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Improving Primary Care Pharmaceutical Use

Pandey

(1991)

Asia

TS&C (repeat meas.)

CHWs

18 subdistricts phased into program

ARI

ARI case mgmt program (CHW small group training, HH visits every 2 wks, home Tx, biweekly supervisory visits)

All cause <5 mortality rate (/1000)

Pneumonia <5 mortality rate (/1000)

RR in yr. 3 = 0.72 = -28%

RR in yr. 3 = 0.70 = -30%

Paredes Solari

(1996)

Latin America

PP&C

Community, MDs

2 periurban areas (mothers of ~450 C and E diarrhea cases; 5 E & 9 C MDs)

Diarrhea

Intensive community intervention (video, market broadcasts, print materials), plus face-to-face visits, booklets, & Rx pads for MDs

Drug use for diarrhea

(all cases)

% AB use

(all cases)

Drug use for diarrhea

(cases seeing MD)

ΔE = 43.1%33.3% = -9.8%

ΔC = 48.8%41.9% = -6.9%

ΔE = 25.5%17.9% = -7.6%

ΔC = 29.3%21.4% = -8.9%

ΔE = 94.6%84.9% = -9.7%

ΔC = 92.4%91.9% = -0.5%

Reddaiah

(1991)

Asia

PP&C

CHWs (multipurpose workers)

1 E (~5000 under-5s) & 1 C (~9000 under-5s) community

ARI

Pilot ARI case mgmt program (train CHWs, monthly refresher, immunization)

All cause <5 mortality rate (/1000)

ARI <5 mortality rate (/1000)

ΔE = 30.318.9 = -37.6%

ΔC = 20.418.5 = -9.3%

ΔE = 5.03.7 = -26.0%

ΔC = 4.45.0 = +13.6%

Bang

(1990, 1994)

Asia

PO&C

CHWs, TBAs, parameds

58 E villages (with 55 CHWs & 86 TBAs), 44 C villages

ARI

ARI case mgmt program (train CHWs & parameds [TBAs later], home Tx, referral, community H ed)

Pneum <5 mortality rate (/1000)

% pneum case fatality

% error free case mgmt

E =8.1 vs. C = 17.5

E = 6.2% vs. C = 13.5%

Δ = 56.7% (yr 1)83.4% (yr 3)

Datta

(1987)

Asia

PO&C

CHWs

37 villages (21 E; 16 C)

ARI

Pilot ARI case mgmt program for low birth weight (LBW) infants (CHW training, weekly home visits, home Tx, referral)

ARI case fatality in LBW infants (/100)

ARI mortality rate in LBW infants (/1000)

E = 8.7

C = 24.6

E = 30

C = 71

-39-

Improving Primary Care Pharmaceutical UseApril, 1997

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