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Item Considerations for unblinding individual study participants during vaccine trials(Vaccine, 2023) Halsey, H.; Evans, S.; Dodoo, A.; et al.Premature unblinding of individual participants is rarely reported in publications, but such unblinding can disrupt vaccine trials by causing worry and drop-out of other participants or ‘‘pseudo unblinding,” in which participants or investigators over-interpret certain symptoms as being related to receiving an investigational product. This review summarizes appropriate reasons for unblinding in vaccine trials. Regulatory guidance could be improved by distinguishing guidance for vaccine trials from drug trials, with the recognition that unblinding individual participants in vaccine studies is rarely needed for management of adverse events following immunization.Item Hypertension and associated factors among patients attending HIV clinic at Korle-Bu Teaching Hospital(Ghana Medical Journal, 2023) Nartey, E.t; Tetteh, R.A.; Anto, F.; Sarfo, B.; Kudzi, W.; Adanu, R.M.Objectives: This study determined the prevalence of hypertension and its associated factors among patients attending the HIV clinic at the Korle-Bu Teaching Hospital (KBTH). Design: A hospital-based cross-sectional study was conducted at KBTH. The prevalence of hypertension was estimated among study participants, and socio-demographic, lifestyle, anthropometric, metabolic and HIV/ART-related factors associated with hypertension were determined by logistic regression modelling. Setting: Study participants were recruited from the HIV clinic at the KBTH. Participants: A total of 311 Persons Living with HIV were recruited as study participants Interventions: Simple random sampling technique was used to recruit study participants. A questionnaire adapted from the WHO STEPwise approach to chronic disease risk-factor surveillance was used to collect study participants' data. Results: The prevalence of hypertension was 36.7%, and the factors associated with hypertension were increasing age, positive family history of hypertension, minimal exercising, current BMI ≥25.0 kg/m2 , total cholesterol level ≥5.17 mmol/L, exposure to anti-retroviral therapy (ART) and increasing duration of ART exposure. Conclusions: This study shows a high prevalence of hypertension among patients attending the HIV clinic at KBTH, associated with exposure to ART and increasing duration of this exposure. Blood pressure monitoring should move from routine to a more purposeful screening of patients for hypertension. Patients with the identified risk factors should be encouraged to have regular blood pressure measurements at home and not only when they visit the HIV clinic.Item Treatment of COVID-19 with Chloroquine: Implication for Malaria Chemotherapy Using ACTs in Disease Endemic Countries(Oxford University Press, 2021) Quashie, N.B.; Duah-Quashie, N.O.Based on reports of parasite resistance and on World Health Organization recommendation, chloroquine was replaced with the artemisinin-based combination therapies (ACTs) as the first choice of drugs for the treatment of uncomplicated malaria. Disuse of chloroquine led to restoration of drug-sensitive para site to some extent in certain countries. Ever since chloroquine and hydroxychloroquine were touted as potential treatment for coronavirus disease 2019 (COVID-19), there has been a dramatic surge in de mand for the drugs. Even in areas where chloroquine is proscribed, there has been an unexpected in crease in demand and supply of the drug. This situation is quite worrying as the indiscriminate use of chloroquine may produce drug-resistant parasites which may impact negatively on the efficacy of amo diaquine due to cross-resistance. Amodiaquine is a partner drug in one of the ACTs and in some of the drugs used for intermittent preventive treatment. We herein discuss the consequences of the escalated use of chloroquine in the management of COVID-19 on chemotherapy or chemoprevention of malaria and offer an advice. We speculate that parasite strains resistant to chloroquine will escalate due to the increased and indiscriminate use of the drug and consequently lead to cross-resistance with amodiaquine which is present in some drug schemes aforementioned. Under the circumstance, the anticipated hope of reverting to the use of the ‘resurrected chloroquine’ to manage malaria in future is likely to diminish. The use of chloroquine and its derivatives for the management of COVID-19 should be controlled.Item High Prevalence of Molecular Markers of Plasmodium falciparum Resistance to Sulphadoxine–Pyrimethamine in Parts of Ghana: A Threat to ITPTp-SP?