Interventions to improve the use of antimalarials in south-east Asia: an overview

Abstract

There are few drugs for malaria, and those which are available for use are subject to rapid development of resistance. Curiously, little effort has been made to improve drug use in malaria-endemic countries and to assess the benefits of such improvements. Advances can be made in public understanding of the value of ingesting a full regimen of antimalarials, in order to achieve complete cure, and in improving simple technologies (blister packaging) to achieve the same result. Better efforts can be made to reduce the availability of fake or substandard drugs in the marketplace. In this article, we describe the outcome of a concerted effort to improve drug compliance and drug quality in an area of multidrug resistance for malaria. These research efforts, guided by the Task Force for Improved Use of Antimalarials, characterized the problems in drug compliance in South-East Asia, and developed interventions to improve drug use in the various countries. Interventions involved drug packaging, public information campaigns, and assessments of drug quality. Results show that blister packaging worked best to improve drug compliance and that the increased cost of packaged medication did not limit its use. Drug quality was a major problem in unregulated countries and should be improved.

PIP: Except for the artemisinin derivatives recently deployed in southeast Asia, resistance has emerged to all antimalarial drugs. The Task Force for Improved Use of Antimalarials was created within the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR) in 1993, with the purpose of establishing, through research, measures to take to protect the few existing antimalarials in the southeast Asian region. Research was conducted in China, Myanmar, Cambodia, Thailand, Laos, and Viet Nam. The task force characterized the problems in drug compliance in southeast Asia, and developed interventions to improve drug use in the various countries. Interventions involved drug packaging, public information campaigns, and assessments of drug quality. It was found that blister packaging worked best in improving drug compliance and that the increased cost of packaged medication did not limit its use. Poor drug quality is a major problem in unregulated countries which should be improved.