The Effect of Albendazole Administration and Iron-Folic Acid Supplementation on Hemoglobin Level in Primary Schoolchildren with Soil-transmitted Helminth Infections

BACKGROUND: Soil-transmitted helminth (STH) infections were the highest infection in children aged 5–15 years old. They lead to iron deficiency anemia and folic acid deficiency. One of the strategies to treat the issues is anthelmintic administration with iron-folic acid supplementation. AIM: This study aims to evaluate the effectiveness of single-dose albendazole and albendazole with iron-folic acid supplementation on hemoglobin (Hb) levels in children with STHs. METHODS: This was an open-label randomized clinical trial conducted in Batubara Regency from September to November 2018. Subjects were primary schoolchildren with STH infections. They were grouped into albendazole and albendazole with iron-folic acid supplementation groups. The data were analyzed by independent t-test and Mann–Whitney U-test. RESULTS: From 139 children, 72 children received albendazole single dose and 67 children received albendazole with 30 mg iron and 250 μg folic acid weekly for 3 months. The median of baseline hemoglobin level was 12.2 gr/dL, whereas after intervention was 12.7 gr/dL. The hemoglobin level increases did not differ significantly between the two groups (p > 0.05). However, clinical improvement was observed. CONCLUSION: Iron-folic acid supplementation in addition to albendazole did not show any benefit for primary schoolchildren with STH infection in Batubara Regency, North Sumatera, Indonesia

The Effectiveness of School-based and Community-based Deworming Methods in Primary School Children with Soil-transmitted Helminth Infection

OBJECTIVE: Soil-transmitted helminth (STH) infection remains a public health problem, especially children. Preventive chemotherapy for school-aged children with STH infection in 2012 had only reached half of the World Health Organization target. Therefore, mass drug administration by community-based deworming (CBD) could be a solution to achieve the target. METHODS: A quasi-experimental study was the sample test in STH-infected primary school children at Suka Village, Indonesia. It was conducted from December 2016 to April 2017. A single dose 400 mg albendazole was given in both study groups. Effectiveness was assessed by Kato-Katz stool examination at the 1st and 3rd months after treatment. RESULTS: We enrolled 257 children and divided into school-based deworming (SBD) and CBD group. SBD consisted of 123 children while CBD was 134 children group which divided based on a school cluster system. The prevalence of STH infection is 55.6% with the most common infection that is ascariasis in both groups. The uninfected children are 72.5% of SBD and 59.5% of CBD group. Reinfection was found in 31.8% of SBD and 54.1% of CBD group. There are no significant differences of worm eggs intensity before and after deworming in both groups (P > 0.05). CONCLUSION: SBD found to be more effective compared to CBD in primary school children with STH infection in Suka village, Indonesia

Efficacy of Albendazole and Albendazole-Mebendazole against Trichuris trichiura Infections

BACKGROUND: Trichuris trichiura infections treatment using albendazole or mebendazole as a single dose is rated unsatisfactory. The combination of albendazole-mebendazole is viewed to have better efficacy against T. trichiura infections due to the nature of each drug. AIM: This study compared the efficacy of albendazole and albendazole-mebendazole for T. trichiura infection treatment in Talawi, Batu Bara, North Sumatra, among primary school children. METHODS: An open randomized clinical trial was carried out in Talawi, Batu Bara. The efficacy of albendazole as a single dose and albendazole-mebendazole as a single dose was compared. Research subjects were school children aged 6–12 years old with T. trichiura infections. Chi-square test was performed to compare the cure rate and unpaired t-test was done to compare the number of eggs per gram (epg) in both groups. RESULTS: From a total of 463 children, 235 of them suffered from T. trichiura infections. The cure rate of the group with 400 mg albendazole as a single dose was 52.5%, while the other group with albendazole 400 mg – mebendazole 500 mg as a single dose was at 71.1% cure rate. The cure rate of the two groups showed a significant difference with p = 0.011. Both groups were observed to have a significant reduction in the number worm eggs with p = 0.04. CONCLUSION: Albendazole 400 mg – mebendazole 500 mg combination as a single dose treatment has better efficacy than albendazole 400 mg alone, where the drug combination gave a higher cure rate and greater reduction in the number of T. trichiura eggs

