ABSTRACT
Background: Ninety-five millions of Pakistan's 161 million people, roughly 60% of Pakistan's population live in malaria endemic regions. Despite a well-established malaria control programme, 500,000 malaria infections and 50,000 malaria-attributable deaths occur each year in Pakistan. In Pakistan 15% population lives in high transmission area, 84% in low transmission and 1% in malaria free area, with 64% vivax and 36% Falciparum infections
Objective: The objective of this study was to assess the therapeutic efficacy and safety of Dihydroartemisinin- piperaquine [DP] for the treatment of uncomplicated Plasmodium vivax malaria in subjects
Methods: Its an observational study, conducted at Outpatient Department of Liaquat University Hospital Hyderabad, from December 2012 to December 2013. World Health Organization [WHO] standard protocol for efficacy studies [open-labelled clinical trial] was followed. The subjects with fever or history of fever for 48 hours aged between 6 months to 15 years with microscopically confirmed uncomplicated P. vivax infection were included. Total 109 patients fulfilled the inclusion criteria. Out of 109 patients, 103 had completed the study. Patients were treated with Dihydroartemisinin-piperaquine over three days. Clinical and parasitological parameters were monitored over a 42-days follow-up period to evaluate drug therapeutic efficacy
Results: Adequate clinical and parasitological response of treatment [ACPR] for Dihydroartemisininpiperaquine [DP] was seen in 102/103 [99.02%] patients, no early or late clinical failure was seen while late parasitological failure was seen on 21[st] day in one patient. No adverse events were reported
Conclusion: Dihydroartemisinin-piperaquine is safe and effective treatment option for uncomplicated vivax malaria
ABSTRACT
Background: Tuberculosis [TB] in children is clearly linked to TB in adults therefore active household contact tracing is an important method of early diagnosis and treatment particularly in high-TB-burden countries
Objectives: To estimate the prevalence of TB among household contacts of children suffering from tuberculosis using active contact tracing and linking them to TB program for treatment
Subjects and Methods: A total of 125 children suffering from active tuberculosis [index cases] aged 12 years or less were randomly selected from the outpatient department of a tertiary care hospital of Hyderabad. Using their home address, all house hold members of the index cases [sharing one kitchen] were identified. The households were visited by a team including a doctor and the supported staff and were screened for TB using history, physical examination, sputum for AFB and X-ray of chest. Clinical suspects were divided in to two populations, equal to or less than 12 years of age and greater than this age. All suspected cases were brought to outpatient's department of the hospital where children were examined and diagnosed by pediatrician and adults were examined by the pulmonologist
Results: There were 125 children and 1365 household members. Prevalence of active TB in adult household contacts was 8.1% and among children was 5.7%. Mother, father, grand parents or siblings were the source of disease spread in children. Family history of TB was present in 95% [pulmonary 78%, extra-pulmonary 22%]
Conclusion: Tuberculosis in children is mostly spreading from household member hence deeply required to undertake active contact tracing in each new case that is diagnosed or being treated
Policy message: National and Provincial TB programs should advocate and undertake active screening of all household contacts of all TB cases