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TIPS ON MALARIA

  • HOW CAN MOSQUITOES BE CONTROLLED?

    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.

  • HOW CAN I PROTECT MYSELF FROM MOSQUITO-BORN DISEASES?

    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.

  • WHO ARE AT RISK?


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.
     

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Tanzania reaping from the INESS project

A few years ago, stock out of antimalarial drugs was one of the barriers for access to treatment in Tanzania. One would undergo all the lab tests and consultation only to have a pharmacist mark the prescription sheet with “O/S” meaning “out of stock” against almost half of the medicines.

The reasons attributed to the stock out at that time were many, but the key ones included inadequate budget allocations to health facilities; delays in distribution of allocated funds; delays in delivery to facilities; inaccurate forecasting at the facility and national level; theft of medications at all levels; stock-outs at the national warehouse run by the Medical Stores Department (MSD); malfunctioning back order system for unfilled items; and limited number of approved brands of medications.

Approval of new brands was slow as there was no mechanism locally to monitor the safety and efficacy of medicines that are already in the market.

But the 2010 Service Delivery Indicators (SDI) Survey which involved visits to 175 public primary health facilities across Tanzania showed that anti-malaria medication (Artemether Lumefantrine, either adult or child dosage, or both) is available in 81% of health facilities.

The improvement in the availability of drugs can be attributed to the presence of mechanisms for testing the effectiveness and safety of drugs and vaccines after they have been deployed in the market.

Testing of drugs and vaccines that have already been deployed for use in real life setting is known as Phase IV studies.

Dr. Ali Mtoro of Ifakara Health Institute (IHI) says Phase IV studies for antimalarial drugs and vaccines have not been previously conducted in Africa under the auspices of African research scientists.

“The INDEPTH Effectiveness and Safety Studies (INESS) platform has enabled African scientists to be involved directly in providing evidence for policy decision and action,” Dr. Mtoro said.

This has helped to reduce the time gap between the licensing of a new drug and its subsequent introduction into health systems for use.

INESS activities in Tanzania started in 2009 and have so far monitored the effectiveness of several antimalarial drugs including Artemether Lumefantrine (ALu).

Senior research scientist at IHI, Dr. Abdulnoor Mulokozi, says he has recently participated in an observational study to evaluate the clinical safety of the Eurartesim drug.

This drug, according to Dr. Mulokozi, is manufactured by Sigma Tau in Italy and was tested on African children from six months of age with not more than 5kg and adults of not more than 100kg. “Pregnant and lactating mothers were excluded from the study,” he said.

While other drugs are taken after the patient has had a meal, the Eurartesim drug is taken on an empty stomach, that is, three to four hours after a meal and then the patient remains fasting for another three to four hours after swallowing the drug.

Asked whether children must also follow this “fasting” rule, Dr. Mulokozi said that simple snacks were allowed for young child during the dosing period. The Eurartesim drug is taken once a day in three consecutive days, preferably the same timing.

The US$200,000 study took place in Rufiji health facilities where IHI maintains one of its largest health and demographic surveillance system (HDSS) sites.

Other HDSS are in Tanzania's Kilombero and Mahenge districts. All the three HDSS sites are part of the global surveillance system sites that are being partly funded by the INDEPTH Network.

Commenting on the drug, one study participant from Rufiji noted that she tolerated the treatment fairly well but it was difficult to adhere to the condition of not eating any meal three to four hours before and after taking the drug.

“Starving for between six and eight hours was the most challenging experience when taking this malaria drug,” the study participant said. A few other participants were reported to have withdrawn their consent due to repeated vomiting and repeated blood withdrawals.

A malaria case management expert at Tanzania's National Malaria Control Programme (NMCP), Dr. Sigsbert Mkude, confirms that Tanzania uses ACTs for the treatment of uncomplicated malaria and that approved ACTs are ALu, Dihydro-artemisinin-piperaquine (DPQ) and Artesunate Mefloquine (ASMAQ).

“There are many business names for those ACTs. The Eurartesim drug you are referring to is just a brand name for one of the DPQ drugs,” says Dr. Mkude.

He explained that Eurartesim is a fixed-dose combination product composed of dihydroartemisinin (DHA) and piperaquine phosphate (PQP). He says the Ministry of Health and Social Welfare has endorsed the World Health Organization (WHO) prequalification of the Eurartesim drug.

When compared with other ACTs, Eurartesim appears to offer significant benefits over existing licensed malaria treatments.

Although Eurartesim has been approved by the Ministry of Health and Social Welfare, its widespread in health facilities is limited.

Dr. Mkude concludes that availability of antimalarial drugs is not a problem in Tanzania but close monitoring of the efficacy of those drugs was necessary.

A malaria focal person from Arusha, Mrs. Anna Nanyanje says Eurartesim was not common in many health facilities in her region. “I don't know this drug and my colleagues are not aware of it,” says Nanyanje.

BY MBARWA KIVUYO, DAR ES SALAAM

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