(Oxford University Press, 2021) Afutu, L.L.; Boampong, J.N.; Quashie, N.B.Malaria in pregnancy is a huge public health problem as it is the cause of maternal anaemia, still birth, premature delivery, low birth weight among others. To tackle this problem, WHO recom mended the administration, during pregnancy, of intermittent preventive treatment with sulphadox ine–pyrimethamine (IPTp-SP). The introduction of this policy is likely to create SP drug pressure which may lead to the emergence of parasite strains resistant to the drug. This study investigated the prevalence of the molecular markers of SP resistance as pointers to potential failure of IPTp-SP among pregnant women attending antenatal clinic, women at the point of baby delivery and out patients department (OPD) attendees. The study was conducted in health facilities located in parts of Ghana. Prevalence of mutations in dhfr and dhps genes of Plasmodium falciparum was determined using the method described by Duraisingh et al. The outcome of the study indicated the presence of high prevalence of strains of P.falciparum with the resistant alleles of the dhfr or dhps genes in the three categories of participants. There was a high prevalence of triple mutations (IRN) in the dhfr gene of P.falciparum isolates: 71.4% in peripheral blood of antenatal attendees; 74.1% in placenta cord blood of delivering mothers and 71.1% in OPD attendees. Quintuple mutations were only found in 2 (0.5%) isolates from OPD attendees. This observation might have occurred due to the increased use of SP for IPTp among others. There is the need for an interventional measure in order to protect pregnant women and their unborn children.Item Knowledge of Pharmacogenetics among Healthcare Professionals and Faculty Members of Health Training Institutions in Ghana(Ghana Medical Journal, 2015-03) Kudzi, W.; Addy, B.S.; Dzudzor, B.Background: Pharmacogenetics has a potential for optimizing drug response and identifying risk of toxicity for patients. Pharmacogenetics knowledge of healthcare professionals and the unmet need for pharmacogenetics education in health training institutions are some of the challenges of integrating pharmacogenetics into routine medical practice. Aim: To assess pharmacogenetics knowledge among healthcare professionals and faculty members of health training institutions in Ghana. Method: Semi-structured questionnaires were used to interview healthcare professionals from selected public and private hospitals. Faculty members from health training institutions were also interviewed. Results: The respondents were Medical doctors 42 (46.7%), Pharmacists 29 (32.2%) and Nurses 19 (21.1%). Healthcare professionals rated their knowledge of Pharmacogenetics as Excellent 5 (5.6%), Very Good 10 (11.2%), Good 53 (60%) and Poor 19 (21.4%). Thirty-two faculty members from health training institutions were also interviewed. Faculty members rated their knowledge of pharmacogenetics as Excellent 2 (6.3%), Very Good 3 (9.4%), Good 9 (28.1%), Fair 12 (37.5%) and Poor 6 (18.8%). Thirty seven percent (12) of these faculty members said pharmacogenetics was not part of their institutions’ curriculum, 7 (22%) did not know if pharmacogenetics was part of their curriculum and only 13 (40.6%) said it was part of their curriculum. Conclusion: Few healthcare professionals and faculty members of training institutions are aware of the discipline of pharmacogenetics. There is the need for continuous professional education on pharmacogenetics and development of competency standards for all healthcare professionals in Ghana.Item Willingness to pay for small solar powered bed net fans: Results of a Becker-DeGroot-Marschak auction in Ghana(Malaria Journal, 2017) Yukich, J.O.; Briët, O.J.T.; Ahorlu, C.K.; Nardini, P.; Keating, J.Background and methods: Long-lasting insecticidal nets (LLINs) are one of the main interventions recommended by the World Health Organization for malaria vector control. LLINs are ineffective if they are not being used. Subsequent to the completion of a cluster randomized cross over trial conducted in rural Greater Accra where participants were provided with the 'Bokoo System' - a set of solar powered net fan and light consoles with a solar panel and battery - or alternative household water filters, all trial participants were invited to participate in a Becker-DeGroot-Marschak auction to determine the mean willingness to pay (WTP) for the fan and light consoles and to estimate the demand curve for the units. Results, discussion and conclusions: Results demonstraed a mean WTP of approximately 55 Cedis (~13 USD). Demand results suggested that at