Drug Policy Bangladesh

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.

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Drug Policy Bangladesh

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

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

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

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.

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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.
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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)

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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.

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Severe Malaria

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

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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).

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A randomized control trial in one of the high
risk malarious area has yielded.

• Case study-I
• Drug-Chloroquine
• Ramu upazila/Coxs Bazar
• Total Pop. in study area-188812
• RI-22 , RII-16,RIII-40
• ETF-34,LTF-33,ACPR-34

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Case study-IITeknaf Upazila/CoxsBazar

• Drug-Chloroquine
• Total Pop. in study area-18500
• ETF-gt25
• LTF-gt25

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Case study-IIISreemongal UZHCMoulavibaza
District

• Drug- Chloroquine
• Pop. in study area 271000 (Year-1999)
• ETF-gt25
• LTF-gt25

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Case Study-IV Ramu upazillaCoxs Bazar District

• Drug-Q3SP
• Total Pop.in study area 188812(Year-1997)
• RI-22,RII-2,RIII-6
• ETF-O, LTF-21, ACR-79

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Study-VRamu Upazila, Coxs Bazar

• Drug-Mefloquine
• Total Pop. in study area-188812 (Year-1997
• RI-13, RII-4, RIII-10
• ETF-0, LTF-11, ACR-89

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Study-VIKaptai Upazila, Rangamati

• Drug-CQ3SP
• ETF-2.9
• LPF-30
• ACPR-67.1

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Study-VIIDhiginala Upazila, Khagrachari

• Drug-CQ3SP
• ETF-4.3
• LCF-7.1
• LPF-1.5
• ACPR-87.1

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Study-VIII Fatikchari Upazila, Chittagong

• Drug-CQ3SP
• ETF-4
• LCF-16
• LPF-2
• ACPR-76

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Case Study-IXMatiranga Upazila/Khagrachari

• Drug-CQ3SP
• ETF-7.7
• LCF-9.2
• LPF-13.8
• ACPR-69.3

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Case Study-XAlikadam Upazila, Bandarbar District

• Drug-CQ3SP
• ETF-3.5
• LCF-20.7
• LPF-1.7
• ACPR-74.1

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Case Study-XIChittagong Medical College

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

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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.

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Revised Malaria Treatment Regimen

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

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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.

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Uncomplicated Malaria Confirm

• Fever or h/o fever over last 48 hours
• Absence of convincing features of any other
  febrile illness
• High index of suspicionsEndemic zone,
  susceptible population, Transmission season
• Presence of asexual form of P. falciparum

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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

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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.

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Uncomplicated Malaria Confirm

• For P.falciparum
• Artemetherlumifantrin - for 3 days
• Quinine for 7 days in special and specific
  situation
• Quinine-7 daysTC-7days or Quinine-7daysDc-7days
• For P. vivax
• CQ for 3 days and primaquine- for 14 days.

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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

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Thank You