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photo Rasmussen

Development of health education materials on appropriate drug use for illiterate mothers in the northern areas of Pakistan

Juroon Nisa1, G Musa1, M Rahim1, Muhibuddin2 and ZA Rasmussen

 

1Aga Khan Health Service (AKHS), Northern Areas and Chitral, Pakistan

2Water, Sanitation, Hygiene and Health Studies Project, AKHS, Pakistan

3Aga Khan University, Departments of Medicine and Community Health Sciences, Karachi

 

Efforts to improve the rational use of drugs in developing countries are hampered by the lack of appropriate educational materials for consumers, especially those who are illiterate. The Collaborative Project on Community Drug Use, an international study conducted partly in Ghizer district, Northern Areas, Pakistan, found that only 45% of drugs were used correctly in terms of dose, frequency and duration, in an area covered by the AKHS primary health care programme. Mothers were anxious for materials which they could use to help them remember how to use drugs properly. Lady health visitors developed story cards and pictures which could be used for this purpose. These were tested in 5 groups of 3-4 mothers each. The story cards focussed on the following themes: keeping medicines out of the reach of children, use of cotrimoxazole (Septran@), pyrantel pamoate (Combantrin@), paracetamol, and antenatal care. Cards were shown to mothers to determine comprehension and solicit suggestions. Mothers could understand story cards on correct medicine storage practices and on specific drugs well, and made practical suggestions for improvement. Pictures developed to show correct frequency and duration of drug use were not well understood.

We conclude that testing of pictorial materials developed for health education on correct drug use is essential. Story cards are an effective means of communicating concepts. Rational drug use can only improve when appropriate materials are available to illiterate audiences. Further efforts to develop these are required.

 

Introduction

Rational use of drugs in developing countries is limited by lack of educational materials for illiterate consumers

Study in Ghizer District, Northern Areas 1992 - 1994 showed that only 45 % of drugs in Primary Health Care area were used correctly in terms of dose, frequency and duration

Illiterate mothers requested materials by which they could remember how drugs should be used

 

Objective

To test health education materials on drug use developed for illiterate mothers

 

Methods

Lady Health Visitors developed pictorial story cards on drug use, using positive and negative stories

Topics

blueball.gif (959 bytes) Keep medicines out of children's reach

blueball.gif (959 bytes) Give multivitamins and iron during pregnancy

blueball.gif (959 bytes) Correct use of selected drugs Septran (cotrimoxazole), Combantrin (pyrantel pamoate), and Paracetamol

blueball.gif (959 bytes) Dose, frequency and duration of drug use

Story cards were tested in September 1995 with 5 groups of 3-4 mothers (mostly illiterate)

Cards were shown to mothers to determine comprehension and to solicit suggestions

 

Results

Dose, Frequency and Duration

Dose easily understood

Frequency and duration difficult to understand without explanation

Side Effects

None identified

Keep medicine out of children's reach

blueball.gif (959 bytes) Good comprehension

blueball.gif (959 bytes) Suggestions

Keep medicine in a cool place, not on windowsill

Have the mother put the medicine far from the child and high up

Have mother crying and child unconscious or vomiting after child takes medicine

Give multivitamins and iron during pregnancy

blueball.gif (959 bytes) Good comprehension

blueball.gif (959 bytes) Suggestion to add information on diet as well as medicine

Septran

blueball.gif (959 bytes) Recognized easily by picture on bottle (child, horse)

blueball.gif (959 bytes) Frequency recalled by picture of 2 fingers

blueball.gif (959 bytes)Most mothers know it should be taken for 5 days

blueball.gif (959 bytes) Many mothers knew it was used for pneumonia

Combantrin

blueball.gif (959 bytes) Did not recognize medicine without bottle or packaging

blueball.gif (959 bytes) Knew it was taken for worms

Paracetamol

blueball.gif (959 bytes)Easily recognized

blueball.gif (959 bytes)Mothers knew to give it for fever, three time daily

blueball.gif (959 bytes)Frequency and duration difficult to understand without explanation

 

Conclusions

Illiterate-mothers understood story cards on medicine storage and specific drugs

Mother could make practical suggestions for improving cards

Pictures showing correct frequency and duration of drug use were not well understood

Story cards are an effective means for communicating concepts

Testing pictorial materials for health education on drug use is essential

 

Recommendations

Further efforts are needed to develop materials on drug use for illiterate audiences

A standard set of pictures on dose, frequency and duration should be dispensed with each drug