. Predictors of ACT Use • Seeking care in the public sector was a strong predictor of ACT use in all four countries where ACT use was documented • Other determinants varied across countries, ACT use was significantly higher when: • Respondents were more educated (Ghana, Kenya, Nigeria) • Households were not poor (Ghana) • Fever was not severe (Nigeria)

  11. Policy Implications and Conclusions The public sector is critically important in implementing national malaria treatment policies Emphasis needs to be put on encouraging ACT use in the private sector and in large urban areas, especially among the poor.

  12. We gratefully acknowledge • WHO EMP and DFID through the Medicines Transparency Alliance, who provided financial support for survey design and implementation • The Harvard Pilgrim Health Care Institute who funded the study • WHO essential medicines advisors, country teams and consultants, who undertook the surveys and provided technical support for data collection and entry

  13. Thank you

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