Antimalarial Drugs for Pediatrics - Prescribing and Dispensing Practices in a Tanzanian City

Purpose: To assess dispensing and prescribing practices with regard to antimalarial drugs for pediatrics in private pharmacies and public hospitals in Dar es Salaam, Tanzania.Methods: This was a cross-sectional, descriptive study that assessed the knowledge and practice of 200 drug dispensers in the private community pharmacies in Dar es Salaam. Two hundred (200) parents of children seeking malaria treatment were also interviewed at the public hospitals.Results: A majority of drug dispensers had moderate (63.3 %) to low knowledge (36.7 %) regarding antimalarial drug use in pediatrics. Parents had moderate (67 %) to low (33 %) level of understanding of the instructions given to them by the prescribers regarding administration of antimalarial drugs to pediatrics at home. Most children were not weighed, and there were indications of wrong calculations of doses of antimalarials in pediatrics.Conclusion: Overall, there were irrational dispensing and prescribing of antimalarial drugs to pediatrics. Since malaria is a major killer disease in Tanzania, especially in children under five years of age, there is a need to institute measures to ensure rational prescribing, dispensing and use of antimalarial drugs in pediatrics.Keywords: Antimalarials, Dispensing, Knowledge, Pediatrics, Pharmacies, Prescribin

Screening for the P-glycoprotein inhibitory pump activity of plant extracts that are used in Tanzanian traditional medicine

An in vitro screening experiment of 45 methanolic plant extracts was carried out to investigate the inhibition of P-glycoprotein (P-gp) in MCF-7R cells. The investigation was carried out using standard functional assay with rhodamine 6G as the fluorescent probe and reserpine, a known inhibitor of P-glycoprotein pump, was used as a reference drug. The results revealed that out of the 45 plant extracts tested, 3 extracts i.e. Bauhinia thoningii, Clerodendrum myricoides and Rhus natalensis exhibited pronounced activity at the concentration of 100 µg/ml. In comparison to the negative control, B. thoningii, C. myricoides and R. natalensis extracts inhibited the pump by a factor of about 2.5, 4 and 4.3, respectively. The remaining 42 extracts did not show any activity. The reference drug reserpine (20 μM) inhibited the pump by a factor of about 11. These preliminary results indicate that the inhibition of P-gp in MCF-7R cells is through a concerted action of compounds present in the extracts and that if isolated might be effective P-gp pump inhibitors in the treatment of cancer. Keywords: plant extract, P-glycoprotein inhibition; rhodamine 6G; MCF-7R cells East and Central African Journal of Pharmaceutical Sciences Vol. 7 2004: 16-2

Intermittent Preventive Therapy and Treatment of Malaria during Pregnancy: A Study of Knowledge among Pregnant Women in Rufiji District, Southern Tanzania

Purpose: To assess the knowledge and awareness of pregnant women regarding the use of sulfadoxinepyrimethamine (SP) for intermittent preventive therapy (IPT) and artemether-lumefantrine (ALu) for treatmentof malaria during pregnancy.Methods: The study was conducted in Rufiji district, southern Tanzania from March 2011 to September 2011. Four hundred and seventy (470) pregnant women in their second and third trimesters were interviewed whenattending antenatal clinics at the selected hospitals, health centers and dispensaries. Focus group discussions (FGDs) were also conducted with 46 pregnant women at the health facilities in the district.Results: More than half (54.3 %) of pregnant women did not know if SP it was used for IPT. Most women (76.6 %) did not know the use of SP for IPT in relationship with gestation age. Overall, the results show that most women had very low knowledge about the use of SP for IPT. Forty three (9.1 %) pregnant women reported to have had malaria during their current pregnancies. The antimalarials reported to be used by pregnant women were quinine 18(42.9 %), SP (23.8 %), ALu (21.4%) and sulphamethoxyprazinepyrimethamine (2.4%). Irrespective of the gestation age of pregnancy, almost all (98.3 %) pregnant women perceived ALu as unsafe drug to be used during pregnancy.Conclusion: Most pregnant women had minimum knowledge about the use and benefits of SP for IPT and ALu for treatment of malaria during  pregnancy. Some erroneous beliefs about the safety of ALu during pregnancy were also identified among pregnant women. For effective implementation of IPT policy and treatment of malaria during pregnancy, pregnant women should be sensitized and educated on the use andbenefits of antimalarial drugs.Keywords: Artemether-lumefantrine, Antenatal clinic, Knowledge, Pregnant women, Sulfadoxinepyrimethamin

Challenges facing effective implementation of co-trimoxazole prophylaxis in children born to HIV-infected mothers in the public health facilities

