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Anti-Malarials- Saying bye to the bitter tablet

By Vision Reporter

Added 9th November 2008 03:00 AM

WHEN it comes to taking medicine, six-month-old Hazel fights, stiffens her body, tilts her head and kicks, like she is possessed by demons.

WHEN it comes to taking medicine, six-month-old Hazel fights, stiffens her body, tilts her head and kicks, like she is possessed by demons.

By Irene Nabusoba

WHEN it comes to taking medicine, six-month-old Hazel fights, stiffens her body, tilts her head and kicks, like she is possessed by demons.

Her mother, Topista Mwagale, says: “Even when you succeed in putting the medicine in her mouth, she spits it out or vomits immediately. But if the medicine is sweet, she takes it. She even tries to reach out for more.”

Unfortunately, Hazel is vulnerable to frequent bouts of malaria. She has suffered from malaria for three months. “I would prefer that she is given injections but my paediatrician discourages it.

So when she shows signs of improvement, I discontinue medication,” Mwagale says. A midwife who prefers anonymity says many health workers are resorting to treating malaria in children using intravenous fluids (drips).

Dr. Mshilla Maghanga, a pharmacist, says such is commonly associated with bitter medicines which discourage drug adherence (following the instructions of the medication) and encourage drug abuse as well as resistance.

“This prolongs the recovery period and could lead to under-dose or over-dose, should the care taker consider repeating the dose,” Maghanga says.

Dr Myers Lugemwa, the acting programme manager of Malaria Control Programme, Ministry of Health, says most anti-malarial drugs are bitter.

“Most parents have to make do with crushing the bitter-tasting anti-malarial tablets for their children to swallow. The syrups are not different,” Lugemwa says.

“Some are neutral tasting and not bitter, but the taste is not pleasant for children. When you are sick, you develop a bitter test in the mouth. This makes medicine intolerable for kids unless it is sweet,” he adds.

Nevertheless, Novartis, a Swiss-based provider of modern anti-malarials commonly known as artemisinin-based combination therapy (ACT) could put these dreaded times behind. It has developed a safe and effective sweet paediatric malaria medicine, coartem-dispersible.

“Coartem-dispersible is undergoing regulatory review and is expected to launch in early January, 2009,” says Hans Reitveld, the company’s director of global marketing and access for the malaria initiative.

“Small children find it difficult to swallow tablets. That is why we made it sweet. One has to simply drop the tablet is small amounts of water and it dissolves easily.

It is more acceptable for the child and easy to administer,” Reitveld says.
He reveals that the cherry-flavoured six-drug combination is expected to be available in Uganda in the first quarter of next year “depending on the national procurement and regulatory bodies”.

Coartem, which has a proven efficacy of 97%, is the most widely used antimalarial in Africa, especially in government facilities.

Uganda is one of the countries using high in a country volumes of coartem with the drug benefiting 8—10 million people annually.

However, much as the anti-malarials are free in public health facilities, most people have to part with about sh15,000—20,000 to access them, which is high in a country where many live below sh3,000 a day.

The price bait has also raised increasing fears of counterfeits as dealers struggle to cash in. But Reitveld says: “Coartem is already being sold at the lowest price.

It will go for about 27 cents of a dollar and given that it is distributed under donor-funded malaria control programmes, it is unlikely to be duplicated because it does not yield economic returns.

But he says there is no evidence that coartem tablets are being forged. He says parasites have not developed resistance to this drug, like it has been with traditional anti-malarials quinine and chloroquin.

According to the World Health Organisation, nearly half of the world live at risk of contracting malaria and 85% of malaria-related deaths reported were children aged five and under.

Researchers hope children will find the formulation easier to swallow and will be able to finish a course of anti-malarials,” the site says.

Ministry of health statistics show that there are 70,000—110,000 malaria-related child deaths annually. Lugemwa says with about six episodes of malaria each year, there is severe anaemia, resulting in a fatality rate of 8%—25% among paediatric admissions, up to 70% of out-patient attendances and over 50% of in-patient admissions in under fives.

“This sweetened coartem is the first to be registered in Uganda. Coartem is very delicate. When you try to do some cosmetics on it, you risk distorting the particles,” Lugemwa says.

He notes that caregivers often crush the conventional pill and mix it with water to make it easier for small children to swallow.

“Cortem should not be tampered with. Crushing it risks weakening the dosage and children often spit it out. Rejection of the drug makes it difficult to assess dosage and renders treatment less effective. It also increases the possibility of drug-resistant strains of evoving parasites,” Lugemwa says.

The development is timely in Uganda, where almost 39 million dozens of coartem have been imported since 2006 when the policy of first line treatment for malaria using ACTS was launched.

The health ministry changed treatment from chloroquine or fansider to the ACTs.
Coartem is the only ACT fixed dose that has been internationally approved for the treatment of acute uncomplicated malaria.

Fruit-flavoured Coartem effective
According to www.africasciencenews.org, a demonstration carried out in Benin, Kenya, Mali, Mozambique and Tanzania found that the fruit-flavoured coartem-dispersible tablets are as effective as crushed standard tablets.

The researchers gave 900 children under 12, crushed artemether-lumefantrine dissolved in water or the cherry-flavoured artemether-lumefantrine.

“It was effective at treating malaria. It dissolves quickly in small amounts of liquid, easing administration and ensuring effective dosing for the youngest victims.”

Anti-Malarials- Saying bye to the bitter tablet

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