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Transcript of Research Utilization
Angie Winczewski and Hanna Hofford
In individuals across the lifespan, how does malaria treatment in the United States compared to malaria treatment in Africa, where malaria is more common, affect prognosis?
Synthesis of Literature
Change in Clinical Practice
Implications of Change
In 2006, there was 1,564 cases of malaria in the United States (Mali, Steele, Slutsker, & Arguin, 2008).
In 2007, the number of malaria cases in the U.S. decreased to 1,505
In 2008, the number decreased further to 1,298 cases.
During that time the U.S. initiated more preventative measures such as:
Taking medication before traveling abroad
Alterations in US. Military Personnel precautionary measures
Decreasing late Dx
Changing treatment standards (Mali, Steele, Slutsker, & Arguin, 2010).
There is little to no quality improvement research or active progress surrounding malaria treatment in the U.S.
May stem from the fact that malaria is viewed as less emergent within the United States, thus, the diminished focus.
Artesunate combos for treatment of malaria in various locations that included Kenya and Uganda
Artesunate was chosen because there have not been reports of drug resistance to P. falciparum malaria and it kills those parasites that have become resistant to other drugs
Results: malaria parasite eradicated quicker with the artesunate combo (Adjuik, Babiker, Garner, Olliaro, Taylor & White, 2004).
Artemisinin-based combination therapies to treat uncomplicated malaria in children in Sub-Saharan Africa.
Results: artemisinin combo therapies were highly effective in treating uncomplicated malaria in children and were safe and tolerable with no reported resistance (Yeka & Harris, 2010).
Both studies showed that drug combination therapies work far more effectively than single modality medications.
Primaquine, another common drug, is not widely used because primaquine can trigger severe hemolytic anemia in G6PD deficient individuals (Eziefula, Gosling, Hwang, Hsiang, Bousema, Von Seidlein, 2012).
The evidence gaps in these studies are:
These studies focused on specific locations and P. falciparum
The gametocidal action of primaquine has not been fully investigated to measure its effect, in regards to safety and efficacy.
IN THE UNITED STATES
Approximately 80 percent of malaria cases and 90 to 95 percent of malaria-related deaths in the world are estimated to be in Africa
Each year between 675,000 and 1,000,000 deaths among children in sub-Saharan Africa are attributed to malaria.
Treatment for Malaria has only recently progressed in sub-Saharan Africa, where malaria is found to be most prominent.
P. falciparum malaria has been the most commonly treated malaria in sub-Saharan Africa
Decreasing late Dx : “Clinicians should ask all febrile patients for a travel history, including international visitors, immigrants, refugees, migrant laborers, and other international travelers.”
Know the Signs and Symptoms: nonspecific, but fever usually present. Other Sx: headache, chills, increased sweating, back pain, myalgia, diarrhea, nausea, vomiting, and cough.
Changing treatment standards: "Treatment should be determined on a basis of the infecting Plasmodium species, the probable geographic origin of the parasite, the parasite density, and the patient’s clinical status”
US. Military Personnel: already on long-term prophylaxis, add primaquine (in regions with P. vivax or P. ovale) or mefloquine (where P. vivax dominates), or docycycline (P. vivax).
Improve implementation of malaria prevention measures among travelers to decrease cases: provide information regarding prevention more consistently, encourage adherence to antimalarial regimen, and continued prophylaxis treatment post return from travels.
Questions to ask:
Is it safe?
Is it effective?
Is it Cost-effective?
Is it accessible?
Is it able to be implemented into everyday practice? Amount of push back present
By implementing these changes we will:
decrease malaria contraction within American citizens and American soldiers
improve prognosis because of quick detection
decrease death rates
improve adherence to antimalarial regimens
Adjuik, M., Babiker, A., Garner, P., Olliaro, P., Taylor, W., White, N., et al. (2004). Artesunate combinations for treatment of malaria: Meta-analysis. Lancet, 363(9402), 9-17. Retrieved from http://europepmc.org/abstract/MED/14723987
"Background: Malaria in Sub-Saharan Africa." Malaria and Development in Africa: A Cross-Sectoral Approach. Retrieved from http://www.aaas.org/international/africa/malaria91/background.html
Eziefula, A. C., Gosling, R., Hwang, J., Hsiang, M. S., Bousema, T., von Seidlein, L., et al. (2012). Rationale for short course primaquine in africa to interrupt malaria transmission. Malaria Journal, 11(1), 360-374. doi:10.1186/1475-2875-11-360
Mali, S., Steele, S., Slutsker, L., & Arguin, P. M. (2008). Malaria surveillance--united states, 2006. Morbidity and Mortality Weekly Report.Surveillance Summaries (Washington, D.C.: 2002), 57(5), 24-39. Retrieved from https://login.ezproxy-eres.up.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=18566568&login.asp?custid=s8474154&site=ehost-live&scope=siteMali, S., Steele, S., Slutsker, L., & Arguin, P. M. (2010). Malaria surveillance -- united states, 2008. MMWR Surveillance Summaries, 59(-7), 1-16. Retrieved from https://login.ezproxy-eres.up.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=2010755793&site=ehost-live&scope=site
Onwujekwe, O., Obikeze, E., Uzochukwu, B., Okoronkwo, I., & Onwujekwe, O. C. (2010). Improving quality of malaria treatment services: Assessing inequities in consumers' perceptions and providers' behaviour in nigeria. International Journal for Equity in Health, 9, 9p. doi:10.1186/1475-9276-9-22
Yeka, A., & Harris, J. C. (2010). Treating uncomplicated malaria in children: Comparing artemisinin-based combination therapies. Current Opinion in Pediatrics, 22(6), 798-803. doi:10.1097/MOP.0b013e32833fac44; 10.1097/MOP.0b013e32833fac44
(Mali, Steele, Slutsker, & Arguin, 2008)