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The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints
Background Timor-Leste changed its malaria treatment protocol in 2007, replacing the first-line for falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. This study explored the factors affecting the implementation of the revised treatment protocol, with an emphasis on ident...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Oxford University Press
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513764/ https://www.ncbi.nlm.nih.gov/pubmed/22460007 http://dx.doi.org/10.1093/heapol/czs019 |
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author | Martins, João Soares Zwi, Anthony B Hobday, Karen Bonaparte, Fernando Kelly, Paul M |
author_facet | Martins, João Soares Zwi, Anthony B Hobday, Karen Bonaparte, Fernando Kelly, Paul M |
author_sort | Martins, João Soares |
collection | PubMed |
description | Background Timor-Leste changed its malaria treatment protocol in 2007, replacing the first-line for falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. This study explored the factors affecting the implementation of the revised treatment protocol, with an emphasis on identifying key constraints. Methods A mixed method approach drew on both qualitative and quantitative data. The study included data from District Health Services in seven districts, community health centres in 14 sub-districts, four hospitals, five private clinics, one private pharmacy and the country's autonomous medical store. In-depth interviews with 36 key informants, five group interviews and 15 focus group discussions were conducted. A survey was also undertaken at community health centres and hospitals to assess the availability of a physical copy of the Malaria Treatment Protocol, as well as the availability and utilization of artemether-lumefantrine and sulphadoxine-pyrimethamine. Results Many factors impeded the implementation of the new malaria protocol. These included: inadequate introduction and training around the revised treatment protocol; unclear phasing out of sulphadoxine-pyrimethamine and phasing in of the revised treatment, artemether-lumefantrine, and the rapid diagnostic test (RDT); lack of supervision; lack of adherence to the revised guidelines by foreign health workers; lack of access to the new drug by the private sector; obstacles in the procurement process; and the use of trade names rather than generic drug description. Insufficient understanding of the rapid diagnostic test and the untimely supply of drugs further hampered implementation. Conclusion To effectively implement a revised malaria treatment protocol, barriers should be identified during the policy formulation process and those emerging during implementation should be recognized promptly and addressed. |
format | Online Article Text |
id | pubmed-3513764 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-35137642012-12-04 The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints Martins, João Soares Zwi, Anthony B Hobday, Karen Bonaparte, Fernando Kelly, Paul M Health Policy Plan Original Articles Background Timor-Leste changed its malaria treatment protocol in 2007, replacing the first-line for falciparum malaria from sulphadoxine-pyrimethamine to artemether-lumefantrine. This study explored the factors affecting the implementation of the revised treatment protocol, with an emphasis on identifying key constraints. Methods A mixed method approach drew on both qualitative and quantitative data. The study included data from District Health Services in seven districts, community health centres in 14 sub-districts, four hospitals, five private clinics, one private pharmacy and the country's autonomous medical store. In-depth interviews with 36 key informants, five group interviews and 15 focus group discussions were conducted. A survey was also undertaken at community health centres and hospitals to assess the availability of a physical copy of the Malaria Treatment Protocol, as well as the availability and utilization of artemether-lumefantrine and sulphadoxine-pyrimethamine. Results Many factors impeded the implementation of the new malaria protocol. These included: inadequate introduction and training around the revised treatment protocol; unclear phasing out of sulphadoxine-pyrimethamine and phasing in of the revised treatment, artemether-lumefantrine, and the rapid diagnostic test (RDT); lack of supervision; lack of adherence to the revised guidelines by foreign health workers; lack of access to the new drug by the private sector; obstacles in the procurement process; and the use of trade names rather than generic drug description. Insufficient understanding of the rapid diagnostic test and the untimely supply of drugs further hampered implementation. Conclusion To effectively implement a revised malaria treatment protocol, barriers should be identified during the policy formulation process and those emerging during implementation should be recognized promptly and addressed. Oxford University Press 2012-12 2012-03-29 /pmc/articles/PMC3513764/ /pubmed/22460007 http://dx.doi.org/10.1093/heapol/czs019 Text en Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2012; all rights reserved. http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Martins, João Soares Zwi, Anthony B Hobday, Karen Bonaparte, Fernando Kelly, Paul M The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints |
title | The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints |
title_full | The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints |
title_fullStr | The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints |
title_full_unstemmed | The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints |
title_short | The implementation of a new Malaria Treatment Protocol in Timor-Leste: challenges and constraints |
title_sort | implementation of a new malaria treatment protocol in timor-leste: challenges and constraints |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513764/ https://www.ncbi.nlm.nih.gov/pubmed/22460007 http://dx.doi.org/10.1093/heapol/czs019 |
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