Caregivers’ Acceptance of Using Artesunate Suppositories for Treating Childhood Malaria in Papua New Guinea

Hinton, Rachael; Auwun, Alma; Pongua, Grace; Oa, Olive; Davis, Timothy; Karunajeewa, Harin; Reeder, John C.

doi:10.4269/ajtmh.2007.76.634

Cited by 19 publications

(28 citation statements)

References 14 publications

(22 reference statements)

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“…22 Non-adherence to ALu treatment found in this study was mostly attributed to untimely dosing rather than missing doses, contrary to concerns that caretakers might discontinue treatment and save the remaining drugs for later use. 1,2 The high level of non-adherence in the last two doses has also been reported in previous studies in Tanzania and Malawi. 8,24 This might be due to some caretakers perceiving that a child playing after an initial dose is cured.…”

Section: Discussionsupporting

confidence: 76%

“…The limited availability of ALu, combined with its rapid onset of action and rapid clearance of severe clinical symptoms, might tempt caretakers to discontinue treatment prematurely 1 and to keep the remaining medicine for an 'anticipated' next attack. 2 This may accelerate the pace of development of drug resistance, 3 thus making it important to maintain high adherence rates to preserve the efficacy of artemisinin-based combination therapy (ACT) in Africa and elsewhere.…”

Section: Introductionmentioning

confidence: 99%

“…Several factors have been reported to influence adherence to treatment, including: education of caretakers and the use of pre-packaged co-blister packets 12,13 ; drug efficacy and rapid improvement of symptoms 1,3,14 ; local perceptions about the disease 15 ; and caretakers perceiving a child playing after a single dose as a sign of cure. 16 Most of these findings, however, are based on studies performed in Asia or during the time when chloroquine (CQ) and SP were the first-line recommended drugs.…”

Section: Introductionmentioning

confidence: 99%

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Adherence to artemether/lumefantrine treatment in children under real-life situations in rural Tanzania

Simba

Kakoko

Tomson

et al. 2012

Transactions of the Royal Society of Tropical Medicine and Hygi

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a b s t r a c tA follow-up study was conducted to determine the magnitude of and factors related to adherence to artemether/lumefantrine (ALu) treatment in rural settings in Tanzania. Children in five villages of Kilosa District treated at health facilities were followed-up at their homes on Day 7 after the first dose of ALu. For those found to be positive using a rapid diagnostic test for malaria and treated with ALu, their caretakers were interviewed on drug administration habits. In addition, capillary blood samples were collected on Day 7 to determine lumefantrine concentrations. The majority of children (392/444; 88.3%) were reported to have received all doses, in time. Non-adherence was due to untimeliness rather than missing doses and was highest for the last two doses. No significant difference was found between blood lumefantrine concentrations among adherent (median 286 nmol/l) and nonadherent [median 261 nmol/l; range 25 nmol/l (limit of quantification) to 9318 nmol/l]. Children from less poor households were more likely to adhere to therapy than the poor [odds ratio (OR) = 2.45, 95% CI 1.35-4.45; adjusted OR = 2.23, 95% CI 1.20-4.13]. The high reported rate of adherence to ALu in rural areas is encouraging and needs to be preserved to reduce the risk of emergence of resistant strains. The age-based dosage schedule and lack of adherence to ALu treatment guidelines by health facility staff may explain both the huge variability in observed lumefantrine concentrations and the lack of difference in concentrations between the two groups.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adherence to artemether/lumefantrine treatment in children under real-life situations in rural Tanzania

Simba

Kakoko

Tomson

et al. 2012

Transactions of the Royal Society of Tropical Medicine and Hygi

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“…In light of these considerations, rectal administration of artesunate suppositories for the treatment of malaria has been accepted as active antimalaria drug (Hinton et al 2007, Karunajeewa et al 2007). Hinton et al (2007) had inferred that community-based intervention using artemisinin-derived suppositories may potentially reduce malaria-related childhood mortality, but acceptability and utilization to rectal administration are required to inform effective deployment strategies. In view of the positive use of rectal suppositories in other parts of Africa, the study was conducted to determine the utilization, efficacy, and parental perfection of rectal suppositories in the management of childhood malaria in children admitted into tertiary health facilities in Abeokuta, Nigeria.…”

Section: Alaria Caused By a Protozoan Parasite Of Genusmentioning

confidence: 99%

Rectal Artesunates, Their Utilization, and Parental Perception in the Management of Malaria in Children from Abeokuta, Southwestern Nigeria