a price which would support full manufacturing cost recovery, a majority of households in the area would be willing to purchase at least one such unit. © 2017 The Author(s).Item Population Pharmacokinetics of the Antimalarial Amodiaquine: a Pooled Analysis To Optimize Dosing(Antimicrobial Agents and Chemotherapy, 2018-09) Ali, A.M.; Penny, M.A.; Smith, T.A.; Workman, L.; Sasi, P.; Adjei, G.O.; Aweeka, F.; Kiechel, J.R.; Jullien, V.; Rijken, M.J.; McGready, R.; Mwesigwa, J.et.al.Amodiaquine plus artesunate is the recommended antimalarial treatment in many countries where malaria is endemic. However, pediatric doses are largely based on a linear extrapolation from adult doses. We pooled data from previously published studies on the pharmacokinetics of amodiaquine, to optimize the dose across all age groups. Adults and children with uncomplicated malaria received daily weight-based doses of amodiaquine or artesunate-amodiaquine over 3 days. Plasma concentration-time profiles for both the parent drug and the metabolite were characterized using nonlinear mixed-effects modeling. Amodiaquine pharmacokinetics were adequately described by a two-compartment disposition model, with first-order elimination leading to the formation of desethylamodiaquine, which was best described by a three-compartment disposition model. Body size and age were the main covariates affecting amodiaquine clearance. After adjusting for the effect of weight, clearance rates for amodiaquine and desethylamodiaquine reached 50% of adult maturation at 2.8 months (95% confidence interval [CI], 1.5 to 3.7 months) and 3.9 months (95% CI, 2.6 to 5.3 months) after birth, assuming that the baby was born at term. Bioavailability was 22.4% (95% CI, 15.6 to 31.9%) lower at the start of treatment than during convalescence, which suggests a malaria disease effect. Neither the drug formulation nor the hemoglobin concentration had an effect on any pharmacokinetic parameters. Results from simulations showed that current manufacturer dosing recommendations resulted in low desethylamodiaquine exposure in patients weighing 8 kg, 15 to 17 kg, 33 to 35 kg, and >62 kg compared to that in a typical 50-kg patient. We propose possible optimized dosing regimens to achieve similar drug exposures among all age groups, which require further validation.Item Population Pharmacokinetic Estimates Suggest Elevated Clearance and Distribution Volume of Desethylamodiaquine in Paediatric Sickle Cell Disease Patients Treated with Artesunate-Amodiaquine(Current Therapeutic Research - Clinical and Experimental, 2019-01) Adjei, G.O.; Amponsah, S.K.; Goka, B.Q.; Enweronu-Laryea, C.; Renner, L.; Sulley, A.M.; Alifrangis, M.; Kurtzhals, J.A.L.Background There is limited information on the safety or efficacy of currently recommended antimalarial drugs in patients with sickle cell disease (SCD), a population predisposed to worse outcomes if affected by acute malaria. Artesunate-amodiaquine (ASAQ) is the first-line treatment for uncomplicated malaria (UM) in many malaria-endemic countries and is also used for treatment of UM in SCD patients. There is, however, no information to date, on the pharmacokinetics (PK) of amodiaquine or artesunate or the metabolites of these drugs in SCD patients. Objectives This study sought to determine the PK of desethylamodiaquine (DEAQ), the main active metabolite of amodiaquine, among paediatric SCD patients with UM treated with artesunate-amodiaquine (ASAQ). Methods Plasma concentration-time data (median DEAQ levels) of SCD children (n = 16) was initially compared with those of concurrently recruited non-SCD paediatric patients with acute UM (n = 13). A population PK modelling approach was then used to analyze plasma DEAQ concentrations obtained between 64 and 169 hours after oral administration of ASAQ in paediatric SCD patients with acute UM (n = 16). To improve PK modeling, DEAQ concentration-time data (n = 21) from SCD was merged with DEAQ concentration-time data (n = 169) of a historical paediatric population treated with ASAQ (n = 103) from the same study setting. Results The median DEAQ concentrations on days 3 and 7 were comparatively lower in the SCD patients compared to the non-SCD patients. A two-compartment model best described the plasma DEAQ concentration-time data of the merged data (current SCD data and historical data). The estimated population clearance of DEAQ was higher in the SCD patients (67 L/h, 21% relative standard error (RSE) compared with the non-SCD population (15.5 L/h, 32% RSE). The central volume of distribution was larger in the SCD patients compared with the non-SCD patients (4400 L, 43% RSE vs. 368 L, 34% RSE). Conclusions The data shows a tendency towards lower DEAQ concentration in SCD patients and the exploratory population PK estimates suggest altered DEAQ disposition in SCD patients with acute UM. These findings, which if confirmed, may reflect pathophysiological changes associated with SCD on DEAQ disposition, have implications for therapeutic response to amodiaquine in SCD patients. The limited number of recruited SCD patients and sparse sampling approach however, limits extrapolation of the data, and calls for further studies in a larger population.Item Factors contributing to the development of anaemia in Plasmodium falciparum malaria: What about drug-resistant parasites?