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From a weighing scale to a pole: a comparison of two different dosage strategies in mass treatment of Schistosomiasis haematobium.

Nordin P, Poggensee G, Mtweve S, Krantz I - Glob Health Action (2014)

Bottom Line: We compared doses given by weight to doses given by height using descriptive statistics and regression.Our study shows that children with the same weight could qualify for up to four different dose levels based on their height.The largest variation of doses based on the WHO dose-pole will be found in children below 20 kg of bodyweight.

View Article: PubMed Central - PubMed

Affiliation: The Skaraborg Institute for Research and Development, Skövde, Sweden; per.nordin@skaraborg-institute.se.

ABSTRACT

Background: Clinical schistosomiasis in endemic countries is treated with a single dose of praziquantel per 40 mg/kg body weight. Treating according to weight, in resource-poor settings when thousands of doses are to be administered in mass treatment campaigns, is considered problematic. A calibrated dose-pole based on height was developed and is now used in mass treatment campaigns for determining the doses for schoolchildren. The dose-pole will generate dose errors since every child population contains individuals that are either short or tall for weight. The aim of this study is to explore whether the WHO praziquantel pole is a satisfactory dose instrument for mass treatment of S. haematobium.

Methods: In 1996 and 2002, 1,694 children were surveyed in the Kilimanjaro Region, Tanzania. We compared doses given by weight to doses given by height using descriptive statistics and regression.

Conclusions and interpretation: The WHO dose-pole for praziquantel is based on height of the patient; however, children with the same height will differ in weight. Our study shows that children with the same weight could qualify for up to four different dose levels based on their height. The largest variation of doses based on the WHO dose-pole will be found in children below 20 kg of bodyweight. Using bodyweight and tablet halves as the smallest tablet division unit to determine the doses of praziquantel, one only has to identify every 6th kilogram of bodyweight; the doses will then vary a lot less than when using the WHO dose-pole.

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Related in: MedlinePlus

Theoretical deviations in mg/kg according to body weight, illustrated by trajectories, when 40 mg/kg is the target dose and 300 mg tablet halves are used as the smallest dose unit.
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Figure 0002: Theoretical deviations in mg/kg according to body weight, illustrated by trajectories, when 40 mg/kg is the target dose and 300 mg tablet halves are used as the smallest dose unit.

Mentions: Given that weight could be measured accurately and only tablet halves used as recommended by WHO (1), the maximum deviation in dose could never be more than 300 mg per individual. This may be of little importance for a child of moderate to heavy weight or an adult. Theoretically, however, for a child of low weight, this would mean a departure from the recommendation of 40 mg/kg as illustrated by the trajectories in Fig. 2. On the other hand, the children in our study vary in weight from 14 to 65 kg (Table 1), which means that the actual dose could deviate from the recommended dose by as much as ±7.5 mg/kg for those with the lowest weight to ±2.5 mg/kg for those with the highest weight.


From a weighing scale to a pole: a comparison of two different dosage strategies in mass treatment of Schistosomiasis haematobium.

Nordin P, Poggensee G, Mtweve S, Krantz I - Glob Health Action (2014)

Theoretical deviations in mg/kg according to body weight, illustrated by trajectories, when 40 mg/kg is the target dose and 300 mg tablet halves are used as the smallest dose unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4256524&req=5

Figure 0002: Theoretical deviations in mg/kg according to body weight, illustrated by trajectories, when 40 mg/kg is the target dose and 300 mg tablet halves are used as the smallest dose unit.
Mentions: Given that weight could be measured accurately and only tablet halves used as recommended by WHO (1), the maximum deviation in dose could never be more than 300 mg per individual. This may be of little importance for a child of moderate to heavy weight or an adult. Theoretically, however, for a child of low weight, this would mean a departure from the recommendation of 40 mg/kg as illustrated by the trajectories in Fig. 2. On the other hand, the children in our study vary in weight from 14 to 65 kg (Table 1), which means that the actual dose could deviate from the recommended dose by as much as ±7.5 mg/kg for those with the lowest weight to ±2.5 mg/kg for those with the highest weight.

Bottom Line: We compared doses given by weight to doses given by height using descriptive statistics and regression.Our study shows that children with the same weight could qualify for up to four different dose levels based on their height.The largest variation of doses based on the WHO dose-pole will be found in children below 20 kg of bodyweight.

View Article: PubMed Central - PubMed

Affiliation: The Skaraborg Institute for Research and Development, Skövde, Sweden; per.nordin@skaraborg-institute.se.

ABSTRACT

Background: Clinical schistosomiasis in endemic countries is treated with a single dose of praziquantel per 40 mg/kg body weight. Treating according to weight, in resource-poor settings when thousands of doses are to be administered in mass treatment campaigns, is considered problematic. A calibrated dose-pole based on height was developed and is now used in mass treatment campaigns for determining the doses for schoolchildren. The dose-pole will generate dose errors since every child population contains individuals that are either short or tall for weight. The aim of this study is to explore whether the WHO praziquantel pole is a satisfactory dose instrument for mass treatment of S. haematobium.

Methods: In 1996 and 2002, 1,694 children were surveyed in the Kilimanjaro Region, Tanzania. We compared doses given by weight to doses given by height using descriptive statistics and regression.

Conclusions and interpretation: The WHO dose-pole for praziquantel is based on height of the patient; however, children with the same height will differ in weight. Our study shows that children with the same weight could qualify for up to four different dose levels based on their height. The largest variation of doses based on the WHO dose-pole will be found in children below 20 kg of bodyweight. Using bodyweight and tablet halves as the smallest tablet division unit to determine the doses of praziquantel, one only has to identify every 6th kilogram of bodyweight; the doses will then vary a lot less than when using the WHO dose-pole.

Show MeSH
Related in: MedlinePlus