RESUMEN
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
RESUMEN
Objectives: To assess the validity /strength of clinical diagnosis of Malaria on the basis of IMNCI algorithm by slide microscopy [gold standard] and to compare the effectiveness of Rapid Diagnostic Test [RDT ]against slide microscopy
Methods: It is a descriptive cross sectional study of 6 month duration conducted at Pediatric Outpatient Department LUH Hyderabad from June-Dec. 2010. Sample of 400[the minimum required sample was 385 with malaria prevalence 5% [0.05] with margin of error of 3% [0.03, frequency vary from 2-8 % among different studies]] febrile children under 5 years classified as Suspected Clinical Malaria according to algorithm of IMNCI were included; The operational definition for Suspected Clinical Malaria was; fever for more than 2 days with no runny nose, no measel rash and no other cause of fever. Hyderabad was considered as low risk area. Rapid diagnostic test [RDT] and slide microscopy were done, and only confirmed cases were treated according to current guidelines given by National Malaria Program/updated IMNCI
Results: Total 2000 patients under 5 years presented with fever and were evaluated. From 2000 cases 20% [400] were diagnosed as suspected clinical Malaria according to IMNCI algorithm; and only 40 cases [10%] have shown positive results for malaria parasite on slide microscopy and 38 cases on RDT. Regarding the plasmodium species 70% were vivax and 30% were falciparum. As regards the effectiveness, RDT has shown 95% sensitivity for the detection of plasmodium antigens in the febrile clinically suspected cases of malaria
Conclusion: Prompt and accurate diagnosis of malaria is needed for implementation of appropriate treatment to reduce unnecessary anti-malarial prescription. RDT is as effective as slide microscopy for the diagnosis of malaria especially in resource poor countries