reviewed malaria drug policy in ghana
Post on 05-Jul-2015
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BYGIDEON DZANDO
BSC.NURSING
Malaria is an endemic disease in sub-
saharan Africa.
Malaria is a major cause of illness and death
in Ghana, especially among children and
pregnant women
In 2012, malaria accounted for 38.9% of all
OPD illnesses and 38.8% of all IP of all
admissions.
Ministry of Health Ghana in its mid term strategic plan
document consider malaria as a priority disease which
must be addressed in order to meet Millennium
Development Goals 4,5 and 6.
Case mgt has remained one of the main strategic
interventions for malaria control in Ghana.
The T3 (TEST,TREAT AND TRACK) initiative has
been initiated recently to replace the existing
presumptive mode of treatment.
The effectiveness of the T3 initiative however
depends on Anti malaria drugs which must be safe ,
effective, available, affordable and acceptable, thus
the need for an up to date evidence base Anti malaria
drug policy to suit Global trends and the nation’s
context
Prevent deaths and complications arising from malaria
Shorten clinical episodes of malaria
Reduce consequences of placental malaria infection
and maternal associated anaemia through
chemoprophylaxis and intermittent preventive
treatment during pregnancy.
Delay the spread of resistance to anti malaria
medications.
The use of Arteminisin based combination for
chemoprophylaxis ant treatment was agreed on through
an informal consultation with WHO in Geneva in the
year 2000.
In 2002,Treatment failure to chroloquine was rated
between 6%-25% and total parasite clearance was
rated below 50%.(MOH)
In 2004,the drug policy changed from Chroloquine to
Artesunate Amodiaquine for uncomplicated malaria.
Adverse effects and negative publications in a section of the mass media led to loss of confidence in the policy by some health care providers.
In 2007,there was a policy review which made
provision for search for alternatives for A/A in mgt of
uncomplicated malaria while Inj. Quinine and
Artemether were recommended for treating severe
malaria.
Sulphadoxine pyremetamine was also encouraged for
use as prophylaxis in pregnancy.
Owing to the developing research in science and
medicine, growing evidence that could influence the
choice of one medicine over another and lessons drawn
from practitioners,
The minister reconstituted the Anti malaria Drug Policy
Working Group and inaugurated it on 23rd August 2012
to review the existing Drug policy.
Evidence that, inj. Artesunate is superior to injection
quinine in managing severe malaria and WHO
recommendation for its use
Unconfimed reports of abortions after the use of oral
quinine in the 1st trimester of pregnancy
Conflicting reports on preference of practitioners
between A/A and a/L as first line treatment for
uncomplicated malaria.
Growing concerns about resistance to the use of
Arteminisin mono-therapy, adverse drug reactions and
compliance to seven days quinine therapy
Recent recommendations by WHO on seasonal malaria
chemo-prevention
OBJECTIVE
To provide prompt safe, effective and appropriate
anti malaria treatment to the entire population
THE T3 MUST BE ADHERED TO
The three Arteminisin combination remains the best
choice.
Artesunate Amodiaquine is the drug of choice. (choice
for children below five years at home).
Alternative drugs are: A/L AND Dihydroarteminisin
piperaquine
1st trim: Oral Quinine or
Oral Quinine + Clindamycin.
2nd trim: Oral Quinine,
oral quinine + clindamycin,
AA
A/L
Alternative ACT, AL, AA or DHTP which has not been
given as first line treatment can be given.
Oral quinine can be used if ACT are contraindicated.
(10mg/kg body weight) + Tetracycline or Doxycycline
or Clindamycin.
ACT’S can be used in pregnancy (1st trim) if need be.
Quinine,AA or AL (2nd trim)
Requires parenteral treatment initially and then
continue with orals if the condition permits.
NB: Children who do not respond to ACT,s within 24
hours be tepid sponged, given supp. arteminisin and
referred to a bigger health facility.
Parenteral Artesunate shall be used as the medication of
choice, followed by a full course of an ACT if client
can tolerate oral medication
ALTERNATIVE: Injection Quinine
1ST TRIM: Start with Injection Quinine ,switch to oral
quinine if client can tolerate oral medication.
2nd and 3rd trim: Inj. Artesunate is the recommended
drug of choice.
IPT shall be commenced after first Quickening (16th week).
Shall be provided as an antenatal package with haematinics and antihelmentics
The medicine shall be administered under DOT.
Drug of choice shall remain SULPHADOXINE (500MG) +PYREMETAMINE (25MG).
Screening must be done to exclude G6PD deficiency or
allergy to sulphonamides
ALTERNATIVE RX:
Prognoquil for 1st trim non immune women
HIV/AIDS positive women shall receive monthly doses
of S.P,EXCEPT when they are taking co-trimoxazole.
Folic Acid should not be given with SP as it counteracts
its efficacy.
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