title: The use of paediatric artemisinin combinations in sub-Saharan Africa: a snapshot questionnaire survey of health care personnel.
abstract: BACKGROUND
  Paediatric drug formulations for artemisinin combination therapy (P-ACT) have been developed over the past few years and have been shown to improve the therapeutic management of young children with uncomplicated falciparum malaria. This process was however not equally paralleled by a timely adoption of P-ACT in national and international treatment recommendations. National malaria programmes in sub-Saharan Africa have not yet widely embraced this new therapeutic tool. To which extent P-ACT is used in the field in sub-Saharan Africa is not known to date.
  
  
  METHODS
  This snapshot questionnaire survey aimed to provide an overview on the current routine practices for the availability and use of P-ACT as anti-malarial treatment for young children in sub-Saharan Africa. Health care personnel in seven countries in West-, Central, and East-Africa were invited to answer a structured questionnaire assessing use and availability of P-ACT.
  
  
  RESULTS
  A total of 71 respondents including doctors, nurses and pharmacy personnel responsible for the anti-malarial treatment of young children were interviewed. P-ACT was used by 83% (95% confidence interval: 73-90%; n = 59) as first-line treatment for young children. Use of 15 different P-ACT products was reported among which only two have received WHO prequalification status and approval by a stringent registration authority. Use of a specific P-ACT product was not linked to consumer prices or availability of supporting clinical trial data, but may depend more on the marketing capacity of the manufacturer. Major differences in frequency and dosing of anti-malarial regimens with identical anti-malarial compounds and the marketing of loose combinations were recorded.
  
  
  CONCLUSIONS
  Paediatric ACT is widely used for the treatment of uncomplicated malaria in young children. However, the majority of P-ACT formulations in use do not meet highest international quality standards evoking concerns for patients' safety and the induction of drug resistance. Improving the quality of currently marketed P-ACT should constitute a public health priority besides their adoption into official treatment recommendations.
authors.affiliation: Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
authors.forename: Selidji T
authors.initials: ST
authors.lastname: Agnandji
authors.forename: Florian
authors.initials: F
authors.lastname: Kurth
authors.forename: Jose F
authors.initials: JF
authors.lastname: Fernandes
authors.forename: Solange S
authors.initials: SS
authors.lastname: Soulanoudjingar
authors.forename: Beatrice P
authors.initials: BP
authors.lastname: Abossolo
authors.forename: Ghyslain
authors.initials: G
authors.lastname: Mombo-Ngoma
authors.forename: Arti
authors.initials: A
authors.lastname: Basra
authors.forename: Raquel
authors.initials: R
authors.lastname: González
authors.forename: Gondo
authors.initials: G
authors.lastname: Kizito
authors.forename: Pembe I
authors.initials: PI
authors.lastname: Mayengue
authors.forename: Lorenz
authors.initials: L
authors.lastname: Auer-Hackenberg
authors.forename: Saadou
authors.initials: S
authors.lastname: Issifou
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lell
authors.forename: Ayola A
authors.initials: AA
authors.lastname: Adegnika
authors.forename: Michael
authors.initials: M
authors.lastname: Ramharter
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000962:Antimalarials / Q000592:standards / Q000627:therapeutic use; D037621:Artemisinins / Q000592:standards / Q000627:therapeutic use*; D002648:Child; D004304:Dosage Forms; D004338:Drug Combinations; D004345:Drug Industry; D004363:Drug Utilization / Q000592:standards*; D006282:Health Personnel; D006291:Health Policy; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D008389:Marketing of Health Services / Q000592:standards; D061214:Patient Safety; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards; D011795:Surveys and Questionnaires
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004304:Dosage Forms; D004338:Drug Combinations; C031327:artemisinin