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Drug Policy Bangladesh

In 1994 Revised Malaria Control Strategy was adopted by Bangladesh (as per the Ministerial Conference in Amsterdam-Malaria Declaration). Adoption: ...

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Drug Policy Bangladesh

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    1. Drug Policy Bangladesh

    Presented by Dr ATM Mustafa Kamal National Programme Manager Malaria and Vector Borne Disease Control DGHS, Dhaka, Bangladesh

    2. 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.

    3. Drug Policy Bangladesh

    Drug policy refers to a set of recommendation and regulations concerning antimalarial drugs which requires: Continuous evaluation Regular review Updating

    4. It will harmonize with the corresponding policies of neighboring countries.

    Objective :To ensure prompt, effective and safe treatment of malaria through selection of optimal regimen for different clinical situation

    5. 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.

    6. 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.

    7. 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)

    8. 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.

    9. Severe Malaria

    Parental quinine (quinine dihydrochloride =10 mg/kg body weight) followed by oral quinine (Total 7 days).

    10. 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).

    11. 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%

    12. Case study-II Teknaf Upazila/Cox’sBazar

    Drug-Chloroquine Total Pop. in study area-18500 ETF->25% LTF->25%

    13. Case study-III Sreemongal UZHC Moulavibaza District

    Drug- Chloroquine Pop. in study area –271000 (Year-1999) ETF->25% LTF->25%

    14. Case Study-IV Ramu upazilla Cox’s Bazar District

    Drug-Q3+SP Total Pop.in study area –188812(Year-1997) RI-22%,RII-2%,RIII-6% ETF-O%, LTF-21%, ACR-79%

    15. 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%

    16. Study-VI Kaptai Upazila, Rangamati

    Drug-CQ3+SP ETF-2.9% LPF-30% ACPR-67.1%

    17. Study-VII Dhiginala Upazila, Khagrachari

    Drug-CQ3+SP ETF-4.3% LCF-7.1% LPF-1.5% ACPR-87.1%

    18. Study-VIII Fatikchari Upazila, Chittagong

    Drug-CQ3+SP ETF-4% LCF-16% LPF-2% ACPR-76%

    19. Case Study-IX Matiranga Upazila/Khagrachari

    Drug-CQ3+SP ETF-7.7% LCF-9.2% LPF-13.8% ACPR-69.3%

    20. Case Study-X Alikadam Upazila, Bandarbar District

    Drug-CQ3+SP ETF-3.5% LCF-20.7% LPF-1.7% ACPR-74.1%

    21. Case Study-XI Chittagong Medical College

    Drug-AS Vs Quinine Artesunate mortality-52/222(23%) Quinine mortality-75/231(32%)

    22. 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.

    23. Revised Malaria Treatment Regimen

    Malaria Case Definition Uncomplicated Malaria Presumptive(UMP) Uncomplicated Malaria Confirm (UMC) Severe Malaria (SM)

    24. 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.

    25. 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

    26. 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

    27. 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.

    28. 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+Dc-7days For P. vivax CQ for 3 days and primaquine- for 14 days.

    29. 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

    30. Thank You

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