Addressing hard-to-reach populations for achieving malaria elimination in the Asia Pacific Malaria Elimination Network countries

Member countries of the Asia Pacific Malaria Elimination Network are pursuing the regional goal of malaria elimination by 2030. The countries are in different phases of malaria elimination, but most have demonstrated success in shrinking the malaria map in the region. However, continued transmission in hard-to-reach populations, including border and forest malaria, remains an important challenge. In this article, we review strategies for improving intervention coverage in hard-to-reach populations. Currently available preventive measures, including long-lasting insecticidal nets and long-lasting insecticidal hammocks, and prompt diagnosis and treatment need to be expanded to hard-to-reach populations. This can be done through mobile malaria clinics, village volunteer malaria workers and screening posts. Malaria surveillance in the hard-to-reach areas can be enhanced through tools such as spatial decision support systems. Policy changes by the malaria programs will be required for implementing the strategies outlined in this article. However, strategies or tools may be suitable for some population groups but difficult to implement in other groups

Quantifying primaquine effectiveness and improving adherence: a round table discussion of the APMEN Vivax Working Group.

The goal to eliminate malaria from the Asia-Pacific by 2030 will require the safe and widespread delivery of effective radical cure of malaria. In October 2017, the Asia Pacific Malaria Elimination Network Vivax Working Group met to discuss the impediments to primaquine (PQ) radical cure, how these can be overcome and the methodological difficulties in assessing clinical effectiveness of radical cure. The salient discussions of this meeting which involved 110 representatives from 18 partner countries and 21 institutional partner organizations are reported. Context specific strategies to improve adherence are needed to increase understanding and awareness of PQ within affected communities; these must include education and health promotion programs. Lessons learned from other disease programs highlight that a package of approaches has the greatest potential to change patient and prescriber habits, however optimizing the components of this approach and quantifying their effectiveness is challenging. In a trial setting, the reactivity of participants results in patients altering their behaviour and creates inherent bias. Although bias can be reduced by integrating data collection into the routine health care and surveillance systems, this comes at a cost of decreasing the detection of clinical outcomes. Measuring adherence and the factors that relate to it, also requires an in-depth understanding of the context and the underlying sociocultural logic that supports it. Reaching the elimination goal will require innovative approaches to improve radical cure for vivax malaria, as well as the methods to evaluate its effectiveness

Risk Factors for Soil-Transmitted Helminthiasis in Preschool Children Living in Farmland, North Sumatera, Indonesia

Background. Disease burden from soil-transmitted helminthiasis (STH) is mainly attributed to its chronic and insidious impact on health and quality of life. Strategy recommended by World Health Organization (WHO) to control it was previously focused on school-aged children, but now preschool-aged children are involved. This study was intended to determine STH infection risk factors in preschool children. Methods. A cross-sectional study was conducted in Suka Village, North Sumatera, Indonesia, from October to December 2016. Subjects were children aged 1 to 5 years without history of taking antihelminthic. Subjects were obtained by consecutive sampling. Demographic data and risk factors for helminthiasis were collected using questionnaire-based interview. Subjects were divided into two groups, positive and negative STH infection, based on Kato Katz method. Analysis was done using chi-square and logistic regression test. p value < 0.05 was considered significant. Results. We enrolled 90 subjects in this study, with the mean age being 31.7 months. STH infection prevalence was 34.4%. Statistical analysis revealed that mother/caregiver hand washing habit (p=0.007), mother/caregiver nail trimming habit (p=0.018), and children nail trimming habit (p=0.022) were significant risk factors for STH infection. Conclusion. Mother/caregiver hand washing habit is the most influential risk factor for STH infection in preschool children

Efficacy of artemether .. lumefantrine and artesunate-amodiaquine for treating uncomplicated falciparum malaria in children

