scholarly journals Malaria Treatment Policy Change and Implementation: The Case of Uganda

2011 ◽  
Vol 2011 ◽  
pp. 1-14 ◽  
Author(s):  
Miriam Nanyunja ◽  
Juliet Nabyonga Orem ◽  
Frederick Kato ◽  
Mugagga Kaggwa ◽  
Charles Katureebe ◽  
...  
Keyword(s):  
Policy Change ◽  
Malaria Control ◽  
Drug Policy ◽  
Change Process ◽  
Uncomplicated Malaria ◽  
First Line ◽  
Effective Policy ◽  
Evidence For Policy ◽  
Line Drug ◽  
Roll Out

Malaria due to P. falciparum is the number one cause of morbidity and mortality in Uganda where it is highly endemic in 95% of the country. The use of efficacious and effective antimalarial medicines is one of the key strategies for malaria control. Until 2000, Chloroquine (CQ) was the first-line drug for treatment of uncomplicated malaria in Uganda. Due to progressive resistance to CQ and to a combination of CQ with Sulfadoxine-Pyrimethamine, Uganda in 2004 adopted the use of ACTs as first-line drug for treating uncomplicated malaria. A review of the drug policy change process and postimplementation reports highlight the importance of managing the policy change process, generating evidence for policy decisions and availability of adequate and predictable funding for effective policy roll-out. These and other lessons learnt can be used to guide countries that are considering anti-malarial drug change in future.

scholarly journals Efficacy of Artemisinin-lumefantrine for the treatment of uncomplicated malaria after more than a decade of its use in Kenya

2020 ◽  
Author(s):  
Gabriel M. Kishoyian ◽  
Eliud N. M. Njagi ◽  
George O. Orinda ◽  
Francis T. Kimani ◽  
Kevin Thiongo ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Uncomplicated Malaria ◽  
Standard Dose ◽  
Parasite Clearance ◽  
First Line ◽  
Study Population ◽  
Treatment Responses ◽  
Lost To Follow Up ◽  
Line Drug

Abstract Background: Plasmodium falciparum resistance to antimalarial drugs remains to be a major threat to the control of malaria globally. After the deployment of artemisinin-based combination therapy (ACT), there have been reports of reduced sensitivity of the drug to parasite clearance. In Kenya, artemisinin-lumefantrine (AL) is the recommended first-line drug in the treatment of uncomplicated malaria. This study sought to assess the efficacy of AL after its reintroduction in Kenya, a decade later. In this study, we assessed clinical and parasitological responses of children under five years in May and November 2015 in Chulaimbo sub-County, Kisumu, Kenya.Method: Patients of ≥6 and ≤60 months of age with confirmed Plasmodium falciparum mono-infection were enrolled in the study. The patients were treated with a standard dose of AL and followed up for 28 days. During which period we monitored treatment responses and follow-up adherence.Results: Of the 90 patients enrolled, fourteen (14) were lost to follow-up, with 76 completing the study period. Seventy-five patients 75 (98.7%) cleared, parasitemia within 48 hours while one (1.3%) cleared on day 3. There was 100% clinical and parasitological parasite clearance. Conclusion: Artemisinin lumefantrine was found to be highly efficacious to plasmodium falciparum parasites in children aged ≥6 and ≤60 months. Based on this, the drug can be used to treat uncomplicated malaria in the study population. However, there is need for continued monitoring of its effectiveness in children and adults to counter the threat of resistance.

scholarly journals Efficacy of Artemisinin-lumefantrine for the treatment of uncomplicated malaria after more than a decade after its use in Kenya

2020 ◽  
Author(s):  
gabriel m kishoyian ◽  
Eliud N.M. Njagi ◽  
George O. Orinda ◽  
Francis T. Kimani ◽  
Kevin Thiongo ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Uncomplicated Malaria ◽  
Standard Dose ◽  
Parasite Clearance ◽  
Close Monitoring ◽  
First Line ◽  
Study Population ◽  
Lost To Follow Up ◽  
Line Drug

Abstract Background: Plasmodium falciparum resistance to antimalarial drugs remains to be a major threat to the control of the disease globally. After the deployment of artemisinin-based combination therapy (ACT), there have been reports of reduced sensitivity of the drug to parasite clearance. In Kenya, artemisinin-lumefantrine (AL) is the recommended first-line drug in the treatment of uncomplicated malaria. This study sought to assess the efficacy of AL after its reintroduction in Kenya, a decade later. We assessed clinical and parasitological responses of children under five years in May and November 2015 in Chulaimbo sub-County, Kisumu, Kenya. Method: Patients of ≥6 and ≤60 months of age with confirmed Plasmodium falciparum mono-infection were enrolled in the study. The children were inpatient for close monitoring, they were treated with a standard dose of AL under supervision of a qualified nurse and followed up for 28 days. We monitored treatment adherence and responses. Efficacy of artemether lumefantrine on Plasmodium falciparum was determined.Results: Of the 90 patients enrolled, fourteen (14) were lost to follow-up, with 76 completing the study period. Seventy-five patients 75 (98.7%) cleared the parasitemia within 48 hours while one (1.3%) cleared on day 3. There was 100% clinical and parasitological parasite clearance. Conclusion: Artemisinin lumefantrine was found to be highly efficacious to plasmodium falciparum parasites in children aged ≥6 and ≤60 months. The results reported here indicate that the drug can be used to treat uncomplicated malaria in the study population. However, there is need for continued monitoring of its effectiveness in children and adults to counter the threat of resistance.