Sam-Wobo

Agbeyangi

Ekpo

et al. 2012

Vector-Borne and Zoonotic Diseases

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Utilization, efficacy, perception, and acceptability of rectal artesunates for treatment of malaria were assessed in 264 children below 5 years attending two tertiary health facilities in Abeokuta, Nigeria. The children systematically selected were 136 from State Hospital Ijaye and 128 from Federal Medical Centre (FMC), Idi-Aba. Body weights and vital statistics of the children were measured; and blood samples were collected before and 24 h after administration of the rectal artesunates (Plasmotrim-50/200 mg Artesunate) to evaluate the efficacy of the suppository. The first dose of rectal artesunate suppository was administered at a dose of 5-10 mg/kg of body weight per rectum. Giemsa thin and thick films were employed to determine parasite species, malaria parasite count/μL (MPC/μL), and percentage of parasitized red blood cells (PPRBCs). Data were analyzed using SPSS version 16.0. Plasmodium falciparum was the malaria parasite identified by blood examination, with a pretreatment prevalence of 98.9%. Male children had higher infection rate (55%) than females (45%), and infection among age groups and weight groups varied. Chi-square analysis revealed a significant difference between weight and malaria parasite count (p<0.05). Post-treatment analysis after 24 h showed that prevalence dropped by 73%, with females having higher crash rate (77%) than males (69%) but with no statistical difference (p>0.05) among the sexes. Chi-square analysis of pre- and post-treatment revealed a significant difference between MPC/μL and PPRBC at p<0.05. This confirmed the efficacy of rectal artesunate in reducing the parasite density (parasitaemia) within 24 h of treatment. On acceptability, 99.60% of parents accepted to use the suppository. However, 87.1% of parents preferred its usage, as it is easy to administer with no adverse effects when administered on their children. If health officials increase more public knowledge on the use of rectal artesunates, the high mortality now experienced in children under 5 years due to malaria disease would be greatly reduced.

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“…In view of potential pharmacokinetic (8), cultural (31), and efficacy (11) concerns regarding artesunate suppositories in this situation, ArTiMist appears to be a valuable alternative. The present study is the first clinical evaluation of this novel antimalarial treatment strategy, and the population models developed from the data have provided initial pharmacokinetic insights.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of a Novel Sublingual Spray Formulation of the Antimalarial Drug Artemether in African Children with Malaria

Salman

Bendel²,

Lee

et al. 2015

Antimicrob Agents Chemother

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A lthough parenteral artesunate is the recommended initial treatment for severe malaria (1), intramuscular (i.m.) artemether is an acceptable and practical alternative (1, 2). Artemether is also a recommended first-line oral therapy in combination with the longer half-life partner drug lumefantrine for uncomplicated Plasmodium falciparum (3) and Plasmodium vivax (4) infections. There are, however, few detailed studies assessing the pharmacokinetics of artemether and its active metabolite dihydroartemisinin (DHA) in either of these settings in children.Artemether-lumefantrine is a safe and effective treatment for uncomplicated pediatric malaria (3, 4), but there is evidence of significant between-dose variability in absorption even when coadministered with a small amount of fat to improve bioavailability (5). In addition, the nausea and vomiting that are frequently associated with malaria, together with an unwell child's refusal to feed or take medications by mouth (6), can reduce the effectiveness of oral treatment through reduced adherence to the World Health Organization (WHO) recommended 3-day regimen (7). In cases of more severe malaria, there is evidence of substantial between-patient variability in the absorption of i.m. artemether (8, 9), with some acidotic children likely exposed to subtherapeutic concentrations when the recommended doses are given (9). Rectal artesunate administration is associated with more rapid absorption and initial parasite clearance than is i.m. artemether administration in severely ill children (8). However, there is also marked between-patient variability in the dispositions of artesunate and DHA, and there is evidence that some children are able to expel artesunate suppositories even in the context of close monitoring as part of a formal pharmacokinetic evaluation (10). This might help explain why artesunate suppositories do not improve mortality compared to that with a placebo in older relative to younger pediatric age groups (11).There is a clear need for a prereferral formulation of an artemisinin derivative that can be easily administered and adequately absorbed in a child who may be unconscious or uncooperative or in whom nausea and vomiting preclude oral dosing. ArTiMist (Essential Nutrition Ltd., Brough, England) is an artemether formulation in neutral oil that can be administered as a metered sublingual spray and which is more rapidly and completely absorbed than is artemether given in tablet form in healthy adult volunteers (see accompanying paper [12]). In the present study, we assessed the pharmacokinetics of ArTiMist in African children with severe malaria or in whom gastrointestinal symptoms prevented the administration of artemether-lumefantrine tablets.

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Caregivers’ Acceptance of Using Artesunate Suppositories for Treating Childhood Malaria in Papua New Guinea

Cited by 19 publications

References 14 publications

Adherence to artemether/lumefantrine treatment in children under real-life situations in rural Tanzania

Adherence to artemether/lumefantrine treatment in children under real-life situations in rural Tanzania

Rectal Artesunates, Their Utilization, and Parental Perception in the Management of Malaria in Children from Abeokuta, Southwestern Nigeria

Pharmacokinetics of a Novel Sublingual Spray Formulation of the Antimalarial Drug Artemether in African Children with Malaria

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