Substandard antimalarials available in Afghanistan: a case for assessing the quality of drugs in resource poor settings.

Good-quality antimalarials are crucial for the effective treatment and control of malaria. A total of 7,740 individual and packaged tablets, ampoules, and syrups were obtained from 60 randomly selected public (N = 35) and private outlets (N = 25) in Afghanistan. Of these, 134 samples were screened using the Global Pharma Health Fund (GPHF) MiniLab® in Kabul with 33/126 (26%) samples failing the MiniLab® disintegration test. The quality of a subsample (N = 37) of cholorquine, quinine, and sulfadoxine/pyrimethamine tablets was assessed by in vitro dissolution testing following U.S. Pharmacopeia (USP) monographs at a bioanalytical laboratory in London, United Kingdom. Overall, 12/32 (32%) samples of sulfadoxine/pyrimethamine and quinine were found not to comply with the USP tolerance limits. Substandard antimalarials were available in Afghanistan demonstrating that continuous monitoring of drug quality is warranted. However, in Afghanistan as in many low-income countries, capacity to determine and monitor drug quality using methods such as dissolution testing needs to be established to empower national authorities to take appropriate action in setting up legislation and regulation.

Prevalence and molecular basis of glucose-6-phosphate dehydrogenase deficiency in Afghan populations: implications for treatment policy in the region.

BACKGROUND: Glucose-6-phosphate dehydrogenase deficiency (G6PD), an x-linked inherited enzymopathy, is a barrier to malaria control because primaquine cannot be readily applied for radical cure in individuals with the condition. In endemic areas, including in Afghanistan, the G6PD status of vivax patients is not routinely determined so the drug is rarely, if ever, prescribed even though it is included as a recommended treatment in local, regional and global guidelines. This study assessed the prevalence and genotype of G6PD deficiency in Afghan populations and examined the need for routine G6PD testing as a malaria treatment and control tool. METHODS: A cross-sectional household survey was conducted using random sampling in five Afghan cities to determine the prevalence of G6PD deficiency in Afghan ethnic groups. Filter-paper blood spots were analysed for phenotypic G6PD deficiency using a fluorescent spot test. Molecular analysis was conducted to identify the genetic basis of the disorder. RESULTS: Overall, 45/1,436 (3.1%) people were G6PD deficient, 36/728 (5.0%) amongst males and 9/708 (1.3%) amongst females. Amongst males the prevalence was highest in the Pashtun ethnic group (10%, 26/260) while in Tajik males it was 8/250 (3.2%); in Hazara males it was 1/77 (1.3%) and in Uzbek males is was 0/125. Genetic testing in those with deficiency showed that all were of the Mediterranean type (Med-) characterized by a C-T change at codon 563 of the G6PD gene. CONCLUSION: Prevalence of G6PD deficiency in Afghanistan varies considerably by ethnic group and is predominantly of the Mediterranean type. G6PD deficient individuals are susceptible to potentially severe and life-threatening haemolysis after standard primaquine treatment. If the aim of increasing access to radical treatment of vivax is to be successful reliable G6PD testing needs to be made routinely available within the health system.

Prevalence of hepatitis 'B' and 'C' in orthopaedics patients at Ayub Teaching Hospital Abbottabad.

BACKGROUND: Hepatitis B and C is a common global health problem and is spreading rapidly in developing countries due to lack of health education, poverty and illiteracy. Both of these infections can be transmitted through blood or body fluids, tattooing, through infected instruments, unsafe shave by barbers and sexual contact. Medical personnel are most exposed to these infections. There should be proper preventive measures to prevent its spread in the community. METHODS: This is a descriptive study carried out from July 2003 to July 2004 on 1630 patients admitted in the department of Orthopaedics Ayub Teaching Hospital Abbottabad. Patients of either sex, of all ages undergoing surgery were included in the study. All patients underwent screening for Hepatitis-B and Hepatitis-C and confirmed by Elisa method in positive patients. RESULTS: Out of 1630 patients 1205 (73.92%) were male and 425 (26.07%) were female. Hepatitis B and C was present in 84 (5.15%) patients. Out of 84 infected patients 51 (3.12%) were suffering from hepatitis C and 33 (2.02%) were suffering from hepatitis B. In 2 (0.12%) patients both hepatitis B and C infections were present. Out of 51 hepatitis C patients, 33 (64.71%) were male and 18 (35.29%) were female. Out of 33 hepatitis B patients, 28 (84.85%) were male and 5 (15.15%) were female patients. Among the predisposing factors previous history of surgery was positive in 18 (21.43%) patients, history of blood transfusion in 13 (15.47%) patients, dental procedure was in 7 (8.33%) patients, and abroad visit in 4 (4.76%) patients. CONCLUSION: The prevalence of hepatitis B and C in orthopaedic patients is quite high with the common risk factors: previous history of surgery or blood transfusion. Therefore, all patients which need surgery should be routinely screened for hepatitis B & C to prevent transmission to other patients, medical staff. There should be separate operation theatres facilities for these patients. There should be policy by the Government for protection of medical personnel who are exposed to these patients and there should be compensation for those who get infected with these infections during their service otherwise the medical personnel especially surgeons will hesitate doing surgeries on hepatitis B and C infected patients.