Publication: Access to primaquine in the last mile: Challenges at the service delivery points in pre-elimination era, Myanmar 11 Medical and Health Sciences 1117 Public Health and Health Services 16 Studies in Human Society 1605 Policy and Administration
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Issued Date
2018-09-18
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ISSN
13494147
13488945
13488945
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2-s2.0-85053671278
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Mahidol University
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SCOPUS
Bibliographic Citation
Tropical Medicine and Health. Vol.46, No.1 (2018)
Suggested Citation
Kay Thwe Han, Khin Thet Wai, Tin Oo, Aung Thi, Zayar Han, Daw Kyin Hla Aye, Aung Ye Naung Win, Jetsumon Prachumsri Access to primaquine in the last mile: Challenges at the service delivery points in pre-elimination era, Myanmar 11 Medical and Health Sciences 1117 Public Health and Health Services 16 Studies in Human Society 1605 Policy and Administration. Tropical Medicine and Health. Vol.46, No.1 (2018). doi:10.1186/s41182-018-0115-8 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/46320
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Title
Access to primaquine in the last mile: Challenges at the service delivery points in pre-elimination era, Myanmar 11 Medical and Health Sciences 1117 Public Health and Health Services 16 Studies in Human Society 1605 Policy and Administration
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Abstract
© 2018 The Author(s). Background: Alongside monitoring of the disease burden, the successful move towards malaria elimination relies on the readiness of the health care delivery system. However, there is a lack of evidence in the gap of existing National Guidelines and access to low dose primaquine in real practice under varying degrees of antimalarial resistance in the pre-elimination phase in Myanmar. Therefore, this study addressed the essential information from the service delivery points (SDPs) of public and private sectors on the availability and the use of primaquine in both supply and demand side. Concomitantly, the study aimed to underscore challenges in health system infrastructure to promote the sustained flow in rolling out primaquine in line with National Guidelines for malaria elimination. Methods: A cross-sectional study conducted from September 2017 to February 2018 included six townships of three states/regions. The team used an observation checklist for documenting primaquine supplies at SDPs. Semi-structured interviews, key informant, and in-depth interviews focused both public and private sectors including staff from the Vector-Borne Diseases Control (VBDC) teams in each state/region and rural health centers (n = 25), those from the non-governmental organizations (NGOs), general practitioners and drug sellers (n = 11), and recently infected malaria patients (n = 11). Triangulation of quantitative and qualitative data provided meaningful interpretations. Results: Public sector staff reported an adequate stock of primaquine, but it was unavailable at the general practitioners' clinics without any connection to NGOs and also at the unlicensed drug shops. Health care providers of the public sector experienced challenges in poor compliance of malaria patients to primaquine treatment in conjunction with an artemisinin-based combination therapy, loss-to-follow-ups especially in conflict areas, and delays in timely substitution of new batches of primaquine. Respondents from the private sector demanded for the refresher training course on updated antimalarial treatment guidelines. Conclusion: Monitoring compliance and safety of primaquine treatment was found as a barrier especially among mobile migrant workers and those who were in conflict areas. An alternative strategy by the NMCP could enable to prevent the underutilization of primaquine in vivax malaria to reach the malaria elimination targets.