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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

Histograms of doses given by the dose-pole for each dose given by the weight and halves approach.
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Figure 0006: Histograms of doses given by the dose-pole for each dose given by the weight and halves approach.

Mentions: A detailed illustration of the problem is given in Fig. 5, where the dose outcomes by the two methods are plotted according to the weight of the children in our study. Essentially, this gives the same message as Table 4, but here we also see the trajectories as in Fig. 2. The trajectories represent the different numbers of tablets according to both methods. The filled circles stand for the weight and tablet halves approach. These trajectories are non-overlapping for weight. The hollow circles represent the dose-pole approach; different children with the same weight will receive different doses simply because their heights differ. In our child population, it would mean that children with the same weight qualify for three different dose levels and sometimes even four (Fig. 6). The dose-pole also appears to give the largest deviations from the target dose in children below 20 kg (Fig. 5).


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)

Histograms of doses given by the dose-pole for each dose given by the weight and halves approach.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0006: Histograms of doses given by the dose-pole for each dose given by the weight and halves approach.
Mentions: A detailed illustration of the problem is given in Fig. 5, where the dose outcomes by the two methods are plotted according to the weight of the children in our study. Essentially, this gives the same message as Table 4, but here we also see the trajectories as in Fig. 2. The trajectories represent the different numbers of tablets according to both methods. The filled circles stand for the weight and tablet halves approach. These trajectories are non-overlapping for weight. The hollow circles represent the dose-pole approach; different children with the same weight will receive different doses simply because their heights differ. In our child population, it would mean that children with the same weight qualify for three different dose levels and sometimes even four (Fig. 6). The dose-pole also appears to give the largest deviations from the target dose in children below 20 kg (Fig. 5).

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