Pharmaceutical services for non-complicated malaria by p. vivax e p. falciparum in high-risk municipalities of the Brazilian Amazon: Organization of services, prescribing, dispensing and adherence to treatment

Malaria is a serious public health hazard worldwide. In the disease is prevalent in the Amazon and the national program rationale is based on early diagnosis and treatment, thus making pharmaceutical services into a key element for control. We present an evaluation of pharmaceutical services for malaria complying with directives of the Brazilian National Medicines Policy. An evaluation methodology was developed. Field work involved a pilot study and visits to fifteen health facilities in six high-risk municipalities. A total of 15 managers and 601 patients were interviewed; 175 were followed prospectively. All participants gave informed consent. Data was analyzed descriptively. National treatment guidelines were present in 12 of 15 facilities. These were over or understocked and supply was not based on forecasting. Only 2 had a storage area and in these Good Storage Practices scored 70%. Only two facilities in 2 municipalities provided prescriptions. Two to 3 antimalarials were included in 76.4% treatment regimens. Adequate labeling occurred in 44.4% for arthemeter-lumefantrine, 12.3% for chloroquine and 6.9% for primaquine. All other medicines presented inadequate or inexistent labeling. There were 473 patients who received P. vivax regimens (21.6% were counseled on medicines), 93 P. falciparum regimens (41.9% were counseled); 35 received regimens not recommended by the official national guideline. Self-reported adherence was 61.1% and for pill counts 56.6%. After application of mandatory criteria for adherence percentages fell to 6.7% in self-reports and 7.3% in pill counts. Pharmaceutical services for malaria present problems in organization of services, prescribing, dispensing and adherence. They may compromise care, leading to increase in disease prevalence and drug resistance in these municipalities.