Child-friendly drug boosts war against bilharzia

A big, bitter tablet will no longer stand in the way of bilharzia treatment for children aged six years and below. Bilharzia is one of the most prevalent parasitic diseases worldwide.
Currently, school children access the treatment, which is through tablets given as single, oral doses. There is also a preventive treatment suitable only for adults and school children.
Younger children, aged six and below, usually cannot swallow the tablets because of their large size and bitter taste.
Due to this, a large, young population remains untreated. Currently, the group of preschool children is left uncatered for in public health programmes due to lack of clinical data and a missing appropriate child-friendly formulation of the drug.

INTELLECTUAL GROWTH
However, Merck Group’s Head of Corporate Affairs, Senior Vice President, Dr Petra Wicklandt says there is hope that children under six in Kenya could soon access a more suitable drug.
She said the formulation of a small, orally dispersible tablet with an acceptable taste is within reach thanks to a partnership between Merck and Kenya Medical Research Institute (Kemri).
“Together with Kemri, we reached the critical milestone of starting a pivotal clinical Phase III study, conducted in Kenya and Cote d’Ivoire. This is important especially since the disease can retard intellectual growth and children would be saved from this,” she said.
Dr Maurice Odiere, the head of the neglected tropical diseases research unit at Kemri said the current pilot study of the drug at Homa Bay Teaching and Referral Hospital has taken off without a hitch.
“We are checking the efficacy and safety of the drug for the trials that will go on until March and so far we are doing well,” he said.
Bilharzia can lead to chronic illness.

UNCLEAR SYMPTOMS
The World Health Organisation (WHO) estimates that at least 206 million people worldwide required treatment in 2016, more than 90 per cent of whom live in Africa.
The disease affects a large proportion of children under 14 years, including an estimated 28 million preschool children. In these very young children, prevalence of infection may exceed 60 per cent.
Dr Odiere said in Kenya nine million people are at risk of contracting the disease and three million school children are affected. In these, 200,000 children below six years may be infected.
People who live in 158 of the 298 sub-counties in the country are at risk of contracting bilharzia, he added.
Schistosomiasis or bilharzia is acquired when people come into contact with fresh water infested with the larval forms of parasitic blood flukes, known as schistosomes.
The microscopic adult worms live in the veins, draining the urinary tract and intestines. Most of the eggs they lay are trapped in the tissues and the body’s reaction to them can cause massive damage.
The disease can affect different parts of the body, including the lungs, nervous system and brain. The area of damage will depend on the species of the parasite.
Left untreated, bilharzia can lead to anaemia, stunted growth, reduced learning ability and chronic inflammation of the organs, which can be fatal in the most serious cases.
“The disease is hard to diagnose sometimes because the symptoms are not clear. Children can develop rushes, vomiting and abdominal pain which is common with other diseases. When it gets serious, you may see blood in stool, in the urine and on enlarged spleen,” he said.

COMBINED APPROACH
Bilharzia is not usually fatal immediately, but it is a chronic illness that can seriously damage the internal organs. In children, it can lead to reduced growth and problems with cognitive development.
The parasites enter the body when a person is swimming, washing or paddling in contaminated water. People can also be infected by drinking the water or eating food washed in untreated water.
Dr Odiere said despite the introduction of the drug and the existing ones for adults, there needed to be a combined approach of health education, improved water sanitation and hygiene in order to ensure the disease did not reoccur.
“Even with the drug we have to ensure these other approaches are tackled because we often see reoccurrence of the disease if the children are exposed to the same water,” he said. Once done, this will be the first child friendly drug for bilharzia in Kenya.