Giving malaria patients pre-packaged medicines halved patient waiting times at dispensaries and also halved the costs of the antimalarial medicines in areas participating in a study in Ghana. The simple pre-packaging method also resulted in a 20% increase in patients' compliance with treatment in these districts, the study found.

Describing the study in the latest issue of the Bulletin of the World Health Organization, the researchers said that pre-packaging antimalarials should help counter disease resistance to these drugs and could also be applied to the treatment of other diseases.

"The pre-packaging of drugs," say the authors, "can be expected to result in more patients taking the full treatment regimen, thereby reducing the risk of resistance to the drugs and extending the time before it will be necessary to switch to a more expensive drug for first-line treatment." The pre-packaging operation, which the authors describe as "low-level technology," requires little or no specialized training and can be done locally and inexpensively.

Studies on pre-packaged antimalarials conducted in other countries, including Burkina Faso, Nigeria and Uganda, in Africa, and China in Asia, have confirmed the positive impact of this strategy that was found in the Ghana study and in addition have reported an 80% reduction in the use of injections and a 70% reduction in wastage of medicines.

In Ghana during the mid-1990s, the cost of treatment to patients was high, largely because of the dispensing of excessive volumes of chloroquine and the prescribing of chloroquine injections for uncomplicated malaria. There were long waiting times at dispensaries and poor compliance with recommended treatment regimens.

Ghanaian health management officials decided to find out of if matters could be improved by offering patients the antimalarial drug chloroquine pre-packaged in plastic bags. The packs of chloroquine tablets were divided into three compartments, each containing a daily dose.

The method worked. After 20 weeks, compliance of adults and children was more than 20% higher in the three test districts than in three control districts where traditional methods of dispensing drugs continued to be used. The costs of the antimalarial drugs and patients' waiting time were 50% less than in the control districts . The intervention, which tended to improve both case and drug management, was well accepted by health staff and did not involve them in additional working time.

The reduction in waiting time at the three dispensaries was achieved because staff were not spending time counting tablets while patients were waiting. The pre-packaging cut the cost of treatment because fewer tablets were dispensed and there was less wastage.

"Both policy-makers and the general public would welcome any intervention that reduced cost without compromising effectiveness or quality," the authors say. "With regard to long-term malaria control, the most important result of the present study is the demonstration that pre-packaging improves compliance."

Staff at the dispensaries were also enthusiastic about the switch to pre-packaging and suggested that other commonly used drugs should be pre-packaged. The patients approved the method because it made it easier for them to remember how to take the prescribed medicine.

The study was conducted by Dr Kojo Yeboah-Antwi, then district director of health services for Wenchi District, Ghana, and colleagues from the Health Research Unit of the Ghanaian Ministry of Health, and the Liverpool School of Tropical Medicine, United Kingdom, and received financial support from the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland.