Combatting Inappropriate Pediatric Medication Sales in Siem Reap, Cambodia

2. THE INAPPROPRIATE SALE OF MEDICATION FOR PEDIATRIC USE IN SIEM REAP PROVINCE, KINGDOM OF CAMBODIA

3. THE INAPPROPRIATE SALE OF MEDICATION FOR PEDIATRIC USE IN SIEM REAP PROVINCE, KINGDOM OF CAMBODIA AUTHORS: Sothearith Tiv Ph., Rathi Guhadasan MBBS MRCP DTM&H, Eliza Romey M.A. INSTITUTION: Angkor Hospital for Children Siem Reap, Kingdom of Cambodia

4. Presentation outline • Background • Objectives • Study Setting • Methodology • Results • Summary • Conclusions and Policy implication

5. Background In Cambodia, many rural inhabitants rely on unqualified drug sellers for their primary health care. Patients can buy medicine from pharmacies without a doctor’s prescription. It is estimated that 80% of pharmacies in Siem Reap province are staffed by unqualified pharmacists. Illegal Drug sellers also operate in markets or from their homes. Medications, often unnecessary, are sold in combinations which are contraindicated, and children are regularly prescribed adult doses.

6. Objectives • To reduce harm caused to children from inappropriate drug prescriptions. • To identify groups of drug sellers in Siem Reap for education about commonly prescribed drugs in children. • To identify areas of weakness in pharmaceutical knowledge for targeted education to different groups of drug sellers in Siem Reap. • To identify common problem areas for targeted public health education at Angkor Hospital for Children (AHC).

7. Study Setting Collect information from 50 AHC outpatients from Siem Reap province presenting at the AHC pharmacy between 1st to 31st December 2003, who have previously taken drugs from elsewhere for the same illness. All questionnaires were administered AHC pharmacy staff using a standardized interview questionnaire.

8. Methodology Data to be gathered including: • gender and age of the child, • patient resident in Siem Reap province, • location and type of drug seller, • information given to drug seller by carer, • advice given by drug seller, • adverse effect, • AHC doctor’s diagnosis, • dose and duration of prescribed medicine.

9. Results • < 5 years : 88% • > 5years : 12% • Males = Females • rural : 62% • urban : 38% • AHC doctor’s diagnosis: • 47%: URI, Dysentery, Diarrhea • 53%: others diseases • Sources of medicine previously purchased: • 74%: clinic and pharmacy • 26%: market

10. Table show the Incorrect Prescription according to Cambodia National guidelines and AHC guideline.

11. Results • Most Common Errors: • Prescribed without indication: Chloramphenicol, Tetracycline, Loperamide, Promethazine • Poly pharmacy • Adult doses • Most Common of Adverse Effects: • Vomiting • Drowsiness • Dizziness • Extrapyramidal reaction

12. Summary • 3cases received medicine from private clinic • Those drugs are often inappropriate and even dangerous. • Adult doses are often prescribed for children and infants. • Multiple preparation of Paracetamol may be prescribe simultaneously. • Incomplete courses of antibiotics, which may lead to partial treatment of condition such as meningitis, are given. This may have serious medical consequence and also lead to the development of antibiotic resistance. • Many patients present late because the drug sellers tried to treat them without referral to hospital or health center for proper diagnosis.

13. Conclusions and Policy implications • Education drug seller and pharmacists • Common dangerous practices • Danger signs necessitating immediate referral to hospital • Public health education in appropriate health seeking behavior and use of medicine • Strict enforcement of regulation relating to sale of drugs for children

14. Thank you