Treatment of Malaria
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A boy in Uganda takes his first dose of artemisinin-based combination therapies. Treatment for three days will completely eliminate the malaria parasites from his body.
Source: Karie Atkinson/USAID |
Recognizing the symptoms of malaria and seeking timely and effective treatment are key to saving the lives of children infected with malaria. Artemisinin drugs are the most rapidly acting and effective antimalarial drugs currently available. Combined with a second effective antimalarial drug, so-called artemisinin-based combination therapy (ACT) has become the standard of treatment of malaria in almost all malaria-affected regions. The rationale for using combination therapy for malaria is that it greatly reduces the probability of the emergence of malaria parasites that are drug resistant, and thus prolongs the effective lifetimes of both drugs. As of 2005, all countries in sub-Saharan Africa had changed their national treatment policy to ACTs.
ACTs currently cost 10 to 20 times more than previous first-line malaria treatments, such as chloroquine, and have a shelf life of just 18 to 24 months. Therefore, good pharmaceutical management is critical to their effective use. In addition, the higher costs of ACTs when compared with monotherapies, such as chloroquine, increase the need for accurate diagnosis of malaria. Currently, most malaria cases are diagnosed solely on clinical grounds, without laboratory confirmation. Because the symptoms and signs of malaria are nonspecific, many people treated for malaria do not have the infection. The result is that costly drugs are wasted and other treatable conditions are missed. Microscopic examination of blood smears is considered the gold standard for diagnosis, but it requires considerable supervisory and logistic support to sustain high-quality performance. In recent years, the development and refinement of rapid diagnostic tests (RDTs) for malaria has offered a potentially simpler solution to laboratory diagnosis of malaria. RDTs, though simple to use, have their limitations. There have been problems with poor quality control during the manufacture of some test kits. All available RDTs also become unstable at high temperatures and humidity. In addition, health care workers may not accept negative test results when those results do not agree with their clinical impression of the cause of a patient’s illness.
USAID is supporting procurement and distribution of ACTs, the training of health workers in appropriate treatment guidelines, and the improvement of laboratory diagnosis of malaria. This work is done in collaboration with four of the Agency’s key collaborating partners: World Health Organization, CU.S. Centers for Disease Control and Prevention (CDC), the Strengthening Pharmaceutical Management, and the JSI DELIVER Project.
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