(Journal of Tropical Pediatrics, 2006-09) Quashie, N.B.; Akanmori, B.D.; Ofori-Adjei, D.; Goka, B.Q.; Kurtzhals, J.A.L.A major manifestation of complicated malaria especially among children is severe anaemia, the pathogenesis of which is not well understood. Among other factors, suppression of the bone marrow's response to erythropoietin, which is rapidly reversed after successful treatment of the malaria, has been implicated in its pathogenesis. Since resolution of malaria restores erythropoiesis, we hypothesized that drug-resistant strains of Plasmodium falciparum would increase the risk of severe anaemia developing from initially uncomplicated malaria. Using both in vivo and in vitro drug-sensitivity tests we compared the prevalence of drug-resistant malaria between severe malarial anaemia (SA) and non-anaemic malaria (NAM) patients. Assessment of treatment outcome using the WHO in vivo criteria showed no significant difference in parasite resistance between the two groups. The mean parasite clearance time was also comparable. Treatment failures of about 14 per cent and 12 percent were observed between SA and NAM patients respectively. The in vitro drug susceptibility test showed overall mean IC 50 values of 0.41×10-6 mol/l and 0.32×10-6 mol/l blood for SA and NAM groups respectively. Geometric mean pre-treatment blood levels of chloroquine did not differ much between the two groups. Findings from this study could not therefore implicate drug-resistant parasites in the pathogenesis of severe malarial anaemia. © 2006 Oxford University Press.Item The selection and use of essential medicines(World Health Organization - Technical Report Series, 2003) De Buschiazzo, P.M.; Helali, A.; Laing, R.; Laporte, J.R.; Ofori-Adjei, D.et.alThis report presents the recommendations of the WHO Expert Committee responsible for updating the WHO Model List of Essential Medicines. The first part contains a summary of the Committee's considerations and justifications for additions and changes to the Model List, including its recommendations. Annexes to the main report include the revised version of the WHO Model List of Essential Medicines (the 15th) and a list of all items on the Model List sorted according to their 5-level Anatomical Therapeutic Chemical (ATC) classification codes. Other annexes cover the proposed procedure for updating and disseminating the WHO Model List of Essential Medicines, and the revised procedure for updating the content of the Interagency Emergency Health Kit.Item Influence of ethnicity on pharmacogenetic variation in the ghanaian population(Pharmacogenomics Journal, 2009-07) Yen-Revollo, J.L.; Van Booven, D.J.; Peters, E.J.; Hoskins, J.M.; Engen, R.M.; Kannall, H.D.; Ofori-Adjei, D.; McLeod, H.L.; Marsh, S.It has been well established that the frequencies of genomic variants can vary greatly between the populations of different countries. We sought to quantify the intra-population variability in Ghana to determine the value of genotyping studies done at a nationwide level. Further, we investigated the differences between the Ghanaian and other African populations to determine the quality of genomic representation provided by a small subgroup within the continent with regard to the general population. We genotyped 934 unrelated Ghanaian individuals for 15 single nucleotide polymorphisms (SNPs) from genes defined as clinically relevant based on their reported roles in the transport of, metabolism of, or as targets of the medicines listed in the World Health Organization Essential Medicines list. Populations within Ghana and between nations in Western Africa were genetically cohesive. In contrast, populations in other areas of Africa were genetically divergent. Gene allele frequency also differed significantly between the populations in African nations and the United States for several of the SNPs. These results demonstrate that national populations in similar geographic regions, like Africa, may have widely