Appolinary AR Kamuhabwa,1 Vicky Manyanga21Unit of Pharmacology and Therapeutics, 2Department of Medicinal Chemistry, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaBackground: If children born to HIV-infected mothers are not identified early, approximately 30% of them will die within the first year of life due to opportunistic infections. In order to prevent morbidity and mortality due to opportunistic infections in children, the World Health Organization recommends the use of prophylaxis using co-trimoxazole. However, the challenges affecting effective implementation of this policy in Tanzania have not been documented.Aim: In this study, we assessed the challenges facing the provision of co-trimoxazole prophylaxis among children born to HIV-infected mothers in the public hospitals of Dar es Salaam, Tanzania.Methodology: Four hundred and ninety-eight infants' PMTCT (Prevention of Mother-to-Child Transmission of HIV) register books for the past 2 years were reviewed to obtain information regarding the provision of co-trimoxazole prophylaxis. One hundred and twenty-six health care workers were interviewed to identify success stories and challenges in the provision of co-trimoxazole prophylaxis in children. In addition, 321 parents and guardians of children born to HIV-infected mothers were interviewed in the health facilities.Results: Approximately 80% of children were initiated with co-trimoxazole prophylaxis within 2 months after birth. Two hundred and ninety-one (58.4%) children started using co-trimoxazole within 4 weeks after birth. Majority (n=458, 91.8%) of the children were prescribed 120 mg of co-trimoxazole per day, whereas 39 (7.8%) received 240 mg per day. Only a small proportion (n=1, 0.2%) of children received 480 mg/day. Dose determination was based on the child's age rather than body weight. Parents and guardians reported that 42 (13.1%) children had missed one or more doses of co-trimoxazole during the course of prophylaxis. The majority of health care workers (89.7%) reported that co-trimoxazole is very effective for the prevention of opportunistic infections among children, but frequent shortage of co-trimoxazole in the health facilities was the main challenge.Conclusion: Most children who were initiated with co-trimoxazole prophylaxis did not experience significant opportunistic infections, and the drug was well tolerated. The major barrier for co-trimoxazole prophylaxis was due to frequent out-of-stocks of pediatric co-trimoxazole formulations in the health facilities. Dose determination was based on the age rather than the weight of children, thus creating potential for under- or over-dosing of children.Keywords: health facilities, opportunistic infections, CD4, parents, guardian

Implementation of co-trimoxazole preventive therapy policy for malaria in HIV-infected pregnant women in the public health facilities in Tanzania

Appolinary AR Kamuhabwa, Richard Gordian, Ritah F Mutagonda Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Background: In 2011, Tanzania adopted a policy for provision of daily co-trimoxazole prophylaxis to HIV-infected pregnant women for prevention of malaria and other opportunistic infections. As per the policy, HIV-infected pregnant women should not be given sulfadoxine-pyrimethamine (SP) for intermittent preventive therapy. The challenges associated with this policy change and the extent to which the new policy for prevention of malaria in pregnant women coinfected with HIV was implemented need to be assessed. Aim: To assess the implementation of malaria-preventive therapy policy among HIV-infected pregnant women in the public health facilities in Dar es Salaam, Tanzania. Methodology: The study was conducted in Kinondoni Municipality, Dar es Salaam, Tanzania, from January 2015 to July 2015. Three hundred and fifty-three HIV-infected pregnant women who were attending antenatal clinics (ANCs) and using co-trimoxazole for prevention of malaria were interviewed. Twenty-six health care workers working at the ANCs were also interviewed regarding provision of co-trimoxazole prophylaxis to pregnant women. A knowledge scale was used to grade the level of knowledge of health care providers. Focus group discussions were also conducted with 18 health care workers to assess the level of implementation of the policy and the challenges encountered. Results: Twenty-three (6.5%) pregnant women with known HIV serostatus were using co-trimoxazole for prevention of opportunistic infections even before they became pregnant. Out of the 353 HIV-infected pregnant women, eight (2.5%) were coadministered with both SP and co-trimoxazole. Sixty (16.7%) pregnant women had poor adherence to co-trimoxazole prophylaxis. Out of the 26 interviewed health care providers, 20 had high level of knowledge regarding malaria-preventive therapy in HIV-infected pregnant women. Lack of adequate supply of co-trimoxazole in health facilities and inadequate training of health care providers were among the factors causing poor implementation of co-trimoxazole prophylaxis for prevention of malaria in HIV-infected pregnant women. Conclusion: There is a need to continue sensitization of pregnant women and communities about the importance of early attendance to the ANCs for testing of HIV and provision of co-trimoxazole prophylaxis. Availability of co-trimoxazole in the health facilities, regular training, and sensitization of health care providers are necessary for effective implementation of this policy. Keywords: SP, policy change, ANCs, health care providers, IPT