E-drug: Drug formulations suitable for use in children (cont'd)
---------------------------------------------
[Norman Nyazema, July 23, responded to Robert
Ogenyi's earlier posted message, regarding
children's formulations, particularly ARVs in
Botswana. Robert feels that Dr Nyazema
misunderstood some of the issues. He wishes to
clarify. BS]
Dear e-druggers
I read with interest the reply to my contribution
from Norman Nyazema that there is a problem
regarding rational use of ARVS in Botswana. This
is not true. Though I can see reading through my
contribution why he could easily have arrived at
such a conclusion. The context of the
contribution is with regards to problems in
adherence to ARV drug regimen in pediatrics
(especially under five years) that cannot give
themselves their medication. They have to depend
on care givers. I was trying to inform in the
setting where the drugs are available, certain
conditions that can and do affect adherence.
� The number of medications given, number of
instruments on measures of doses to be given for
the numerous medications, complexity of the
measures etc which can becomes cumbersome and
difficult to understand by caregivers whether
old, bad of sight, uneducated etc.
� Absence of standardized user-friendly
measuring device. In our set up, a different
measuring device is given for different
medication; different instructions for different
measuring devices as well as different
calibrations of measure on the different
measuring instruments, making it difficult for
these sets of caregivers. There is need for
appropriate devices, a sort of one measuring
instrument for all medication (Liquid) to help
these sets of people improve adherence.
Yes, Most of our patients under five are provided
care by elderly people. Where this is the case,
adherence to treatment in pediatrics is and will
continue to be a problem even outside ARVs.
The mention of stock out was an observation,
which happened only during the beginning of the
program when we experienced some delay in
supplies but it is definitely does not translate
into a rational drug use problem nationally. It
was added to illustrate how unavailability can
compound adherence issue. If the impression reads
like we get stock outs frequently, it was
un-intended and does not reflect the true
situation on ground. It is a wrong basis for
drawing and making such a conclusive generalized
statement.
The moderator has rightly put it into
perspective, the problem is not in the education
or information given to caregivers but in
providing appropriate support to make the care
giving job not an additional burden but easier
for them. The aim of my contribution is two fold.
First, is the need to develop and provide devices
that will allow easier, correct, and consistent
doses of the medication to be given to the child
and at the same time user friendly. Secondly is
to highlight the need to build in support for
such class of caregivers to improve on adherence
in children under-fives.
One of the known impacts of HIV/AIDS across the
continent is the increase in orphaned children.
It has also been documented that this has led to
an increase in the number of older people
providing care for such orphans. Care in the
sense of socioeconomic support as well as
healthcare, including HIV/AIDS care. This is a
recognized and well-documented consequence of the
devastating impact of HIV/AIDS across sub-Saharan
Africa. The issue of 'OLD, WEAK AND NOT TOO GOOD
OF SIGHT People administering ARVs to children';
is a problem that exists and will continue to
exist across Africa and even other regions of the
world where the epidemic is allowed to reach an
advanced stage.
I do not understand what you were referring to,
or the people you mentioned that are aware of
what you are talking about. You might send me
some details of that. But, in my opinion, the
Antiretroviral treatment program of the
Government of Botswana has been a tremendous
success though it is generally agreed that it has
not met its target in terms of the total number
of people to be enrolled into the program. It has
enjoyed the highest political, financial and
technical support. The situation I used in my
contribution occurred in the beginning of the
program and all implementers of programs know
that such teething problem like stock-out is
likely to occur until the system stabilizes.
There is a third phase, expansion of the
treatment to more centers across the nation.
There has been a detailed and consistent
application of designs in the roll out of the
program here in Botswana. A great deal of
attention is paid to all detail of the technical
requirement of the program along with the
concomitant provision of the budgetary allocation
needed to implement it. Such commitment and
fastidious implementation of the National
HIV/AIDS policy surely shows a high degree of
preparedness as well as a high level of
seriousness in the fight against the scourge in
Botswana. No one who has been on ground can even
begin to either accuse or question the
preparedness or seriousness on the part of the
government of Botswana in the roll out of the
program. Right from the start of the program, the
requirement or insistence of the presence of
Pharmacist(s) at every treatment site and in all
the supply chain of the system was a deliberate
attempt to ensure and monitor rational drug use
in ARVs across Botswana. So far, a tremendous
amount of progress has been made in that
direction and the impact of the presence of the
Pharmacists as professionals in the systems has
been acknowledged to have contributed in no small
measure to the levels of rational drug use in the
system.
Robert Ogenyi
Head of Pharmacy
Mahalapye District Hospital
Botswana
Robert Ogenyi <robitess2000@yahoo.com>
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