scholarly journals New InhA Inhibitors Based on Expanded Triclosan and Di-Triclosan Analogues to Develop a New Treatment for Tuberculosis

2021 ◽  
Vol 14 (4) ◽  
pp. 361
Author(s):  
Sarentha Chetty ◽  
Tom Armstrong ◽  
Shalu Sharma Kharkwal ◽  
William C. Drewe ◽  
Cristina I. De Matteis ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Protein Crystal ◽  
First Line ◽  
Isoniazid Resistance ◽  
Structure Based Drug Design ◽  
Extensively Drug Resistant ◽  
New Treatment ◽  
Flexible Ligands ◽  
Line Drug

The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) has reinforced the need for the development of new anti-TB drugs. The first line drug isoniazid inhibits InhA. This is a prodrug requiring activation by the enzyme KatG. Mutations in KatG have largely contributed to clinical isoniazid resistance. We aimed to design new ‘direct’ InhA inhibitors that obviate the need for activation by KatG, circumventing pre-existing resistance. In silico molecular modelling was used as part of a rational structure-based drug-design approach involving inspection of protein crystal structures of InhA:inhibitor complexes, including the broad spectrum antibiotic triclosan (TCS). One crystal structure exhibited the unusual presence of two triclosan molecules within the Mycobacterium tuberculosis InhA binding site. This became the basis of a strategy for the synthesis of novel inhibitors. A series of new, flexible ligands were designed and synthesised, expanding on the triclosan structure. Low Minimum Inhibitory Concentrations (MICs) were obtained for benzylphenyl compounds (12, 43 and 44) and di-triclosan derivative (39), against Mycobacterium bovis BCG although these may also be inhibiting other enzymes. The ether linked di-triclosan derivative (38) displayed excellent in vitro isolated enzyme inhibition results comparable with triclosan, but at a higher MIC (125 µg mL−1). These compounds offer good opportunities as leads for further optimisation.

scholarly journals Deploying triple artemisinin-based combination therapy (TACT) for malaria treatment in Africa: ethical and practical considerations

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Paulina Tindana ◽  
Freek de Haan ◽  
Chanaki Amaratunga ◽  
Mehul Dhorda ◽  
Rob W. van der Pluijm ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Combination Therapy ◽  
Southeast Asia ◽  
Malaria Control ◽  
Lessons Learned ◽  
Line Treatment ◽  
African Continent ◽  
First Line ◽  
First Line Treatment ◽  
Made In

AbstractMalaria remains a major cause of morbidity and mortality in Africa, particularly in children under five years of age. Availability of effective anti-malarial drug treatment is a cornerstone for malaria control and eventual malaria elimination. Artemisinin-based combination therapy (ACT) is worldwide the first-line treatment for uncomplicated falciparum malaria, but the ACT drugs are starting to fail in Southeast Asia because of drug resistance. Resistance to artemisinins and their partner drugs could spread from Southeast Asia to Africa or emerge locally, jeopardizing the progress made in malaria control with the increasing deployment of ACT in Africa. The development of triple artemisinin-based combination therapy (TACT) could contribute to mitigating the risks of artemisinin and partner drug resistance on the African continent. However, there are pertinent ethical and practical issues that ought to be taken into consideration. In this paper, the most important ethical tensions, some implementation practicalities and preliminary thoughts on addressing them are discussed. The discussion draws upon data from randomized clinical studies using TACT combined with ethical principles, published literature and lessons learned from the introduction of artemisinin-based combinations in African markets.

Sedação Paliativa, Perspetiva de Um Clínico

2018 ◽  
Vol 26 (52) ◽  
pp. 127-138
Author(s):  
Madalena Feio ◽  
Keyword(s):  
Double Effect ◽  
Palliative Sedation ◽  
Ethical Principles ◽  
First Line ◽  
Scientific Societies ◽  
Refractory Symptoms ◽  
Medical Associations ◽  
Line Drug

Palliative sedation does not have a universally accepted definition. It is used as a measure of last resort for the control of refractory symptoms in the last days of life. The ethical principles invoked in its use are those of double effect and proportionality. Its prevalence varies according to the place of care, type of study and country. The most frequent indications for its use are the control of dyspnea, delirium and pain. The recommended first line drug is midazolam. The studies performed do not diminish the survival of the patient. It is important that fami­ly support is maintained throughout the process. Several scientific societies and medical associations have defined guidelines that regulate their implementation.

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