Primaquine Dosing Errors: The Human Cost of a Pharmaceutical Anachronism

Meltzer, Eyal; Morrison, Lindsay R.; Stienlauf, Shmuel; Schwartz, Eli

doi:10.4269/ajtmh.14-0109

Cited by 4 publications

(4 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Periods between primary infection and periods of clinical illness or relapse may be on the order of years and add to the clinical complexity of making the diagnosis [11]. Treatment is further complicated by uncertainty regarding the dosing of primaquine for P. ovale spp., with variation in practice based on regional experience and courses ranging from 7 to 14 days, weight-based recommendations ranging from 0.25 to 0.5 mg of base/kg/day, and dosing dependent on interpretation of base for salt components [22, 23]. Peruvian treatment experience and guidelines for P. vivax support a 7-day course of primaquine dosed at 0.5 mg base/kg/day [24].…”

Section: Discussionmentioning

confidence: 99%

A cluster of the first reported Plasmodium ovale spp. infections in Peru occuring among returning UN peace-keepers, a review of epidemiology, prevention and diagnostic challenges in nonendemic regions

Guerra

Ore²,

Valdivia

et al. 2019

Malar J

View full text Add to dashboard Cite

Background Plasmodium ovale curtisi and Plasmodium ovale wallikeri are regarded as less virulent forms of malaria with a geographic distribution including Southeast Asia, Central and West Africa, and is increasingly reported as an infection in returning travellers. A species of malaria that may have delayed or relapsing presentations similar to Plasmodium vivax , the clinical presentation of P. ovale spp. has been described to have prepatent periods of 2 weeks or slightly longer with reports of relapse following primary infection out to 8–9 months. This presentation may be obscured further in the setting of anti-malarial exposure, with report of delayed primary infection out to 4 years. Presented is a cluster of 4 imported P. ovale spp. cases in returning Peruvian military personnel assigned to United Nations peace-keeping operations in the Central African Republic. Case presentation From January to December 2016, Peruvian peace-keepers were deployed in support of United Nations (UN) operations in the Central African Republic (CAR). While serving abroad, Navy, Army, and Air Force members experienced 223 episodes of Plasmodium falciparum malaria following interruption of prophylaxis with mefloquine. Diagnosis was made using rapid diagnostics tests (RDTs) and/or smear with no coinfections identified. Cases of malaria were treated with locally-procured artemether-lumefantrine. Returning to Peru in January 2017, 200 peace-keepers were screened via thick and thin smear while on weekly mefloquine prophylaxis with only 1 showing nucleic acid within red blood cells consistent with Plasmodium spp. and 11 reporting syndromes of ill-defined somatic complaints. Between a period of 5 days to 11 months post return, 4 cases of P. ovale spp. were diagnosed using smear and polymerase chain reaction (PCR) following febrile complaints. All cases were subsequently treated with chloroquine and primaquine, with cure of clinical disease and documented clearance of parasitaemia. Conclusion These patients represent the first imported cases in Peru of this species of malaria as well as highlight the challenges in implementing population level prophylaxis in a deployed environment, and the steps for timely diagnosis and management in a non-endemic region where risk of introduction for local transmission exists.

show abstract

Section: Discussionmentioning

confidence: 99%

A cluster of the first reported Plasmodium ovale spp. infections in Peru occuring among returning UN peace-keepers, a review of epidemiology, prevention and diagnostic challenges in nonendemic regions

Guerra

Ore²,

Valdivia

et al. 2019

Malar J

View full text Add to dashboard Cite

show abstract

“…A lack of awareness may be due to limited community consultation and inadequate information dissemination processes in relation to the NHI. Studies in other developing countries have also shown a low level of awareness of health insurance especially among the informal sector of the population [ 1 , 13 ]. This study also suggests the need for more interventions to increase knowledge among NHI cardholders.…”

Section: Discussionmentioning

confidence: 99%

“…Further, those who access services often experience high out-of-pocket (OOP) expenses. High OPP expenses are a disincentive for people to access the care they need and can be catastrophic for poorer households [ 1 – 6 ]. Achieving UHC requires adequate and sustainable funding.…”

Section: Introductionmentioning

confidence: 99%

“…Under the scheme, all citizens contribute a small co-payment at point of service except the poor, pregnant women and children under five, with the government further reimbursing facilities. A key determinant for those enrolled in the scheme in accessing health services is knowledge of the scheme and its benefits [ 1 , 2 , 12 ]. The purpose of the current study was to assess the knowledge of those enrolled in the NHI scheme in Lao PDR.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors affecting knowledge of National Health Insurance Policy among out-patients in Lao PDR: an exit interview study

Chaleunvong

Phoummalaysith²,

Phonvixay³

et al. 2020

Global Health Action

View full text Add to dashboard Cite

Background: Universal health coverage is target 3.8 of the Sustainable Development Goals. In many lower-middle-income countries, however, major coverage gaps exist. Those who do receive services often experience high out-of-pocket expenses. To achieve universal health coverage, Lao PDR, a lower-middle-income country in SouthEast Asia, is shifting from a fragmented model of health financing to a national health insurance scheme. Objective: The objective of this cross-sectional survey was to assess the knowledge of the NHI in Lao PDR among insured in-and outpatients using health services at selected public health facilities at provincial, district and health centre level in six provinces. Methods: This was a cross-sectional survey. Healthcare facilities were selected based on the rate of use of health services at the health facility and participants selected using systematic random sampling. Exit interviews were conducted with in-and outpatients of each selected health facility, using a pre-tested structured questionnaire. Descriptive statistics were generated including means (median), frequency and percentages. Poisson regression was applied to determine the factors associated with knowledge of the insurance scheme. Results: In total 326 participants were recruited (response rate 93%). Of these, less than twothirds (62.3%) said they had their eligibility documents with them. Only 23.6% knew the copayment fee at the health centre level; while 18.1% and 18.7% knew about the co-payment fee at the district and provincial healthcare level, respectively. A key determinant of accessing NHI and health services was knowledge of the scheme and its benefits. Conclusion: This study suggests in Lao PDR, awareness about health insurance is low. More innovative demand-side strategies are needed to create awareness and understanding of the NHI and its benefits. Without an understanding of what insurance policies mean, universal health coverage cannot be achieved, even where appropriate and acceptable services are accessible.

show abstract