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Malaria
Poverty
Infected Mosquito
Severe Illness
Anaemia Infected Human Chronic effect Neurologic/C ognitive Developmental Low birth weight Acute Illness Anaemia Impaired growth & development Malnutrition
Infant mortality
Impaired productivity
Malaria Epidemic Prone Areas Malaria Endemic Areas Malaria Endemic - Roll Back Malaria Pilot Areas
CNS Manifestations
Unrousable Coma Impaired Conscious Convulsion Severe Prostation Hyper-parasitaemia Severe Anamia
304
86 185 33 193 172 51
39 (31)
36 (27) 2 (1) 1 (3) 0 0 0
19
10 8 1 4 6 16
362 (44)
132 (16) 195 (24) 35 (4) 197 (24) 178 (22) 67 (8)
Hyperpyrexia
Others Total n (row%)
14
7 741 (89)
1 (7)
0 40 (4.8)
0
3 48 (6)
15 (2)
10 829
Jaundice
2 (0.5)
6 (3.2)
Artesunate Versus Quinine for Treatment of Severe Falciparum Malaria: a Randomised Trial
South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) group* Lancet 2005; 366: 71725
Infected Mosquito
Severe Illness
Anaemia Infected Human Chronic effect Neurologic/ Cognitive Developmental Low birth weight Acute Illness Anaemia Impaired growth & development Malnutrition
Infant mortality
Impaired productivity
Malaria
Pl vivax
32%
After inclusion of physicians impression
19%
23%
14%
14%
37%
RMM RDT PM RRM PPL Diagnostic 64% Capability (SM) 65% 69% 27%
RDT: Addition of 5%
JITMM 2002
Diagnostic Facilities
1995- clinical diagnosis
2004-shift to laboratory confirmation RDT or microscopy Need for development of facilities of diagnosis at periphery by RDT and fixed centers by
microscopy
Newer Antimalarials
For Uncomplicated Malaria
Artemisinin based Combination Antimalarials Artemether-Lumefantrine
Combination Treatment
Artemisininn based treatment
Either Artemether+Lumefantrine (Bangladesh) Artesunate + mefloquine
No new insecticide over last 2 decades Pyrethroids: Newer insecticide Use of OPC and Carbamet ITMN or LLN Ensure adequate number of mosquito nets
Conclusion
Morbidity & mortality from malaria in BD remained significant & unchanged over last 5
years.
Planning and implementation at micro level The umbrella to be provided by the national Government NMCP, BD needs to be strengthened attitude,
Thank You
Introduction:
National malaria control program in Bangladesh adopted the treatment regimen in 1994 which is currently practised.
Evidence suggests Chloroquine resistance for P. falciparum malaria is 40 70% in high endemic areas in Bangladesh. To ensure radical cure Govt. of Bangladesh in collaboration with WHO adopted and approved
Case Definitions: Uncomplicated Malaria Confirmed (UMC): Diagnosis is confirmed by Blood slide examination or
Case Definitions:
Uncomplicated Malaria Presumptive (UMP): When microscopy or Rapid diagnostic test (RDT) is not available Fever or History of Fever over last 48 hours. Absence of convincing feature of any other febrile illness.
Case Definitions:
Severe Malaria (SM): Presence of asexual form of P. falciparum in blood slide examination (or + ve RDT) Fever or History of Fever over last 48 hours. With one or more of the following features of severity: Unconsciousness Convulsion Unable to stand or walk Vomiting or severe Diarrhoea Severe anaemia Confused or abnormal behavior
Treatment objectives:
Primary: Save life. Secondary: Prevention of recrudescence, transmission or emergence of resistance. Pregnancy: saving the mothers life
After
rapid
clinical
assessment
and
confirmation of the diagnosis of severe malaria, full doses of antimalarial treatment should be started without delay.
There
is
insufficient
evidence
to
Treatment Recommendations
(WHO)
Quinine: 20mg salt/kg on admission (i.v.
infusion over 4 hours, or i.m.) 10mg/kg 8 hourly. Artemether: 3.2mg/kg i.m. given on then
IMPAIRED CONSCIOUSNESS?
YES
NO
NO
infections. Important source of resistance. Important that a full course of curative treatment is completed.
Uncomplicated Malaria
Uncomplicated malaria is defined as symptomatic malaria without signs of vital
organ dysfunction
Uncomplicated Malaria :Treatment Objectives To cure the infection rapidly and reliably.
Artemisinin-based combinations are the recommended treatments for uncomplicated falciparum malaria: Likely to be effective everywhere artemether-lumefantrine; 1.5 / 12 mg/kg twice daily for 3 days artesunate + mefloquine; 4 / 8 mg /kg daily for 3 days Only likely to be effective in certain areas (depending on the efficacy of the partner drug) artesunate + amodiaquine; 4 / 10 mg /kg daily for 3 days artesunate + SP; 4mg/kg daily for 3 days/ single dose 1.25/25mg/kg on day 1.
Co-artem vs Q3+SP
Randomized, 28-day in-vivo test, 8-day hospitalization
14 12 10 8 6 4 2 0
Day-0 Day-1 Day-2
Q3SP Coartem
Day-3
Day-4
Day-5
Day-6
Day-7
Day-14
Day-21 Day-28
Summary
Revised Malaria Rx Case definition Uncomplicated malaria presumptive (UMP)Blood slide/RDT-ve Uncomplicated malaria confirmed (UMC)-
Previous regimen
Uncomplicated malaria (UM)
Treatment failure
malaria (TFM) Severe malaria (SM)
Slide/RDT+ve
Severe malaria(SM)Slide/RDT +ve
Thank you.