Medication among Children in Africa South of Sahara: Qualitative Systematic Review

1. Medication among Children in Africa South of Sahara: Qualitative Systematic Review Professor Ebba Holme Hansen and Professor Susan R. Whyte ehh@farma.ku.dk University of Copenhagen, Denmark Copenhagen University’s Global Health Cluster temporary fund provided partial funding 

2. Problem statement • The use of medicines is an important aspect of child health • Children are not just “small adults” • However, this topic has been sparsely dealt with in international research, not least in low-income societies. • Objective • To provide an overview of empirical evidence on children and medication in Africa south of Sahara

3. Systematic searches conducted without restrictions in • Medline • Embase • Psychinfo Structured by using the same search terms in similar combinations in all databases • In all searches: • “children” • “Africa, south of Sahara” • “Children” defined as 0-18 years • “Medicines” defined by 80 different search terms

4. Flow chart of included/excluded studies 1530 potentially relevant references Duplicates 719 830 potentially relevant articles • - Purely economic studies • - Diagnostic tools • Drug abuse • Purely clinical studies • Studies where children • and adults are mixed 132 included studies

5. Data handling and extraction Titles and abstracts assessed for eligibility Full text papers Extraction on data sheets

6. Illnesses – in 132 studies

7. Main points • 132 studies from 24 countries • Most studies dealt with children under 5 years • In many studies age group was not specified • Very few studies on prescribing and use • Most studies recognised the multiple sources of treatment (popular, professional, folk sectors)

8. Main points (contd.) • Doses, dispensing, dosage forms barely mentioned • Few studies on perceptions • No reviews of the field of children and medicines in Africa

9. Implications • This study shows that medicine use in children is a neglected topic • except medication treatment of malaria/fever and diarrhoea in small children • As medicine use behaviours may track from childhood and adolescence into adulthood, knowledge about this topic also have implications for the improvement of medicine use in future adult populations • The study indicates a lack of research interest in, particularly, older children as autonomous beings • This little research only provides hints about proper interventions and policies to improve use of medicines among children • Research to lay the foundation for future interventions should be high on the agenda

10. Research gaps • Studies on medicine use for chronic conditions and acute conditions other than malaria/fever and diarrhoea • Characterisation of issues specific to children over 5 • The meaning and implications of (lack of) dosage forms for children • Analyses of policies of relevance to children’s medicine use • Children’s own experiences and the meaning of medicines in their daily lives.