The findings of this study suggest that most caregivers of young children have adequate knowledge about medications and appropriate practice in their administration. In addition, they also have a high adherence level in the medication administration. However, those with children taking a greater number of medications, getting their refills from private health institutions and with more complicated medical conditions were more likely to be less adherent to the medication administration. The findings also helps us better understand the issues related to the medication administration in the context of Malaysia , and could be used to guide healthcare providers in educating caregiver.
Consistent with the finding of a previous study , this study shows that children under 5 years of age are more likely to be victims of an inappropriate medication administration practice. The absence of age-appropriate drug formulations commonly requires caregivers to crush a tablet, reconstitute a powder formulation and accurately measure a liquid formulation . Inappropriate practices are likely to be unavoidable due to the lack of proper techniques and devices, as well poor palatability of the medications [5, 9, 18]. Apart from relying on the pharmaceutical to develop more child-friendly formulations , health care providers could educate caregivers how to improve the acceptance of medications in children by masking their poor taste with food  and adopt several strategies well supported by the existing literature, including the use of pictographic instructions and the teach-back method, to avert inappropriate medication administration practices [20–22].
Caregivers were found to be well informed about their children’s medications in general. This suggests that health care providers have been providing them with sufficient medication-related information, as highly recommended in the existing guidelines [23, 24]. In contrast with caregivers from other developing countries who still tended to use a household spoon for medication administration [7, 9], all participants in this study managed to measure the medication correctly by using a proper measuring device. However, unlike other countries [18, 25], caregivers in Malaysia were commonly not familiarized with the generic names of medications [23, 24]. To avoid errors caused by the confusion, it is important to educate them about different names used for a medication, in addition to its indication, dosage, frequency and treatment duration .
Having an appropriate practice in the medication administration in most caregivers in this study was suggestive of the sufficiency and accuracy of the medication instructions they received [23, 24]. Only caregivers who are able to handle the medications correctly at home can shield their children from undesirable adverse events . While dosing errors are common with liquid formulations [7, 8, 26], it is found that most caregivers in this study were able to perform the measurement according to the instructions.
Non-adherence to the medication administration was more common in the caregivers with children taking a greater number of medications, having multiple medical conditions, and getting their refills from private health institutions apart from this hospital. The need to deal with a complicated treatment regimen has long been a known factor for non-adherence among the caregivers of young children . Users who refilled medications from different health institutions may be facing variations in healthcare services, different adherence counselling structure and varied practice of health care providers in providing adherence educations which may result in decreased adherence . In addition, the absence of an effective information exchange mechanism across different health institutions from which caregivers get their refills could lead to repeated administration of the same medication. While the practice of refilling medications from different institutions to overcome logistic hassles may be beneficial , further investigation may be required to explore other reasons of such practice.
As this study was limited to its single-centre design, a similar assessment could be conducted on a larger scale. Also, the assessment was based on self-reporting of caregivers, and therefore the findings might not reflect their actual practice. It would be more ideal if a direct observation on the medication administration practice at home could be performed in future studies [6, 8].