varying genetic allele frequencies for clinically relevant SNPs. Further genotyping studies of specific populations are necessary to provide the best medical care to all individuals. © 2009 Nature Publishing Group All rights reserved.Item Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials(The Lancet, 2009-10) Aponte, J.J.; Schellenberg, D.; Egan, A.; Breckenridge, A.; Carneiro, I.; Critchley, J.; Danquah, I.; Dodoo, A.; Kobbe, R.; Lell, B.; May, J.et.al.Background: Intermittent preventive treatment (IPT) is a promising strategy for malaria control in infants. We undertook a pooled analysis of the safety and efficacy of IPT in infants (IPTi) with sulfadoxine-pyrimethamine in Africa. Methods: We pooled data from six double-blind, randomised, placebo-controlled trials (undertaken one each in Tanzania, Mozambique, and Gabon, and three in Ghana) that assessed the efficacy of IPTi with sulfadoxine-pyrimethamine. In all trials, IPTi or placebo was given to infants at the time of routine vaccinations delivered by WHO's Expanded Program on Immunization. Data from the trials for incidence of clinical malaria, risk of anaemia (packed-cell volume <25% or haemoglobin <80 g/L), and incidence of hospital admissions and adverse events in infants up to 12 months of age were reanalysed by use of standard outcome definitions and time periods. Analysis was by modified intention to treat, including all infants who received at least one dose of IPTi or placebo. Findings: The six trials provided data for 7930 infants (IPTi, n=3958; placebo, n=3972). IPTi had a protective efficacy of 30·3% (95% CI 19·8-39·4, p<0·0001) against clinical malaria, 21·3% (8·2-32·5, p=0·002) against the risk of anaemia, 38·1% (12·5-56·2, p=0·007) against hospital admissions associated with malaria parasitaemia, and 22·9% (10·0-34·0, p=0·001) against all-cause hospital admissions. There were 56 deaths in the IPTi group compared with 53 in the placebo group (rate ratio 1·05, 95% CI 0·72-1·54, p=0·79). One death, judged as possibly related to IPTi because it occurred 19 days after a treatment dose, was subsequently attributed to probable sepsis. Four of 676 non-fatal hospital admissions in the IPTi group were deemed related to study treatment compared with five of 860 in the placebo group. None of three serious dermatological adverse events in the IPTi group were judged related to study treatment compared with one of 13 in the placebo group. Interpretation: IPTi with sulfadoxine-pyrimethamine was safe and efficacious across a range of malaria transmission settings, suggesting that this intervention is a useful contribution to malaria control. Funding: Bill & Melinda Gates Foundation. © 2009 Elsevier Ltd. All rights reserved.Item Interindividual variability in pharmacokinetics of generic nucleoside reverse transcriptase inhibitors in TB/HIV-coinfected ghanaian patients: UGT2B7*1c is associated with faster zidovudine clearance and glucuronidation(Journal of Clinical Pharmacology, 2009-08) Kwara, A.; Lartey, M.; Boamah, I.; Rezk, N.L.; Oliver-Commey, J.; Kenu, E.; Kashuba, A.D.M.; Court, M.H.There are limited data on the pharmacokinetics of generic nucleoside reverse transcriptase inhibitors (NRTIs) in native African populations, in whom they are commonly used. The authors characterized the pharmacokinetics of lamivudine (n = 27), zidovudine (n = 16), and stavudine (n = 11) in human immunodeficiency virus (HIV)/ tuberculosis (TB)-coinfected Ghanaians and evaluated associations between zidovudine metabolism and UDP- glucuronosyltransferase (UGT) 2B7 polymorphisms. Lamivudine, zidovudine, and stavudine apparent oral clearance (CL/F) values (mean ± SD [% coefficient of variation [CV]) were 7.3 ± 2.8 (39%), 31.9 ± 33.6 (106%), and 16.4 ± 5.8 (35%) mL/min/kg, respectively, whereas half-life values were 4.2 ± 1.9 (46%), 8.1 ± 7.9 (98%), and 1.5 ± 1.0 (65%) hours, respectively. Zidovudine CL/F was 196% higher (P =.004) in UGT2B7*1c (c.735A>G) carriers versus noncarriers. This was confirmed using human liver bank samples (n = 52), which showed 48% higher (P =.020) zidovudine glucuronidation and 33% higher (P =.015) UGT2B7 protein in UGT2B7*1c carriers versus noncarriers. In conclusion, generic NRTI pharmacokinetics in HIV/TB-coinfected Ghanaians are similar to other populations, whereas the UGT2B7*1c polymorphism may explain in part relatively high interindividual variability in zidovudine clearance. © 2009 the American College of Clinical Pharmacology.Item Artemether-lumefantrine: An oral antimalarial for uncomplicated malaria in children(Expert Review of Anti-Infective Therapy, 2009-09) Adjei, G.O.; Goka, B.Q.; Binka, F.; Al