Penicillin Allergy label - the unmet needs - causes and potential solutions.

Summary: Background. Penicillin allergy is the most prevalent drug allergy. Its overdiagnosis has been associated with inappropriate antibiotic prescribing, increased antimicrobial resistance, worse clinical outcomes, and increased healthcare costs. Methods. 403 inpatients were audited against National Institute of Clinical Excellence (NICE) Clinical Guidance 183 (CG183) on diagnosis, investigations, documentation, and management of penicillin allergy. 50 junior doctors were surveyed to explore barriers to best practice, investigating their knowledge of, and confidence using the NICE CG183 guidelines. Their views on potential solutions were also explored. Results. The audit identified: 13% (54/403) of patients labelled penicillin allergic; 24% (13/54) fulfilled criteria for referral but none were referred to specialists. With regards to documentation: 33% (18/54) documented exact drug name; 72% (39/54) documented signs and symptoms; 20% (11/54) documented reaction severity; 2% (1/54) documented indication for the drug taken; 4% (2/54) documented number of doses taken or days before onset of the reaction and 0% documented route of administration. The survey revealed barriers including: 1- lack of awareness and confidence in applying the NICE CG183 on diagnosis and management; 2- tendency to err on the side of caution when de-labelling patients. All agreed that decision support tools would address barriers to best practice and appropriate penicillin allergy de-labelling Conclusions.The current practice of diagnosing, documenting, and managing penicillin allergies does not meet NICE CG183. A lack of awareness and confidence using NICE CG183 are the main contributing barriers to best practice. Decision support tools, including a drug allergy app, would help overcome these barriers.

Management of the use of public health pesticides in the face of the increasing burden of vector-borne diseases in the Eastern Mediterranean region.

The Eastern Mediterranean Region of the World Health Organization is facing an increasing burden of vector-borne diseases. Progress in controlling these diseases is compromised by the limited number of vector control interventions, most of which rely on the use of pesticides. Seventeen countries of the Region participated in a global survey that aimed to map and document registration and management practices for public health pesticides. This paper aims to draw the attention of policy- and decision-makers to the challenges the Region is facing in managing public health pesticides properly to control disease vectors and, based on the outcome of the survey, recommends a set of actions to guide national policy and to strengthen national capacity for the sound management and judicious use of public health pesticides.

The mosquito dunk (Bacillus thuringensis israelienses) as a control agent against mosquito larvae in Khartoum State, Sudan Abdalmagi

Background: During the mid-1970s, larvicides have become available that are highly effective, yet selective in action, and therefore environmentally safe to non-target organisms, as well as for human exposure(1). Objectives: The small field trial was carried out from 12th of January to 16th of February 2008 in Khartoum State to evaluate the efficacy and persistence mosquito dunk® (Bti) against mosquito larvae and to measure the effect of physic-chemical properties on mosquito dunk. Material & Methods: The efficacy and persistence of Bacillus thuringiensis subspecies israelensis (mosquito dunk®) as a biological control agent against mosquito larvae was conducted in Khartoum State. Twelve ponds were used as natural breeding habitats of mosquitoes; six of them were treated with dunk at a rate of 1 dunk per 100 square feet and six ponds left untreated (control). Results: The study revealed that more than 80% reduction in immature stages density was observed up to 5, 3 and 2 weeks for the 3rd, 2nd and 4th instars of Anopheline spp., respectively. However, the study showed that the mosquito dunk was noteffective (under 80% mortality) against 1st, instar larvae and pupae of Anopheline species as well as Culex developmental stages. Conclusion & Interpretations: The dunk was very effective in controlling 3rd and 4th instars of Anopheles spp; for 2 weeks interval. Therefore we propose a surface application regime of once every 2 weeks for mosquito dunk

Management of the use of public health pesticides in the face of the increasing burden of vector-borne diseases in the Eastern Mediterranean Region

The Eastern Mediterranean Region of the World Health Organization is facing an increasing burden of vector-borne diseases. Progress in controlling these diseases is compromised by the limited number of vector control interventions, most of which rely on the use of pesticides. Seventeen countries of the Region participated in a global survey that aimed to map and document registration and management practices for public health pesticides. This paper aims to draw the attention of policy- and decision-makers to the challenges the Region is facing in managing public health pesticides properly to control disease vectors and, based on the outcome of the survey, recommends a set of actions to guide national policy and to strengthen national capacity for the sound management and judicious use of public health pesticides

Malaria control in an urban area: a success story from Khartoum, 1995-2004.

Khartoum is an urban area with low malaria transmission. Early control efforts were successful in reducing the risk but malaria has resurged in recent years. In 2002, the Government of Sudan, with support of the World Health Organization, embarked on an initiative aimed at freeing Khartoum of malaria. The initiative's prevention strategy has focused on larval control interventions. The results indicate a significant reduction in malaria prevalence, confirmed and clinically diagnosed malaria cases among outpatient attendance and the number of malaria-associated deaths. It is proposed information be collected on parity rates and that a sub-sample of the adult mosquito collections be subjected to ELISA or PCR for identification of malaria parasite infections in mosquitoes in areas showing active foci.

Stratification of Khartoum urban area by the risk of malaria transmission.

A cross-sectional community-based study was carried out in Khartoum urban area aimed at stratifying the area by risk of malaria transmission. Two thousand households (8092 individuals) were surveyed during the cold, dry and rainy seasons of 2002. Households with screened windows, using bednets or both were 5.0% (95% CI: 4.1-6.0), 10.9% (95% CI: 9.5-12.3) and 1.8% (95% CI: 1.2-2.5) respectively. Access to health services was high. Only 3.8% (95% CI: 2.9-4.7) of households kept antimalarial drugs at home. The parasite rate, spleen rate and fever rate were very low (0.21%, 0.17% and 0.97% respectively). Overall, people in Greater Bahry suffer a greater burden of malaria than those in Greater Khartoum or Greater Omdurman, with a seasonal pattern of transmission.