Drug dosing errors in simulated paediatric emergencies ­ Comprehensive dosing guides outperform length-based tapes with precalculated drug doses

Background: The accuracy of drug dosing calculations during medical emergencies in children has not been evaluated extensively. The objectives of this study were to evaluate the accuracy of drug dose calculations using the Broselow tape, the PAWPER XL tape plus its companion drug-dosing guide, a custom-designed mobile phone app and no drug-dosing aid (control group). Methods: This was a prospective study in which 32 emergency medicine volunteers participated in eight simulations of common paediatric emergency conditions, using children models. The participants used the three methods to estimate the children's weight and calculate drug doses. The accuracy of and time taken for the drug dose determinations were then evaluated for each of the methods. Results: The overall accuracy of drug dose determinations was extremely and potentially dangerously low in the control group in which no dosing guide was used as well as in the Broselow tape group (<20% of doses were correct). The accuracy was significantly higher with the PAWPER XL tape group and the mobile app group (47% and 31% respectively). The times taken to obtain the required information did not differ in a clinically meaningful magnitude. Conclusions: Both an accurate weight estimation and a dosing guide with comprehensive information were necessary to produce an accurate prescription. The information on the Broselow tape was not sufficient for this purpose. The current guidelines recommending the use of tapes with limited information should be revised. The results from the comprehensive dosing guides were substantially better, but still had a lower proportion of accurate prescriptions than desirable. The role of training in every aspect of the emergency paediatric weight estimation and drug dosing procedure cannot be underestimated and should be routine in any environment where emergency care may be needed

Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia

Objective:To describe the implementation and feasibility of an innovative mass vaccination strategy ­ based on single-dose oral cholera vaccine ­ to curb a cholera epidemic in a large urban setting.Method:In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.Findings:Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign ­ 2.31 United States dollars (US$) per dose ­ included the relatively low cost of local delivery ­ US$ 0.41 per dose.Conclusion:We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered

Determinants socio-economiques de l'automedication aux antimalariens a Kisangani/RD Congo

Objectif de l'etude: evaluer l'importance et les determinants socio-economiques de l'automedication aux anti-malariens dans la commune de la Tshopo a Kisangani Materiel et methodes: Nous avons realise une etude transversale utilisant un questionnaire d'enquete pour collecter les donnees. Par un echantillonnage systematique; 384 menages au minimum ont ete enquetes.Resultats: Au total 386 responsables de menage ont participe a l'enquete. 346 (89;6) de responsables avaient reconnu pratiquer l'automedication aux anti-malariens. Deux facteurs socio-economiques etaient significativement lies a l'automedication dans l'analyse classique : le revenu mensuel des responsables (p=0;0013) et la charge familiale en terme de nombre d'enfants (p=0;0034). L'age; le sexe; l'occupation des responsables; le niveau d'instruction et la religion des responsables n'etaient pas associes a la pratique.A l'analyse multi variee; les deux facteurs sont restes significatifs : les revenus superieurs a 100 dollars americains previennent la pratique [ORaj=0;25 (0;11-0;58); p=0;001] et le nombre eleve d'enfants dans le menage la favorise [ORaj=3;94(1;62-9;55); p=0;0024] entre 3-4 enfants et ORaj=3;34(1;067-10;46); p=0;038); a partir de 7 enfants) Conclusion:La prevalence de l'automedication aux anti-malariens est alarmante dans la commune de la Tshopo a Kisangani. La menace de la resistance; la circulation possible de medicaments de qualite douteuse et le contexte local de controle de qualite fait de cette pratique un probleme important de sante publique. Une evaluation serieuse de cette pratique serait donc utile dans le futur