Adelaide Agyepong, Ryan Nippard, Yaami Premakumar, Melissa Soon, Michael Zafur, Jora Singh Grewal
Deployment of Rectal Artesunate for the initial management of Nil Per Os under 5 children Margaret...
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Transcript of Deployment of Rectal Artesunate for the initial management of Nil Per Os under 5 children Margaret...
Deployment of Rectal Artesunate for the initial management of Nil Per Os under 5 children
Margaret Gyapong, Irene Agyepong, Evelyn Ansah, John Gyapong, Patricia Anaarfi
Ghana Health Service
Rationale Mortality from malaria on the increase: 1-2m deaths each
year Over 90% in African children due to
Access to and cost of care Poor quality of care Perceptions about disease causation
WHO commission use of Artesunate for severe malaria in clinical trials Rectal Formulation Achieves 99-100%reduction in parasitaemia within 24hrs Permits emergency treatment of Nil Per Os Patients
Double blind placebo controlled trials are currently underway ?Survival benefit
Current study Examining and optimising mechanisms for deployment in a rural
district.
Specific Objectives
To determine community definition and treatment seeking for severe malaria in children.
To identify from the sources of care treatment and referral practice for children with severe malaria.
To design and implement a multi media health education strategy at community and health facility level in preparation for the use of Rectal Artesunate
To document the proportion of febrile Nil Per Os children who received Rectal Artesunate and sought subsequent care at a health facility.
To document the course of action of febrile Nil Per Os children who received Rectal Artesunate but did not seek care at a Health facility.
To document the outcome of the child’s condition after receiving the Rectal Artesunate.
Design and Methods 1 Observational Study using Qualitative and Quantitative
methods and in two phases (Formative, Intervention) Formative just completed
Addressed Objectives 1&2 conducted at 2 levels. Community Level
Focus Group Discussions Key Informant Interviews Non Participant Observation Problem tree
Facility Level Key Informant Interviews Non Participant Observation Case Studies Record Review
Design and Methods 2 Issues discussed with Carers of children
How they define malaria and severe malaria Whether they can identify NPO malaria Courses of action for simple and severe malaria Sources of care Rectal use of drugs How long it takes to access care
Issues discussed with health care providers How they define malaria and severe malaria How they recognize NPO malaria Kinds of treatment given Rectal use of drugs Referral practice How long it takes patients to arrive at health facility
Study area
Study Area
Population about 100,000 Rural Subsistence farmers,
fishermen and petty traders 4 health Centers 6
community clinics Private Maternity homes
and clinics No hospital Malaria number 1 90% of <5 admissions due
to severe malaria 2% of inpatients die
Community sources of care
Home Traditional Healers Chemical Shops Drug Peddlers Health Centers Community Clinics Hospitals
Perceptions on malaria Local Terms for Malaria
Asra, Atridii or fever similar to findings from earlier studies (Agyepong et al 1998)
Two Types of Asra “Eyoo” Female type which is mild.
Headache, Fever, hot body, loss of appetite, bitterness in the mouth,
Easily treated with orthodox tablets and herbal preparations
“Eku” Male Type more serious and can Kill inability to eat or drink, convulsions, change in
mental status, anaemia,lump or sore in stomach not easy to treat since there may be spiritual
connotations
Rectal use of drugs
Well known term “fitompuonya” Term not used as everyday word particularly not in
the presence of elders without saying “excuse me”. The route is not used commonly in the treatment of
“Asra eyo” Route used more commonly in treating some of the
signs and symtoms of “Asra Eku” Treatments are mainly ground herbal preparations
that may or may not contain one or more of the following Ground Ginger, Ground pepper, soap diluted
with water Pellets or tablets not used rectally
symptom Source of Care Type of treatment
Loss of Blood “Muo ta”
Home, Herbalist, chemical seller
Cook leaves of “Bedro”and drink it regularlyGrind seeds of “Bedro” plant mix with milk and water and drinkMix tomato paste with Coca cola or malt and drinkEat nutritious food, haematinics
Ulcer in the stomach“mimi pa”
Home, Herbalist, Hospital/Health Center
Boil leaves of “nunum” tree and give liquid to child to drinkGrind the leaves and use as enema.Grind bark of “Nyaba“Standard Hospital Treatment
Lump in the stomach“mimi kpo”
Herbalist Grind herbs for drinking and enema
Convulsion“hiowe”
Home, Herbalist, Hospital/Health Center
Incantations and herbs ground with garlic and smeared on the child.Smear mud from bathroom drain on childPour overnight water from cooking pot on child Standard Hospital Treatment
Loss of consciousness“eheli” “etomu”
Home, Herbalist, Hospital/Health Center
Put pepper in fire and put child close to it while shouting out loud the name of the child.Standard Hospital Treatment
Dirty Stomach“mimi semu”
Home, Grind herbs and give enema
Key Issues
Specific terms exist for various signs and symptoms of severe malaria
Signs and symptoms of severe malaria(depending on line of questioning) may not always be linked to each other and and affects help seeking.
Various sources of care exist and are used but Hospital is last resort
Traditional health care providers have strengths which can be adopted for use in health care provision
Rectal use of drugs common with severe malaria due to perceived ability to offer quick relief
Policy/program issues
Use of Rectal Artesunate may not be a problem for the main intervention.
Care givers and traditional sources of care are key and should be used during the intervention but with adequate training and supervision.
Health education should highlight strengths of various treatment practices but discourage harmful ones.
Areas for future research
Community understanding of severe malaria
Rationale for various treatment practices for severe malaria
THANK YOU