Amoxicillin Adherence Aids

UNICEF is working in partnership with WHO and other stakeholders to accelerate child pneumonia mortality declines by advancing WHO prequalification for the medicines used to treat pneumonia, including Amoxicillin dispersible tablets.

Child held in mother's arm

The Challenge

Pneumonia is the leading cause of infectious disease death among children under five. Over 920,000 children died from pneumonia in 2016, accounting for 16 percent of all child deaths under five years of age. The high burden of childhood pneumonia deaths belies the fact that pneumonia-related mortality is preventable with simple interventions and appropriate treatment. WHO recommends Amoxicillin for the treatment of childhood pneumonia, preferably in child-friendly dispersible tablet (DT) formulation. Despite these recommendations, only roughly one-third of pneumonia cases receive antibiotics as part of the treatment regimen, and even when antibiotics are available, the full course of antibiotics is not consistently taken.

The Project

Lack of knowledge amongst caregivers and healthcare providers in terms of dosage, preparation and administration of Amoxicillin DT as well as the patients’ failure to properly complete the prescribed course of Amoxicillin DT can lead to treatment failure, pneumonia relapse and the increased potential of drug resistance.

The project’s goal is to increase the correct utilization of the Amoxicillin treatment regimen which is dependent on an understanding of how to take the medication as prescribed.  To increase the capacity of community based caregivers and health care providers (HCP) to prescribe and dispense appropriate treatment for childhood pneumonia, UNICEF and PATH have developed a job aid (JA) and user-friendly product presentation (PP) for Amoxicillin DT. The JA and PP designs included consultation with a designer, manufacturers, and key stakeholders in the Amoxicillin supply chain. Caregivers and HCP need to have a clear understanding of how to administer Amoxicillin DT to children including the dosage, frequency and timing of treatment as well as preparation. Job aids and clear instructions for medication can facilitate better treatment adherence and when used by HCP, job aids can improve performance, promote compliance with standards and recommendations and reduce the costs of training and re-training. Medicine labels using pictograms have also been shown to improve understanding of and adherence to treatment regimens among patients and caregivers.  

Prior to the roll-out of the adherence aids, a qualitative study was conducted in Zimbabwe, Niger, the Solomon Islands and Bolivia to assess their acceptability, usability and feasibility. Across the four countries, knowledge of pneumonia was persistently poor amongst caregivers, yet they demonstrated an overtly positive response to the product presentations, which they regarded as being highly relevant, acceptable and beneficial in reinforcing how Amoxicillin should be administered to children.  

The tools were fit for purpose and the product presentations worked well as a guide or aide-mémoire, although errors in some caregivers’ reading of the instructions demonstrated that they were not sufficiently reliable as a stand-alone tool.  It was evident, however, that if the product presentation was described to caregivers at the clinic when Amoxicillin was prescribed, then issues of misinterpretation could be mitigated.  Overall, both the caregivers and service providers who participated in the study reacted positively to the new materials, and core findings demonstrated high levels of acceptability, usability and feasibility.