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  • 1. Hildenwall, Helena
    et al.
    Lindkvist, Jenny
    Tumwine, James
    Bergqvist, Yngve
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Pariyo, George
    Tomson, Göran
    Peterson, Stefan
    Low validity of caretakers’ reports on antimalarial and antibiotic use in children with severe pneumonia at hospital in Uganda2009In: Transactions of the Royal Society of Tropical Medicine and Hygiene, ISSN 0035-9203, E-ISSN 1878-3503, Vol. 103, no 1, p. 95-101Article in journal (Refereed)
    Abstract [en]

    Febrile children in low-income countries receive care from multiple sources, and caretakers’ ability to report drug intake is crucial for appropriate prescription of drugs when reaching health facilities. This study describes and validates caretakers’ reported use of sulfamethoxazole, chloroquine and sulfadoxine in their children. We performed a cross-sectional study in 139 children diagnosed with severe pneumonia at hospital in Kampala, Uganda. Caretakers were interviewed regarding treatments given prior to arrival at the hospital. Reported drug intake was compared to drug levels in blood sampled on filter paper, analyzed by HPLC methods. Caretakers under-reported intake of the studied drugs. Positive and negative predictive values were 67 and 64% for sulfamethoxazole, 69 and 52% for chloroquine and 85 and 62% for sulfadoxine. Many caretakers were unaware of what drug had been given to the child, and more so if treated outside the home (risk ratio 2.6, 95% CI 1.2–5.6). We conclude that caretakers’ reports of drug intake have limited validity. Health workers need to improve counseling of caretakers during drug dispensing, especially for antibiotics. The roles and names of different drugs should be emphasized during counseling, and existing information systems such as immunization cards should be considered for record-keeping of treatment given.

  • 2. Kofoed, P.E.
    et al.
    Ursing, J.
    Poulsen, A.
    Rodrigues, A.
    Bergqvist, Yngve
    Dalarna University, School of Technology and Business Studies, Chemical Engineering.
    Aaby, P.
    Rombo, L.
    Different doses of amodiaquine and chloroquine for treatment of uncomplicated malaria in children in Guinea-Bissau: implications for future treatment recommendations2007In: Transactions of the Royal Society of Tropical Medicine and Hygiene, ISSN 0035-9203, E-ISSN 1878-3503, Vol. 101, no 3, p. 231-238Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to compare different doses of chloroquine (CQ) and amodiaquine (AQ) for the treatment of falciparum malaria in children. Children with Plasmodium falciparum monoinfection were allocated by block randomisation to treatment with CQ 50/kg mg or 25 mg/kg or AQ 15 mg/kg or 30 mg/kg. The main outcomes were the cumulative adequate clinical and parasitological response (ACPR) rates and the number of true recrudescences as determined by PCR. A total of 729 children were included. In an evaluability analysis, the PCR-uncorrected cumulative ACPR rates on Day 28 for the treatment groups CQ 50/kg mg or 25 mg/kg and AQ 15 mg/kg or 30 mg/kg were 90%, 76%, 92% and 94%, respectively; the PCR-adjusted ACPR rates on Day 28 were 92%, 80%, 94% and 94%, respectively. No differences in adverse effects were observed. AQ has a high cure rate given as 30 mg/kg and 15 mg/kg, although it is not superior to treatment with CQ 50 mg/kg. However, 25 mg/kg of CQ is less efficient. As an interim option, Guinea-Bissau could change the recommended first-line treatment of uncomplicated malaria to CQ 50 mg/kg, reserving AQ as a partner drug for a future combination therapy.

  • 3.
    Lindkvist, Jenny
    et al.
    Dalarna University, School of Technology and Business Studies, Chemical Engineering.
    Malm, Mikaela
    Dalarna University, School of Technology and Business Studies, Chemical Engineering.
    Bergqvist, Yngve
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Straightforward and rapid determination of sulfadoxine and sulfamethoxazole in capillary blood on sampling paper with liquid chromatography and UV detection2009In: Transactions of the Royal Society of Tropical Medicine and Hygiene, ISSN 0035-9203, E-ISSN 1878-3503, Vol. 103, no 4, p. 371-376Article in journal (Refereed)
    Abstract [en]

    A method for the determination of sulfadoxine and sulfamethoxazole in capillary blood on sampling paper has been developed and validated. The method is straightforward with minimal sample preparation, and is suitable for rural settings. Separation of sulfadoxine, sulfamethoxazole and internal standard was performed using a Purospher STAR RP-18 endcapped LC column (150 x 4.6 mm) with a mobile phase consisting of acetonitrile: sodium acetate buffer pH 5.2, 1=0.1 (1:2, v/v). For sulfadoxine, the within-day precision was 5.3% at 15 mu mol/l and 3.7% at 600 mu mol/l, while for sulfamethoxazole it was 5.7% at 15 mu mol/l and 3.8% at 600 mu mol/l. The tower limit of quantification was determined to 5 mu mol/l and precision was 5.5% and 5.0% for sulfadoxine and sulfamethoxazole, respectively.

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