Background Artesunateamodiaquine (ASAQ) has been used as a firsdine treatment for uncomplicated faldparum malaria in Indonesia since 2004. Its efficacy depends on amodiaquine resistance of the infecting parasites. Artemetherlumefantrine (AL) has been shown to be highly efficacious in treating uncomplicated faldparum malaria in several countries. However, there have been few studies on these antimalarial medications in Indonesia. Objective To compare the efficacy of AL to ASAQ for treating uncomplicated faldparum malaria in children. Methods An open, randomized, controlled trial was conducted in schoolaged children in the Mandailing Natal Regency, North Sumatera Province, Indonesia, from October to December 2010. A total of 280 pediatric, uncomplicated falciparum malaria patients were randomly assigned to receive either AL or ASAQ for 3 days. Participants were followedup on days 1,2,3,7, 14, 28 and 42 following the first medication dose. The outcomes noted were adequate clinical and parasitological response (ACPR), parasite reduction, parasite clearance time, fever clearance time and adverse events. Analysis was based on intentiontotreat. Results In this study, ACPRs on day 42 were 86.4% and 90.7% for the ASAQ and AL groups, respectively (pO.260). On days 7 and 14, the AL group had higher cure rates than that of the ASAQ group (P<O.OS). Early treatment failure, late treatment failure and parasitological failure for both groups were similar. We also found faster parasite clearance time and higher parasite reduction in the AL group than in the ASAQ group. However, fever clearance time was shorter in the ASAQ group. The incidence of adverse events such as nausea, vomiting, malaise, and pruritus were similar between the two groups (PO.441). Conclusion AL had higher efficacy than ASAQ for the treatment  of uncomplicated falciparum malaria in children. [Paediatr rndones. 2012;52:260-6]

Albendazole alone vs. albendazole and diethylcarbamazine combination therapy for trichuriasis

Background Trichuris trichiura is one of the most common soil-transmitted helminths, estimated to infect l billion people worldwide. Several studies have compared the efficacies of albendazole and diethylcarbamazine, but the efficacy of a combination of these two drugs has been inconclusive. Objective To assess the effectiveness of a single dose of albendazole compared to a combination of albendazole and diethylcarbamazine for trichuriasis treatment. Methods A randomized, clinical open trial was conducted from June to September 2009 on elementary school children with trichuriasis from two villages in the North Sumatera Province. Stool specimens were collected at baseline and at days 7, 14, 21, and 28 after treatment, and examined by the Kato Katz method. Subjects were randomized into two groups. Group I received a single dose of albendazole (400 mg) and group II received albendazole (400 mg) plus diethylcarbamazine (6 mg! kg). Statistical analyses used were Chi square test for cure rates and Wilcoxon rank test for egg reduction rates. Results One hundred eight children were enrolled and randomized into group l (53 children) and group II (55 children). The prevalence of T. trichiura infection was 54.7%. There were no significant differences (P=0.52) in the cure rate between groups I and II (66% and 60%, respectively) or in egg reduction rates at day 28 (54.5% and 60.07%, respectively, P= 0.10). Conclusion Albendazole alone and abendazole combined with diethylcarbamazine have similar efficacies for trichuriasis treatment, in terms of cure rates and egg reduction rates

Intravenous and Oral Paracetamol Have the Same Effect in Reducing Fever in Pediatric Patients

Background: The antipyretic effect of intravenous versus oral paracetamol is not well known. This study was aimed to compare the antipyretic effect of intravenous and oral paracetamol therapy to reduce fever.Materials and Methods: This was an open-label randomized clinical trial study. The subjects were children who presented to Pediatric Ward and Emergency of Haji Adam Malik Hospital, aged from 2 months to 18 years old, with axillary temperature ≥38.0ºC. Subjects were divided into two groups, group 1 received 15 mg/kg paracetamol intravenous and group 2 received the same dose of paracetamol but given through intravenous. The temperature reduction was analyzed by ANOVA, and the change in temperature was recorded at 0, 15, 30, 60, 120, and 180 minutes after drug administration.Results: In the first group, the mean temperature was decreased (p<0.001) from 15 to 180 minutes after the administration of paracetamol. Nausea was documented as the adverse effect for both oral and intravenous administration groups.Conclusion: The administration of 15 mg/kg paracetamol, either though intravenous or oral, have similar effect in reducing fever in children. Paracetamol therapy though intravenous route can be given if it cannot be given orally.Keywords: antipyretic, pediatrics, fever, intravenous, oral, paracetamo