Drug Policy Bangladesh

Presented by

Dr ATM Mustafa KamalNational 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

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

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 andSevere 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-IITeknaf Upazila/Cox’sBazar

Drug-Chloroquine

Total Pop. in study area-18500

ETF->25%

LTF->25%

Case study-IIISreemongal 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(Year-1997)

• RI-22%,RII-2%,RIII-6%• ETF-O%, LTF-21%, ACR-79%

Study-VRamu 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-VIKaptai Upazila, Rangamati

Drug-CQ3+SP

•ETF-2.9% •LPF-30%•ACPR-67.1%

Study-VIIDhiginala 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-IXMatiranga Upazila/Khagrachari

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

Case Study-XAlikadam Upazila, Bandarbar District

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

Case Study-XIChittagong 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+Dc-7days

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