Zinc/ORS and Amoxicillin 250mg DT

According to the standard treatment guidelines ZINC/ORS is used for Diarrhoea treatment and AMOXICILIN for Pneumonia treatment.

The current situation:

  • Tanzania has made considerable progress in the reduction of child mortality. Despite the progress, diarrhoea and pneumonia continue to rank among the three leading causes of under five deaths. According to the Ministry of Health and Social Welfare (MoHSW), the number of children under five years seeking outpatient care for diarrhoea and pneumonia are 1.3 million and 1.6 million, respectively.( Annual Health Statistical Tables and Figures, MoHSW 2011).
  • Almost half of children sick with diarrhoea receive a form of Oral Rehydration Solution (ORS) for its treatment, only 4.7% receive zinc as a part of that treatment. The last official statistics collected for pneumonia from the Tanzanian Demographic and Health Survey (TDHS) 1991-92 show that only 22% of sick children received antibiotics for pneumonia treatment.
  • Amoxicillin 250mg DT is registered with TFDA and co packed Zinc/ ORS is under the process of registration. A waiver has been obtained to import co packed ORS/ Zinc by TFDA.
  • The following are the amount procured so far for the public sector

 

Efforts made to tackle these major child killers.

  • Integrated Management of Childhood Illness (IMCI) was introduced in 1996.
  • Zinc in 2009
  • Revision of the guideline in 2010 to place Amoxicillin as the first line for pneumonia treatment.
  • In order to reduce the diarrhoea and pneumonia among children, Haemophilus influenza type b (Hib) vaccine was incorporated into the routine immunization program in 2009 followed by Pneumococcal Conjugate Vaccine (PCV) and Rotavirus (Rota) vaccine starting from January 2013.

 

Challenges

  • Limited availability and accessibility to diarrhoea and pneumonia medicine in optimal formulation, including the capacity of supply management and monitoring.
  • Frequent stock out of essential paediatric medicines at public facilities.
  • Poor quality of care in public and private sectors, including adherence to IMCI guideline which compromises the rational use of medicine; (very low use of zinc).

 

Advantages of Amoxicillin DT over Suspension.

  • Dose accuracy: Dosing of liquids by spoon is unreliable.
  • Storage: Long shelf-life as compared to suspension. The shelf life for DT is 3 years and that of syrup is one to two years but the syrup requires to be refrigerated after reconstitution and will only last up to 10 days after opening.
  • Dispersible tablets are more stable in high temp and humidity as compared to syrups ones. (MSD had to discard a lot of syrup due to expiry as well as moulding (resulting from high temperature and humidity) before distribution)
  • No need for refrigeration.
  • The amount of water needed for Amoxicillin DT is small ac compared to amoxicillin syrup. For one tablet you need two teaspoonful of water only while the syrup you need to reconstitute up to the required mls usually 80mls
  • Transport: Less bulky and lighter in weight. A mother can easily carry the tabs in her purse
  • Less susceptible to high temperatures.
  • Acceptability: Paediatric dispersible tablets are already in use in Tanzania for malaria, and well tolerated.
  • Cheaper: Based on WHO price lists, dispersible tablets could represent a cost saving compared to suspensions.

* Treatment for Pneumonia and ear infection you are supposed to give two times for 5 days

PRICE COMPARISON

 

PARAMETER TABLETS SYRUP
Age/ weight Daily dose Total amount of tablets required Costs Daily dose Total mls required Costs
2-4 month (4 -5.9kg) 0.5 (250mg tab) 5 TZS 255.55 5ml 50 (one bottle required) 2500 TSHS
4 to 12 month ((6 to 9.9 kg) 1(250mg tabs) 10 TZS 511.11 10ml 100( one bottle required) 2500 TSHS
12 month to 5 years 1.5 (250mg tabs) 15 TZS 766.66 15ml 150(2 bottles required 5000 TSHS

Assumption: The $2.71 is the factor price, added 15% for freight cost and the tentative market price is $0.312.

NOTE:

  • Because of these advantages, it is more likely that the stock-out will be less and children are treated with recommended first line. Also the inclusion of Amoxicillin 250mg DT into the ADDO list will widen the availability of this product even to the private sector.
  • Global trends is to shift from dry syrup to dispersible tablets as much as possible.
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