Background : Amoxicillin dispersible tablet (DT) has been considered as low-cost and high-impact antibiotic for the treatment of childhood pneumonia, however failure to complete the course as prescribed can lead to treatment failure, pneumonia relapse, and the potential for the patient to develop drug resistance. Interventions with job aids and user instructions should be appropriate to improve adherence to the course of treatment.
Material : A quasi-experimental, mixed methods study was conducted in three phases between October 2015 and February 2016 in the two rural sub-districts of Bangladesh. An intervention with job aid and user-friendly instructions was introduced and used in intervention sub-district while standard amoxicillin DT packaging and instructions were used in comparison sub-district. The primary outcome is improving adherence behavior of amoxicillin DT for the treatment of childhood pneumonia. We conducted a semi-structured survey with 56 caregivers in intervention sub-district and 38 caregivers in comparison sub-district. We also evaluated the tools through qualitative interviews with health providers and caregivers to assess the feasibility, usability, and acceptability of the tools in intervention sub-district.
Results : For 5-day courses, about 32.1% (95%CI: 21.0-47.6) caregivers in intervention sub-district and 2.6% (95%CI: 0.3-17.2) in comparison sub-district maintained adherence behavior for their children for treatment of childhood pneumonia with Amoxicillin DT. More children under 12 months were given age-appropriate treatment than older children. Key stakeholders and health care providers considered the use and integration of the tools into the health system to be feasible and acceptable. Key steps to introduce the tools into the health system in intervention sub-district included official approval of tools, advocacy for consensus, and training for the service providers.
Conclusions : The provision of tools for the treatment of childhood pneumonia with amoxicillin DT had a positive influence on adherence behaviors. These tools can help close information gaps and overcome the barriers posed by medical illiteracy and remembering instructions from providers.