E-drug: Re: WHO on artemisine combination therapy
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In Kenya, the statistics show that a large proportion of Malaria
deaths are in Children below Five and Pregnant women. I am
delighted that there is a constant move to try and tackle this
disease through various prevention and treatment options.
However, I will continue to request the policy makers to remember
to ensure that there are drug formulations appropriate for these
children under five, even in resource challenged populations. Is
there such a formulation for "COartem"? Not in Kenya. Has any one
done a study that could quantify the extent of treatment
failures(and resistance) attributed to inability of children under five
to take tablets? (Even when they are crushed and dispersed in an
appropriate liquid?). As one who works with children, I see the
bewildered faces of parents, even among the very well educated
ones, when asked to crush a quarter tablet of Folic Acid and
disperse in some clean drinking water and give to their children as
directed! (turning them into drug compounders at home!) The
package insert for coartem gives the dosing schedule as follows
5-<15kg, one tablet at the time of initial diagnosis, and then 8,24
and 48 hours thereafter(total course comprises 4 tablets) I
remember voicing this concern of paediatric-appropriate
formulations during an experts meeting on access to ARVs in
Nairobi in July 2000 and I was a lone voice (One comment was that
paediatric formulations are more costly than adult ones). I am
probably opening up a pandoras box given the complex nature of
treating the child which always involves a 3rd party(parent) So, my
plea is for the policy makers to be conscious of the fact that they
are dealing with a vulnerable group called children and their ability
to take a drug is very much part of the treatment plan (does
concordance apply in paediatrics?). Please say YES to the children
in these matters!
Dr Atieno Ojoo
Chief Pharmacist
Gertrude's Garden Childrens' Hospital
P O Box 42325-00100
GPO, Nairobi
Kenya
Tel; 254 2 763474-7
Fax; 254 2 763281
Email; mojoo@gerties.org
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