Improving malaria treatment

"WHO (World Health Organization) is releasing the first ever guidance on procuring safe and efficient anti-malarial medicines. The guidelines will help countries select and obtain effective, good quality medicines and save lives by improving the way patients are diagnosed and treated" (WHO).

New guidelines recommend "the use of diagnostic tests and a new artemisinin-based combination therapy". Robert Newman, "director of the WHO global malaria" program, said "It is time to move away from the idea that everyone with a fever is suspected to have malaria" (Bernama).

Tests to determine whether or not malaria is the febrile culprit are necessary to prevent further drug-resistant malaria from developing. However, reliable tests are expensive and unavailable in rural villages, where they are most needed. "The WHO. . . recommended the rural health clinics, where microscopes are often unavailable, use Rapid Diagnostic Tests because they are easy for community health workers to handle" (Bernama).

"Each year there are 250 million cases of malaria and 860,000 deaths as a result. Approximately 85 percent of the deaths are children" (Bernama).

Malaria treatment guidelines: http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html

Bernama. "WHO releases new malaria treatment guidelines." 10 March 2010. http://www.bernama.com/bernama/v5/newsworld.php?id=481148

WHO. "Improving malaria diagnosis and treatment." 09 March 2010. http://www.who.int/en/

Substandard Medicines

"A high percentage of medicines circulating on national markets", in ten Sub-Saharan African countries, "are of substandard quality and thus may contribute to the growth of drug-resistant strains of Plasmodium falciparum, the most virulent form of malaria." First results of the "large-scale study of key antimalarial medicines" were released for Madagascar, Senegal, and Uganda by the Promoting the Quality of Medicines (PQM) Program, a USAID-funded program.

"Within Madagascar, Senegal and Uganda, the study" focused "on artemisinin-based combination therapy (ACT) products, currently the WHO's recommended form of first-line treatment for uncomplicated malaria, and sulfadoxine-pyrimethamine (SP) products, often used for preventative treatment of malaria during pregnancy." Researchers collected samples from "public and regulated private sectors" and from "informal markets, as many patients obtain their medicines from these sources."

"Substandard and counterfeit versions of antimalarial medicines are highly problematic throughout Africa, Asia and Latin America because of the direct threat they pose to the lives of individual patients as well as their contribution to the development of drug-resistant strains of these diseases." The "study found that approximately 44 percent of sampled medicines from Senegal, 30 percent of samples from Madagascar, and 26 percent of samples from Uganda that underwent full quality control laboratory testing failed such testing and were thus substandard."

"Substandard" medicines are classified as "those that do not meet the quality specifications set for them, primarily because they do not contain the correct amount of the active ingredient(s), do not dissolve properly in the body or include unacceptable levels of potentially harmful impurities." According to the released results, "[n]o samples in the full study completely lacked the active ingredient(s). The results also showed that, as a general rule, when a brand passed or failed in one country, it would also pass or fail in other countries. This indicates that the problem of quality is created at the source, rather than during passage through the distribution chain."

Substandard medicines were not limited to informal markets, and their point of sale varied by country. "In Madagascar, for instance, poor quality medicines appear to be widespread across regions and not limited to any particular type of distributor [public, private, or informal]. In Uganda, samples fared much better in the public sector than in the country's private sector. Despite overall failure rates, this was one of the bright spots the study revealed; in Uganda's public sector, all ACT and SP samples passed quality tests."

The purpose of this study was reveal "the prevalence of substandard antimalarials in Sub-Saharan Africa, which are believed to contribute to antimicrobial resistance of Plasmodium falciparum. Already, Plasmodium falciparum has become resistant to traditional" treatments "such as chloroquine, and more recently to SP products. The sustainability of treatment success depends to a large extent on preventing Plasmodium falciparum's exposure to incomplete doses of these medicines to minimize the possibility of the emergence of drug resistance."

Source:
US Pharmacopeia (2010, February 10). One-third of antimalarial medicines sampled in three African nations found to be substandard. http://vocuspr.vocus.com/vocuspr30/Newsroom/ViewAttachment.aspx?SiteName=USPharm&Entity=PRAsset&AttachmentType=F&EntityID=108111&AttachmentID=f2e22216-44a5-41a2-a9bc-464b7a98e3bf

Malaria in Zimbabwe

Zimbabwe has received a bleak prognosis for 2009 regarding malaria and cholera cases. Cholera continues to surge at epidemic levels, high numbers of malaria cases are also expected. "Malaria may be worse in Zimbabwe in 2009" than it has been in previous years. "That's because efforts to control cholera may be diverting attention away from programs to prevent malaria. The warning comes from the Rollback Malaria Campaign" (DeCapua).

"It's not just the rainy season that's helping to spread" the diseases, "but also a weakened healthcare system and poor water and sanitation". The Rollback Malaria Campaign adds that "there's been much less indoor residual spraying against mosquitoes", "and current heavy rains will help increase the mosquito population." Treatment "kits to help manage severe malaria cases are not reaching those in need due to distribution problems and that there's a shortage of healthcare workers due to Zimbabwe's economic crisis" (DeCapua).

According to recent statistics, fewer than 7% of young children sleep under any kind of mosquito net. Since mosquitoes are most active at night, the use of a net is paramount in avoiding bites from the mosquitoes that may carry malaria.
For more statistics please visit the Zimbabwe country profile.

Bureaucratic bottlenecks have limited the program's effectiveness in Zimbabwe, but other challenges are even more difficult to overcome. "Problems with flow of global fund within country resulted the loss of part of funding" and there is a constant shortage of personnel (RBM Campaign).

However, there is good news for Zimbabwe. Malaria-related deaths fell between 2001 and 2007 largely because of malaria treatment programs.

The number of deaths is expected to rise in 2009 due to the projected increase in numbers of cases.

[Photo provided by the RBM Campaign]

Currently, "malaria is found in all areas of Zimbabwe except the city of Harare" (Uyaphi). According to the MD Travel Health Website, "Prophylaxis with Lariam, Malarone, or doxycycline" Malaria treatment "is recommended for all areas, except the cities of Harare and Bulawayo".


Malaria prevention in Zimbabwe is dependent of funds raised outside of the country. If you would like to donate to the RBM Campaign, please visit their donation page.