Efficacy of anti malarial drugs in afghanistan 2

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  • WHO MEETING ON PROGRESS ACHIEVED WITH MALARIA ELIMINATION IN THE WHO EUROPEAN REGION , ASHGABAT, TURKMENISTAN, 30 OCTOBER – 1 NOVEMBER 2007
  • Efficacy of anti malarial drugs in afghanistan 2

    1. 1. Therapeutic efficacy of anti-malarial drugs in Afghanistan Najibullah Safi, MD, MSc. HPM, DMPPM Primary Health Care Advisor WHO - Afghanistan
    2. 2. Outline of the presentation <ul><li>General information about malaria in Afghanistan </li></ul><ul><li>Aim, method, results, conclusion and recommendation of the study ( therapeutic efficacy of anti-malarial drugs in Afghanistan) </li></ul>
    3. 3. Introduction <ul><li>Major determinant of malaria transmission in Afghanistan are: </li></ul><ul><ul><li>Altitude (below 2000m above the sea level) </li></ul></ul><ul><ul><li>Agriculture (rice cultivation) </li></ul></ul><ul><li>Three strata </li></ul><ul><ul><li>First stratum: medium to high transmission </li></ul></ul><ul><ul><li>Second stratum: low transmission </li></ul></ul><ul><ul><li>Third stratum: has less potential for malaria transmission </li></ul></ul>
    4. 4. Malaria transmission in Afghanistan
    5. 5. Strategies for malaria control <ul><li>Prompt diagnosis and effective treatment </li></ul><ul><li>Vector control and malaria prevention, in the framework of IVM more focusing on LLINs </li></ul><ul><li>IEC/BCC </li></ul><ul><li>Health system strengthening </li></ul><ul><li>Timely detection and control of malaria epidemics </li></ul>
    6. 6. Anti-malarial treatment in health care system of Afghanistan <ul><li>Health post (HP) </li></ul><ul><li>Basic health center (BHC) </li></ul><ul><li>Comprehensive health center </li></ul><ul><li>District hospital </li></ul><ul><li>Provincial hospital </li></ul><ul><li>Specialized hospital </li></ul>Clinical Malaria Clinical Malaria Clinical Malaria Clinical Malaria Clinical Malaria Confirmed Malaria Clinical Malaria Clinical Malaria
    7. 7.
    8. 8.
    9. 9.
    10. 10. Study aim, method, results, conclusion and recommendations
    11. 11. Background <ul><li>Malaria is endemic with seasonal transmission in Afghanistan </li></ul><ul><li>Incidence exhibits a bimodal pattern </li></ul><ul><ul><li>Peak of Vivax in July and August </li></ul></ul><ul><ul><li>Peak of Faciparum in October </li></ul></ul><ul><li>Since 1940s cholorquine has been used widely in the treatment of malaria, and remains first line therapy for the treatment of confirm PV </li></ul>
    12. 12. Background cont. <ul><li>In 2002, PF malaria comprised 20% of all reported cases </li></ul><ul><li>Spread of chloroquine resistance was likely to be contributing factor to the increase of PF cases </li></ul><ul><li>Chloroquine resistance was first reported in 1986 </li></ul><ul><li>In 1999, a study reported 67%treatment failure in the east of the country </li></ul>
    13. 13. Background cont. <ul><li>Access to effective malaria treatment is a cornerstone for malaria control program </li></ul><ul><li>To guide the development of national malaria treatment guideline , anti-malarial drug efficacy data is needed </li></ul><ul><li>In 2003, four sentinel sites were established to monitor the efficacy of anti-malarial drugs </li></ul>
    14. 14. Sentinel sites for efficacy study
    15. 15. Aim, Patients and Methods <ul><li>Aim: to monitor the efficacy of anti-malarial drugs and guide the formulation of National Malaria Treatment Guideline </li></ul><ul><li>28 days in vivo efficacy study </li></ul><ul><li>Study subjects recruited from patients attending clinics for febrile illness </li></ul>
    16. 16. Patients and Methods cont. <ul><li>Inclusion criteria: </li></ul><ul><ul><li>Fever in past 24 hours </li></ul></ul><ul><ul><li>Over 6 months age </li></ul></ul><ul><ul><li>Giemsa stained positive slide for PF, mono infection with parasite density of 1000-100000/  l </li></ul></ul><ul><ul><li>Live within one hour car journey of the centre </li></ul></ul><ul><ul><li>Informed consent </li></ul></ul>
    17. 17. Patients and Methods cont. <ul><li>Exclusion criteria </li></ul><ul><ul><li>Any sign of sever disease </li></ul></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Currently in treatment for malaria </li></ul></ul><ul><ul><li>Febrile disease other than malaria </li></ul></ul><ul><li>Follow up: parasitological follow up on day 2 and parasitological and clinical follow up on days 3, 7, 14, 21 and 28 </li></ul>
    18. 18. Outcome <ul><li>Early treatment failure if: </li></ul><ul><ul><li>On day 1-3 patients suffered from sever illness, or if on day 2 parasitaemia was greater than enrollment day </li></ul></ul><ul><ul><li>Persistent fever in the presence of parasitaemia on day 3 </li></ul></ul><ul><li>Late clinical treatment failure if: </li></ul><ul><ul><li>The patient suffered from auxiliary temperature ≥ 37.5°C on day 4-28 </li></ul></ul><ul><li>Late parasitological failure if: </li></ul><ul><ul><li>Parasitaemia, without symptoms, was recorded on days 7-28 </li></ul></ul>
    19. 19. Summary result of the study
    20. 20. Conclusion and recommendations <ul><li>SP + Artesunate remain efficacious </li></ul><ul><li>The combination has the advantage of being clinically efficacious as well as delaying the development of resistance </li></ul><ul><li>The combination may decrease transmission because of gametocidal effect of Artesunate </li></ul><ul><li>Chloroquine is still effective for the treatment of Vivax malaria </li></ul>
    21. 21. Conclusion and recommendations <ul><li>To continue up-dating the national treatment protocols of malaria, the 3 sentinel sites should be maintained and provided with adequate technical capacity to continuously monitor the therapeutic efficacy of antimalarial drugs in Afghanistan </li></ul>
    22. 22. Thanks questions and comments

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