Children’s Medicines in Tanzania: A National Survey of Administration Practices and Preferences

Abstract

ObjectiveThe dearth of age-appropriate formulations of many medicines for children poses a major challenge to pediatric therapeutic practice, adherence, and health care delivery worldwide. We provide information on current administration practices of pediatric medicines and describe key stakeholder preferences for new formulation characteristics.Patients and MethodsWe surveyed children aged 6–12 years, parents/caregivers over age 18 with children under age 12, and healthcare workers in 10 regions of Tanzania to determine current pediatric medicine prescription and administration practices as well as preferences for new formulations. Analyses were stratified by setting, pediatric age group, parent/caregiver education, and healthcare worker cadre.ResultsComplete data were available for 206 children, 202 parents/caregivers, and 202 healthcare workers. Swallowing oral solid dosage forms whole or crushing/dissolving them and mixing with water were the two most frequently reported methods of administration. Children frequently reported disliking medication taste, and many had vomited doses. Healthcare workers reported medicine availability most significantly influences prescribing practices. Most parents/caregivers and children prefer sweet-tasting medicine. Parents/caregivers and healthcare workers prefer oral liquid dosage forms for young children, and had similar thresholds for the maximum number of oral solid dosage forms children at different ages can take.ConclusionsThere are many impediments to acceptable and accurate administration of medicines to children. Current practices are associated with poor tolerability and the potential for under- or over-dosing. Children, parents/caregivers, and healthcare workers in Tanzania have clear preferences for tastes and formulations, which should inform the development, manufacturing, and marketing of pediatric medications for resource-limited settings.

Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children’s Acceptability of Oral Formulations (CALF) Study

“…(Hermes Pharma, 2015). In contrast, Adams et al found that caregivers in Tanzania preferred pills to be swallowed intact, over chewable forms for school aged children (Adams et al, 2013). Notable differences in parental attitudes to orodispersible tablets have also been shown 290 between European countries (Valovirta and Scadding, 2009).…”

“…This can be 375 with the aim to improve acceptability, to facilitate administration, provide an appropriate dose, or a combination thereof. The nature, motives and consequences of these practices remains an under researched area; however, they have been widely reported amongst healthcare professionals (Skwierczynski and Conroy, 2008, Akram and Mullen, 2012, Richey et al, 2013 and as "coping strategies" among children and their caregivers (Hansen et al, 2008, Adams et al, 2013, Bryson, 380 2014.…”

Evidence of acceptability of oral paediatric medicines: a review*

“…The quantity of solid dosage forms was reported as a main problem when administering medicines to patients with HIV. [51] In a study by Adams et al, [52] the number of tablets that parents/caregivers and healthcare workers thought was acceptable for children in Tanzania to take as a single dose was reported. Typically, one tablet was felt to be most appropriate for children in early years of primary school (under 8 years) rising to two tablets in last years of primary school (9-12 years).…”

Taste acceptance of Captopril and Furosemide Extemporaneous Oral Pediatric Formulations among Hospitalized Children

“…However, this "ideal" situation is unlikely to be achieved in the short term, especially where resources are limited. Adams et al [47] noted the frequent need for preparation of drug formulations by crushing the pills made them so bitter to the point of causing vomiting in pediatric patients of rural and urban areas of Tanzania. A similar situation is found in Brazil, where the need to prepare extemporaneous formulations is still a commonplace reality, particularly in pediatrics and even more with respect to cardiovascular drugs [1,10,48,49].…”

“…In addition, a vehicle provides greater stability of the formulation [50]. Access to safe and palatable pediatric formulations and its rational use must remain a major goal in health development worldwide [47], and may have a substantial effect on child morbidity [28].…”