Table 55.3Potential Nonclinical Interventions: Evidence from Developing Countries

Strategy Intervention Reference Description Study location
Treatment strategiesCombination therapy for malaria Nosten and others 2000 Use of an artesunate-mefloquine combination was found to reduce incidence of mefloquine resistance in Plasmodium falciparum malaria.Thailand
Cycling strategy Kublin and others 2003 Replacement of chloroquine with sulfadoxine- pyrimethamine resulted in a decline in chloroquine-resistant strains over an eight-year period to levels that permit reintroduction of the drug.Malawi
Drug heterogeneityBonhoeffer, Lipsitch, and Levin 1997; Laxminarayan and Weitzman 2002Modeling studies demonstrated the superiority and cost-effectiveness of policies involving use of different antibiotics on different patients compared with those using the same antibiotics on all patients.n.a.
Directly observed therapy short course Balasubramanian, Oommen, and Samuel 2000 Directly observed therapy reduced the probability of treatment failure.Kerala, India
Dye and others 2002 Directly observed therapy for TB was 2.8 times cheaper to deliver and between 2.4 and 4.2 times more effective than conventional treatment.South Africa
Reducing selection pressureTraining providers Bexell and others 1996 Continuing education seminars for paramedical prescribers resulted in patients being prescribed antibiotics less frequently at intervention centers (34 percent) compared with control centers (42 percent). Drug choice and dosing were also improved.Lusaka, Zambia
Santoso, Suryawati, and Prawaitasari 1996 One-on-one educational interventions and seminars for medical and paramedical prescribers reduced antimicrobial prescription by 17 and 10 percent, respectively (p < 0.001).Yogyakarta and Central Java provinces, Indonesia
Training drug sellers Agyepong and others 2002 Training drug dispensers on patient communication resulted in modest improvements in the proportion of patients showing strict, full adherence to antimalarial regimen.Dangme West District, Ghana
Treatment guidelines with education Qingjun and others 1998 Blister packages increased compliance with chloroquine therapy to 97 percent, from 83 percent in the control group.Hunan province, China
Direct education of patients Helitzer-Allen and others 1993 Introduction of a nonbitter antimalarial tablet and a new educational message were effective in improving antimalarial prophylaxis compliance among pregnant women by 57 to 91 percent.Malawi
Paredes and others 1996 Video, radio, and printed bulletins were used to educate women in an intervention community on the management of watery infantile diarrhea. The overuse of nonindicated medicines (antibiotics and antidiarrheals) dropped 11 percent in the intervention group and only 7 percent in the control group.Lima, Peru
Reducing spread of resistance pathogensHand washing Kurlat and others 1998 Training of nursing staff in hand washing, handling of infants, and care of intravenous lines resulted in 40 percent reduction in bacterimia rates.Argentina
Bednets (malaria) Maxwell and others 2002 Use of netting resulted in a 55 to 75 percent reduction in malaria morbidity and consequent conservation of antimalarial drug use.Tanzania
Vaccination Klugman 2001 Pneumococcal vaccines target the serotypes most commonly encountered clinically, which are more likely to be resistant to antimicrobials.South Africa

Source: Authors.

From: Chapter 55, Drug Resistance

Cover of Disease Control Priorities in Developing Countries
Disease Control Priorities in Developing Countries. 2nd edition.
Jamison DT, Breman JG, Measham AR, et al., editors.
Copyright © 2006, The International Bank for Reconstruction and Development/The World Bank Group.

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