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| Tech Brief Principal Preparer: Michel Pacqué, ORC Macro/CSTS+ | ||||||||
Malaria: Prompt Treatment Saves Lives
Malaria causes between 300 and 500 million illnesses and kills 1 to 2 million people each year. More than 90% of these illnesses and deaths occur in sub-Saharan Africa, where 1 in every 5 childhood deaths is caused by malaria, making it the number one killer of young children. Most episodes of malaria are treated outside the formal health care sector. Inappropriate home treatment is a threat to proper management of malaria, however, and may contribute to the development of drug resistance.
The clinical presentations of malaria and pneumonia overlap. In addition, infants often have more than one disease. Thus it is important that, at all levels and in all areas where possible, children are treated within an IMCI framework. Formal and informal providers need, at a minimum, to be skilled or trained to be able to diagnose, counsel, treat, and refer when necessary. Diagnose: With the spread of resistance to antimalarial drugs, accurate diagnosis, especially of adults, has become important as a means to avoid presumptive treatment of all febrile patients with antimalarial drugs. Conventional microscopic diagnosis is sensitive, specific, and relatively inexpensive; however, it requires trained staff and an infrastructure that is not always available at the periphery of the health care system. In these settings, especially in areas with lower rates of transmission, where malaria accounts for a small proportion of all fevers, the use of a rapid diagnostic test for malaria diagnosis should be considered. Counsel: Counseling should focus on compliance with treatment and referral guidance; recognition of danger signs at home; and home-care strategies such as continued feeding and fluids. Health care workers should also discuss the advantages of using an insecticide-treated bednet. (See the Global Health Technical Brief, “Bednets Reduce Malaria.”) Treat and refer: Included in the management of malaria are recognition and management of anemia, including iron supplementation, de-worming, and counseling of caretakers on nutrition. Programs should also ensure that referral facilities can provide good quality care for complicated or severe malaria. Ensure prompt referral of and immediate care for severe cases of malaria Mitigate the spread of drug resistance The World Health Organization recommends that any country facing resistance to its first-line single-drug antimalarial therapy change to combination therapy, ideally with an artemisinin drug. These drugs rapidly reduce malaria symptoms and parasite density in the blood. Four artemisinin-based combination therapy (ACT) regimens are recommended: artemether-lumefantrine (Coartem®), amodiaquine-artesunate, SP-artesunate, and mefloquine-artesunate. Drug policy changes are slow and costly, however. A major drawback to the adoption of ACT as first-line malaria treatment in most countries has been that it costs 8 to 10 times more than chloroquine or SP alone. Also, it can take several months to fill new orders. Since in Africa 50% to 80% of patients with suspected malaria first seek treatment outside the formal health care system, the role of the private sector in drug policy changes also needs consideration.
1Adapted from: Breman JG. The ears of the hippopotamus: manifestations, determinants and estimates of the malaria burden. Am J Trop Med Hyg 2001;64 (Suppl 1-2):1-11. http://www.ajtmh.org/cgi/reprint/64/1_suppl/1-c References: Last Revised: 8/9/05 Designed and produced by: The INFO Project at the Johns Hopkins Bloomberg School of Public |