Kurtzhals, J.Artemether-lumefantrine (AL; Coartem®, Riamet®) is the first fixed-dose artemisinin combination therapy (ACT) regimen to be manufactured under Good Manufacturing Practice conditions, and is the most widely adopted ACT regimen used in malaria control programs. AL is approved for the treatment of uncomplicated malaria in adults, children and infants, and as treatment of uncomplicated malaria in nonimmune travelers returning from malarious areas. AL is efficacious for treating uncomplicated malaria in children and the frequency of associated adverse events is not higher than other available ACT regimens. In this review, available evidence on efficacy and safety of AL in the treatment of uncomplicated malaria, with emphasis on children where appropriate, and focusing on characteristics that are potentially important for malaria control policy decisions, are presented and discussed. © 2009 Expert Reviews Ltd.Item A review of the safety of niclosamide, pyrantel, triclabendazole and oxamniquine(International Journal of Risk and Safety in Medicine, 2008) Ofori-Adjei, D.; Dodoo, A.N.O.; Appiah-Danquah, A.; Couper, M.Detailed safety review of the intestinal anthelminthics (pyrantel and niclosamide) and antischistosomal and antitrematodes (oxamniquine and triclabendazole) was conducted using publications in journals and major reference sources combined with the assessment of adverse drug reaction (ADR) reports in the database of the WHO Collaborating Centre for International Drug Monitoring in Sweden. Data from available limited publications on the subject provide evidence in support of the overall safety of these medicines with no publication citing an unfavourable safety assessment of any of the drugs. Whilst there have been concerns about the risk of seizures with oxamniquine, these concerns have not diminished the extent to which the medicine has been used in several countries. All four medicines appear to be safe and well tolerated even when used in mass treatment campaigns in several countries. This safety review indicates that oxamniquine, triclabendazole, niclosamide and pyrantel have favourable benefit-risk profiles for use in humans. However, in order to enhance the evidence base to determine safety issues in relation to medicines that are used heavily in settings with poor or non-existent pharmacovigilance systems, it is recommended that the WHO pushes its current supportive efforts for the setting up of such systems globally, especially in resource-limited countries. The four drugs are all retained on the current list of the WHO Model List of Essential Medicines. © 2008 - IOS Press and the authors. All rights reserved.Item Factors contributing to the development of anaemia in Plasmodium falciparum malaria: What about drug-resistant parasites?(Journal of Tropical Pediatrics, 2006-09) Quashie, N.B.; Akanmori, B.D.; Ofori-Adjei, D.; Goka, B.Q.; Kurtzhals, J.A.L.A major manifestation of complicated malaria especially among children is severe anaemia, the pathogenesis of which is not well understood. Among other factors, suppression of the bone marrow's response to erythropoietin, which is rapidly reversed after successful treatment of the malaria, has been implicated in its pathogenesis. Since resolution of malaria restores erythropoiesis, we hypothesized that drug-resistant strains of Plasmodium falciparum would increase the risk of severe anaemia developing from initially uncomplicated malaria. Using both in vivo and in vitro drug-sensitivity tests we compared the prevalence of drug-resistant malaria between severe malarial anaemia (SA) and non-anaemic malaria (NAM) patients. Assessment of treatment outcome using the WHO in vivo criteria showed no significant difference in parasite resistance between the two groups. The mean parasite clearance time was also comparable. Treatment failures of about 14 per cent and 12 percent were observed between SA and NAM patients respectively. The in vitro drug susceptibility test showed overall mean IC 50 values of 0.41×10-6 mol/l and 0.32×10-6 mol/l blood for SA and NAM groups respectively. Geometric mean pre-treatment blood levels of chloroquine did not differ much between the two groups. Findings from this study could not therefore implicate drug-resistant parasites in the pathogenesis of severe malarial anaemia. © 2006 Oxford University Press.Item Preliminary safety assessment of sulphadoxine-pyrimethamine during intermittent presumptive treatment of pregnant women in a region with high prevalence of G6PD deficiency(International Journal of Risk and Safety in Medicine, 2005-01) Dodoo, A.N.O.; Gyansa-Lutterodt, M.; Frempong, N.; Thompson, H.; Amofa, G.; Bart-Plange, C.; Allotey, N.K.; Eghan, K.E.Pregnant