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1.
Med Sante Trop ; 29(4): 392-398, 2019 Nov 01.
Article in English | MEDLINE | ID: mdl-31884993

ABSTRACT

In the Democratic Republic of the Congo, the first recourse in case of suspected malaria in the health system is the private pharmacy sector. This study was therefore designed to assess private provider adherence to national case management guidelines in Kimpese, a rural area of Central Kongo province. A descriptive cross-sectional survey of 103 pharmacies took place in March 2016. The study included 97 pharmacies. The artemether-lumefantrine combination recommended as the first-line treatment for uncomplicated P. falciparum malaria was available in 100% of pharmacies but only 3% stocked quality-assured medicines. The sulfadoxine-pyrimethamine recommended for intermittent preventive treatment of malaria in pregnant women and quinine, which is no longer part of national policy, were widely available (>97.0% of pharmacies). Among providers, fewer than 20% were aware of the national malaria treatment guidelines. The main reasons for non-adherence to national guidelines among private dispensers was the high cost (up to 10 times more expensive than sulfadoxine-pyrimethamine treatment) and adverse effects of artemisinin-based combination therapies. Governmental interventions to improve private sector engagement in implementation of the national guidelines and to prevent the spread of ineffective and non-quality assured antimalarial medicines must be intensified.


Subject(s)
Antimalarials/therapeutic use , Artemether, Lumefantrine Drug Combination/therapeutic use , Guideline Adherence/statistics & numerical data , Malaria/drug therapy , Pharmaceutical Services/standards , Pharmacies , Private Sector , Pyrimethamine/therapeutic use , Sulfadoxine/therapeutic use , Adult , Aged , Case Management , Cross-Sectional Studies , Democratic Republic of the Congo , Drug Combinations , Female , Humans , Male , Middle Aged , Rural Health , Young Adult
3.
Metab Brain Dis ; 29(2): 359-66, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24481810

ABSTRACT

While risk factors for konzo are known, determinants of cognitive impairment in konzo-affected children remain unknown. We anchored cognitive performance (KABC-II scores) to serum levels of free-thyroxine (free-T4), thyroid-stimulating hormone (TSH), albumin, and motor proficiency (BOT-2 scores) in 40 children including 21 with konzo (median age: 9 years) and 19 without konzo (median age: 8 years). A multiple regression model was used to determine variables associated with changes in KABC-II scores. Age (ß: -0.818, 95% CI: -1.48, -0.152) (p = 0.018), gender (ß: -5.72; 95% CI: -9.87, -1.57 for females) (p = 0.009), BOT-2 score (ß: 0.390; 95% CI: 0.113, 0.667) (p = 0.008), and free-T4 (ß: 1.88; 95% CI: 0.009, 3.74) (p = 0.049) explained 61.1 % of variation in KABC-II scores. Subclinical hypothyroidism was not associated with poor cognition. A crude association was found between serum albumin and KABC-II scores (ß: 1.26; 95 % CI: 0.136, 2.39) (p = 0.029). On spot urinary thiocyanate reached 688 µmol/l in children without konzo and 1,032 µmol/L in those with konzo. Female gender and low serum albumin are risk factors common to cognitive and proportionally associated motor deficits in children exposed to cassava cyanogens. The two types of deficits may share common mechanisms.


Subject(s)
Child Nutrition Disorders/diagnosis , Cognition/physiology , Cyanides/adverse effects , Manihot/adverse effects , Nitriles/adverse effects , Paraparesis, Tropical Spastic/diagnosis , Child , Child Nutrition Disorders/epidemiology , Child Nutrition Disorders/etiology , Cognition/drug effects , Cyanides/administration & dosage , Female , Humans , Male , Nitriles/administration & dosage , Paraparesis, Tropical Spastic/epidemiology , Paraparesis, Tropical Spastic/etiology , Psychomotor Performance/drug effects , Psychomotor Performance/physiology
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