Exploring the lack of administration devices for liquid medicines in India

Dr Smita Salunke (UCL School of Pharmacy) used UCL Global Engagement Funds to seek parents’ opinions on the availability and use of medicine administration devices in India.

Dr Smita Salunke (UCL School of Pharmacy) in India

4 November 2022

In some parts of the world such as the United Kingdom, administration devices including oral syringes are widely used to administer liquid medicines to children. These devices ensure the correct amount of medicine is administered, reducing the risk of overdosing or underdosing that is more likely when using devices such as spoons or cups. Yet in some low and middle income countries, oral syringes and other similar devices are not widely available or commonly used.

In response to this, Dr Smita Salunke – who also works with the European Paediatric Formulation Initiative (EuPFI) – developed a research project to capture the views of parents from different parts of India on the challenges associated with using existing administration devices in India. To do this, she collaborated with the Society for Paediatric Medicines & Healthcare Initiative (PMHI) in Mumbai, the Rochiram T. Thadani School in Mumbai, and the Delhi Pharmaceutical Sciences and Research University.

Traditional and innovative administration devices

“In the United Kingdom, we’re used to the fact that dosing syringes come in the package of medicines such as Calpol,” Smita explained. “But in countries like India, this is not the case; you just get the medicine most of the time. As a result, parents are using a whole range of devices such as household spoons to administer medicines to children, which are not necessarily leading to accurate doses being given.”

This was the basis of the research project that Smita developed, to explore which administration devices are typically used in India, the instructions parents receive for using these devices, and the challenges they face. The team developed a questionnaire which was completed by parents in Delhi, Kolkata, Mumbai and Bangalore. Families from a range of socioeconomic backgrounds completed the questionnaires, and some participated in interactive sessions so the team could gain further information about their views on the innovative administration devices that are already available in other parts of the world.

The research found that the majority of parents in India administer liquid medicines to their children using traditional devices, which includes measuring cups, household spoons or droppers. The results also showed that 88% of parents had never seen or used innovative devices, such as oral syringes, which have been used for a long time and are not considered innovative or new in other countries.

“It’s clear there is a need for advocacy on the provision of appropriate dosing devices for all oral liquid medications,” said Smita. “Efforts are needed from both healthcare professionals and parents to ensure the appropriate devices are used, to ensure the right dosing happens. Many parents we spoke to didn’t think slight differences in dosing would make a difference, but it really does for some medications, and can lead to side effects that can be life threatening.”

Improving knowledge about innovative devices

Part of the research also looked at what factors would influence parents’ decisions to buy dosing syringes or other innovative devices. “In a low to middle income country, we expected cost to be a factor,” said Smita. “In fact, most parents said quality would be their first priority, and they’d be willing to spend more on a dosing syringe made from good quality materials, or that was recommended by a healthcare professional.”

As a result of this work, the PMHI in Mumbai has now adopted this as an area of work they will take forward. They are developing a roadmap to help raise awareness of the issues among healthcare professionals and parents, and they are developing a series of leaflets and activities to support this.

The success of this project has enabled Smita to use this as a model study to use in other countries. In collaboration with the EuPFI devices workstream, she has already commenced a study in Thailand, and has further studies planned in China and some African countries. “My passion is to co-create solutions to address global challenges, especially in terms of medicines for children in developing countries,” Smita said. “This funding has helped me gain access to the right partners in low and middle income countries to drive both awareness and policies on the use of appropriate dosing devices for all oral liquid medications, and improve the lives of children.”

Another benefit of the collaboration is the exposure to different methodologies and areas of expertise some of the researchers gained. One of the Indian students involved in the project used her experience on this project to further her academic career at the University of Dublin. “It was a very successful project for many reasons, and it’s good to see all the positive effects this work has brought about,” Smita said.

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