Transcript Drug Policy Bangladesh

Drug Policy Bangladesh
Presented by
Dr ATM Mustafa Kamal
National Programme Manager
Malaria and Vector Borne Disease Control
DGHS, Dhaka, Bangladesh
Malaria Situation in Bangladesh
• Country Area 147,570 sq.
km and Pop. 133.4 million
• 13 out of 64 districts are
high endemic
• 14.7 million people are at
high risk
• 60,000 - 75,000 lab
confirmed cases per year
• Estimated 1.0 million
clinical cases annually
• Focal outbreaks in eastern
border are not infrequent
• Drug resistance (CQ,SP)
reported in CHT.
Drug Policy Bangladesh
Drug policy refers to a set of recommendation
and regulations concerning antimalarial drugs
which requires:
• Continuous evaluation
• Regular review
• Updating
Objective :To ensure prompt, effective and
safe treatment of malaria through selection
of optimal regimen for different clinical
situation
It will harmonize with the corresponding
policies of neighboring countries.
National drug policy making body
•The Directorate of Drug Administration
is the apex body;
•For formulation of national antimalarial
drug policy WHO guidelines are strictly
followed;
•Bangladesh has a National Drug Policy.
Previous drug policy
In 1994 Revised Malaria Control Strategy was
adopted by Bangladesh (as per the Ministerial
Conference in Amsterdam-Malaria Declaration).
Adoption:
Clinical Case Definition- Uncomplicated
Malaria; Treatment failure malaria and
Severe Malaria.
Uncomplicated Malaria
UM cases were treated with chloroquine
(dose= 25 mg/kg body weight) in 3 days
regimen followed by primaquine, a single
dose (45 mg)
Treatment failure Malaria
Treatment failure malaria cases are treated
with Quinine (10 mg/kg body weight) for 3
days followed by: primaquine in a single dose
(45 mg) and Fansidar (SP) 3 tablet single dose.
Severe Malaria
• Parental quinine (quinine
dihydrochloride =10 mg/kg body
weight) followed by oral quinine (Total
7 days).
Drug resistance
The degree of drug resistance of P.
falciparum to chloroquine and SP are
increasing particularly in the high endemic
areas (Myanmar and India Border districts).
A randomized control trial in one of
the high risk malarious area has
yielded.
Case study-I
Drug-Chloroquine
Ramu upazila/Cox’s Bazar
Total Pop. in study area-188812
RI-22% , RII-16%,RIII-40%
ETF-34%,LTF-33%,ACPR-34%
Case study-II
Teknaf Upazila/Cox’sBazar
Drug-Chloroquine
Total Pop. in study area-18500
ETF->25%
LTF->25%
Case study-III
Sreemongal UZHC
Moulavibaza District
Drug- Chloroquine
• Pop. in study area –271000 (Year-1999)
• ETF->25%
• LTF->25%
Case Study-IV
Ramu upazilla
Cox’s Bazar District
Drug-Q3+SP
• Total Pop.in study area –188812(Year1997)
• RI-22%,RII-2%,RIII-6%
• ETF-O%, LTF-21%, ACR-79%
Study-V
Ramu Upazila, Cox’s Bazar
Drug-Mefloquine
• Total Pop. in study area-188812 (Year-1997
• RI-13%, RII-4%, RIII-10%
• ETF-0%, LTF-11%, ACR-89%
Study-VI
Kaptai Upazila, Rangamati
Drug-CQ3+SP
•ETF-2.9%
•LPF-30%
•ACPR-67.1%
Study-VII
Dhiginala Upazila,
Khagrachari
Drug-CQ3+SP
• ETF-4.3%
• LCF-7.1%
• LPF-1.5%
• ACPR-87.1%
Study-VIII
Fatikchari Upazila, Chittagong
Drug-CQ3+SP
•ETF-4%
•LCF-16%
•LPF-2%
•ACPR-76%
Case Study-IX
Matiranga Upazila/Khagrachari
Drug-CQ3+SP
•ETF-7.7%
•LCF-9.2%
•LPF-13.8%
•ACPR-69.3%
Case Study-X
Alikadam Upazila, Bandarbar District
Drug-CQ3+SP
• ETF-3.5%
• LCF-20.7%
• LPF-1.7%
• ACPR-74.1%
Case Study-XI
Chittagong Medical College
Drug-AS Vs Quinine
• Artesunate mortality-52/222(23%)
• Quinine mortality-75/231(32%)
Based on drug resistance status GoB
approved new antimalarial treatment
regimen and introduced Atimisinin
based Combination Therapy (ACT).
10 November 2004 Revised Malaria Treatment
Regimen adopted by MOHFW.
Revised Malaria Treatment Regimen
Malaria Case Definition
• Uncomplicated Malaria Presumptive(UMP)
• Uncomplicated Malaria Confirm (UMC)
• Severe Malaria (SM)
Uncomplicated Malaria Presumptive
•Fever or h/o fever over last 48 hours;
•Absence of convincing features of any other
febrile illness;
•High index of suspicion, Endemic zone,
susceptible population, transmission season;
•Without microscopy or RDT.
Uncomplicated Malaria Confirm
•Fever or h/o fever over last 48 hours;
•Absence of convincing features of any other
febrile illness;
•High index of suspicions：Endemic zone,
susceptible population， Transmission season
•Presence of asexual form of P. falciparum
Severe
Malaria
•Fever or H/o fever over last 48 hours;
•With one or more feature of severity;
•Presence of asexual form of P. falciparum
in blood slide examination or +ve RDT
Revised Malaria Treatment Regimen
Uncomplicated Malaria presumptive:
•UMP cases should be treated with Chloroquine for 3
days
•Blood slide or RDT should be done, As soon as
possible.
Uncomplicated Malaria Confirm
For P.falciparum:
•Artemether+lumifantrin - for 3 days
•Quinine for 7 days in special and specific situation
•Quinine-7 days+TC-7days or Quinine-7days+Dc7days
For P. vivax
•CQ for 3 days and primaquine- for 14 days.
Severe malaria
•IV/IM Quinine followed by oral Quinine-7 days
•AM/Artesunate in selected cases
•IM Quinine/Rectal artesunate (?) in pre-hospital
treatment
•Immediate referral should be made
Thank You