Treatment of Paediatric Malaria During a Period of Drug Transition to Artemether-lumefantrine in Zambia: Cross Sectional Study

Overview

Journal BMJ

Specialty General Medicine

Date 2005 Oct 1

PMID 16195289

Citations 50

Authors

Dejan Zurovac

Mickey Ndhlovu

Alexander K Rowe

Davidson H Hamer

Donald M Thea

Robert W Snow

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate treatment practices for uncomplicated malaria after the policy change from chloroquine to sulfadoxine-pyrimethamine and to artemether-lumefantrine in Zambia.

Design: Cross sectional survey.

Setting: Outpatient departments of all government and mission facilities in four districts in Zambia.

Participants: 944 children with uncomplicated malaria seen by 103 health workers at 94 health facilities.

Main Outcome Measures: Antimalarial prescriptions in accordance with national guidelines and influence of factors on health workers' decision to prescribe artemether-lumefantrine.

Results: Artemether-lumefantrine, sulfadoxine-pyrimethamine, and chloroquine were available, respectively, at 48 (51%), 94 (100%), and 71 (76%) of the 94 facilities. Of 944 children with uncomplicated malaria, only one child (0.1%) received chloroquine. Among children weighing less than 10 kg, sulfadoxine-pyrimethamine was commonly prescribed in accordance with guidelines (439/550, 79.8%). Among the children weighing 10 kg or more, sulfadoxine-pyrimethamine was commonly prescribed (266/394, 68%), whereas recommended artemether-lumefantrine was prescribed for only 42/394 (11%) children. Among children weighing 10 kg or more seen at facilities where artemether-lumefantrine was available, the same pattern was observed: artemether-lumefantrine was prescribed for only 42/192 (22%) children and sulfadoxine-pyrimethamine remained the drug of choice (103/192, 54%). Programmatic activities such as in-service training and provision of job aids did not seem to influence the prescribing of artemether with lumefantrine.

Conclusion: Although the use of chloroquine for uncomplicated malaria was successfully discontinued in Zambia, the change of drug policy towards artemether-lumefantrine does not necessarily translate into adequate use of this drug at the point of care.

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References

Mutabingwa T, Anthony D, Heller A, Hallett R, Ahmed J, Drakeley C . Amodiaquine alone, amodiaquine+sulfadoxine-pyrimethamine, amodiaquine+artesunate, and artemether-lumefantrine for outpatient treatment of malaria in Tanzanian children: a four-arm randomised effectiveness trial. Lancet. 2005; 365(9469):1474-80. DOI: 10.1016/S0140-6736(05)66417-3. View

Korenromp E, Williams B, Gouws E, Dye C, Snow R . Measurement of trends in childhood malaria mortality in Africa: an assessment of progress toward targets based on verbal autopsy. Lancet Infect Dis. 2003; 3(6):349-58. DOI: 10.1016/s1473-3099(03)00657-1. View

Rowe A, Hamel M, Flanders W, Doutizanga R, Ndoyo J, Deming M . Predictors of correct treatment of children with fever seen at outpatient health facilities in the Central African Republic. Am J Epidemiol. 2000; 151(10):1029-35. DOI: 10.1093/oxfordjournals.aje.a010131. View

Bijl H, Kager J, Koetsier D, van der Werf T . Chloroquine- and sulfadoxine-pyrimethamine-resistant Falciparum malaria in vivo - a pilot study in rural Zambia. Trop Med Int Health. 2000; 5(10):692-5. DOI: 10.1046/j.1365-3156.2000.00629.x. View

Shretta R, Omumbo J, Rapuoda B, Snow R . Using evidence to change antimalarial drug policy in Kenya. Trop Med Int Health. 2000; 5(11):755-64. DOI: 10.1046/j.1365-3156.2000.00643.x. View

Snow R, Trape J, Marsh K . The past, present and future of childhood malaria mortality in Africa. Trends Parasitol. 2002; 17(12):593-7. DOI: 10.1016/s1471-4922(01)02031-1. View

Rowe A, Lama M, Onikpo F, Deming M . Health worker perceptions of how being observed influences their practices during consultations with ill children. Trop Doct. 2002; 32(3):166-7. DOI: 10.1177/004947550203200317. View

Rowe A, Onikpo F, Lama M, Deming M . Risk and protective factors for two types of error in the treatment of children with fever at outpatient health facilities in Benin. Int J Epidemiol. 2003; 32(2):296-303. DOI: 10.1093/ije/dyg063. View

Piola P, Fogg C, Bajunirwe F, Biraro S, Grandesso F, Ruzagira E . Supervised versus unsupervised intake of six-dose artemether-lumefantrine for treatment of acute, uncomplicated Plasmodium falciparum malaria in Mbarara, Uganda: a randomised trial. Lancet. 2005; 365(9469):1467-73. DOI: 10.1016/S0140-6736(05)66416-1. View

10.

. The efficacy of antimalarial monotherapies, sulphadoxine-pyrimethamine and amodiaquine in East Africa: implications for sub-regional policy. Trop Med Int Health. 2003; 8(10):860-7. DOI: 10.1046/j.1360-2276.2003.01114.x. View

11.

Adjuik M, Babiker A, Garner P, Olliaro P, Taylor W, White N . Artesunate combinations for treatment of malaria: meta-analysis. Lancet. 2004; 363(9402):9-17. DOI: 10.1016/s0140-6736(03)15162-8. View

12.

Talisuna A, Bloland P, DAlessandro U . History, dynamics, and public health importance of malaria parasite resistance. Clin Microbiol Rev. 2004; 17(1):235-54. PMC: 321461. DOI: 10.1128/CMR.17.1.235-254.2004. View

13.

Myint H, Tipmanee P, Nosten F, Day N, Pukrittayakamee S, Looareesuwan S . A systematic overview of published antimalarial drug trials. Trans R Soc Trop Med Hyg. 2004; 98(2):73-81. DOI: 10.1016/s0035-9203(03)00014-2. View

14.

Hamer D, Macleod W, Addo-Yobo E, Duggan C, Estrella B, Fawzi W . Age, temperature, and parasitaemia predict chloroquine treatment failure and anaemia in children with uncomplicated Plasmodium falciparum malaria. Trans R Soc Trop Med Hyg. 2004; 97(4):422-8. DOI: 10.1016/s0035-9203(03)90076-9. View

15.

Williams H, Durrheim D, Shretta R . The process of changing national malaria treatment policy: lessons from country-level studies. Health Policy Plan. 2004; 19(6):356-70. DOI: 10.1093/heapol/czh051. View

16.

Zurovac D, Rowe A, Ochola S, Noor A, Midia B, English M . Predictors of the quality of health worker treatment practices for uncomplicated malaria at government health facilities in Kenya. Int J Epidemiol. 2004; 33(5):1080-91. DOI: 10.1093/ije/dyh253. View

17.

Falade C, Makanga M, Premji Z, Ortmann C, Stockmeyer M, Ibarra de Palacios P . Efficacy and safety of artemether-lumefantrine (Coartem) tablets (six-dose regimen) in African infants and children with acute, uncomplicated falciparum malaria. Trans R Soc Trop Med Hyg. 2005; 99(6):459-67. DOI: 10.1016/j.trstmh.2004.09.013. View