women in 20 administrative districts of Ghana are being monitored intensively for adverse events following intermittent presumptive treatment with sulphadoxine-pyrimethamine. Preliminary results indicate a low level of adverse events (0.16%) suggesting good tolerability of the drug, despite the relatively high G6PD deficiency prevalence of more than 20%. Since the real possibility of under-reporting cannot be overlooked, the focused surveillance approach being used in the study is being complemented with in-depth interviews following home visits and focus group discussions with patients and healthcare workers. © 2005 - IOS Press and the authors. All rights reserved.Item Amodiaquine-induced dystonic reactions: Case reports and implications for policy change in Ghana(International Journal of Risk and Safety in Medicine, 2005-01) Akpalu Jr., A.K.; Nyame, P.K.; Dodoo, A.N.O.Ten cases of amodiaquine-induced dystonic reactions observed in a single ward in Ghana's Premier Teaching Hospital, over a period of 4 years are presented. All the reactions resolved without sequalae on treatment with diazepam and benztropine. The importance of increased safety monitoring of amodiaquine as it is (in combination with artesunate) introduced as first line treatment for uncomplicated malaria in Ghana is highlighted. © 2005 - IOS Press and the authors. All rights reserved.Item Compliance with good practice in prescription writing at outpatient clinics in Saudi Arabia(Eastern Mediterranean Health Journal, 2005-09) Irshaid, Y.M.; Al Homrany, M.; Hamdi, A.A.; Adjepon-Yamoah, K.K.; Mahfouz, A.A.A sample of prescription orders received from outpatient departments by a hospital pharmacy in Asir, Saudi Arabia, were analysed over 1 year for the essential elements of prescriptions. The prescriber's name, address and signature were on 83.3%, 9.6% and 81.9% of prescriptions respecti-vely. The patient's name, age and sex were on 94.6%, 77.3% and 51.3%. No prescription contained the patient's address and weight. Generic drug names were used in only 15.1% and strength of medication and dose units were included in 26.6% and 55.6% of prescriptions. Most prescriptions (94.0%) had no quantity indicated and had only partial instructions for patient use (90.7%); the diagnosis was included in about two-thirds. The prescriber's handwriting was illegible in 64.3% of prescriptions. Measures to improve the situation are suggested.Item Pretreatment blood concentrations of chloroquine in patients with malaria infection: Relation to response to treatment(Journal of Tropical Pediatrics, 2005-06) Quashie, N.B.; Akanmori, B.D.; Goka, B.Q.; Ofori-Adjei, D.; Kurtzhals, J.A.L.Resistance of Plasmodium falciparum to chloroquine has been reported in many areas in Ghana. Most of these reports, which are from hospital-based studies, indicate RI and RII rather than RIII type of resistance. Since high pretreatment levels of chloroquine have also been measured in patients with malaria infection in Ghana, we hypothesized that the 'added effect' of the pretreatment ingested drug to the full dose given at the hospital may be responsible for the low proportion of RIII type of resistance observed. To ascertain this, pretreatment blood levels of chloroquine were correlated with treatment outcomes in 231 paediatric malaria patients, referred to a major hospital in Ghana. The rate of parasite clearance and prevalence of recrudescence, 14 days post-treatment, were determined for each patient. Results from this study showed no correlation between pretreatment chloroquine levels and day 0 parasitaemia. Two hundred and seven patients (89.6 per cent) had parasites that were sensitive to chloroquine whilst 24 (10.4 per cent) had resistant parasites. Of the latter group 17, six, and one patients had P. falciparum parasites, which were resistant at RI, RII and RIII levels, respectively. Seventy-five per cent of the patients without any detectable pretreatment blood chloroquine had parasites that were sensitive to chloroquine whilst 89.8 per cent, 98 per cent, and 100 per cent with pretreatment blood chloroquine concentration ranges of 0.5-100.5/ml, 100.5-200/ml, and >200/ml, respectively, had chloroquine-sensitive parasites. An inverse relationship was thus observed between pretreatment blood chloroquine concentration and the degree of resistance in this study. We conclude that pre-hospital treatment ingested chloroquine contributes significantly to the resolution of malaria in children in Ghana, in the presence of chloroquine resistance. © The Author [2005]. Published by Oxford University Press. All rights reserved.