A suppository form of the common antimalarial artesunate has dramatically cut child deaths from severe malaria in a trial in rural Zambia, one of the organisations behind the programme has said.

According to the WHO’s world malaria report published in 2017, Zambia's entire population of nearly 17 million people had an about three million malaria cases in 2016, with about seven per cent of the cases progressing to severe malaria during which patients may become unconscious.

Children under five years old are the age group most susceptible to severe malaria due to a lack of immunity and if left untreated, severe malaria can quickly become fatal, experts say.

During a 12-month trial with a suppository formulation of the common antimalarial artesunate, deaths from severe malaria cases declined from eight to 0.25 per cent despite identifying 225 and 1,215 cases respectively at the study’s baseline and endline, the researchers announced the findings today.

“By improving access to key severe malaria medicines and improving case management, the project was able to reduce mortality from untreated severe malaria.” Pierre Hugo, MMV

“Knowledge of severe malaria danger signs at a community level improved significantly, with more than 85 per cent of community health volunteers knowing three or more danger signs at endline compared to less than 50 per cent at baseline,” explained Pierre Hugo, a director at the Swiss-based not-for-profit Medicines for Malaria Venture (MMV), in an interview with SciDev.Net.

Although WHO guidelines for the treatment of malaria have included recommendations for the use of the suppository form of the drug, known as rectal artesunate suppository (RAS), for over ten years, until recently there was no quality-assured RAS product on the market.

In the past this has forced malaria-endemic countries to choose from sources of drug supply that did not meet international standards.

As a result, the MMV is collaborating with two Indian pharmaceutical companies, Strides and Cipla, to secure WHO prequalification of RAS as part of a project funded by the international malaria initiative UNITAID.

As part of the trial, trained community health volunteers administered the drug to all children from six months to six years old with severe malaria cases and referred them to health facilities, with 70 per cent aided by use of emergency transport system, the researchers added.

The trial was so successful because the suppository formulation means the drug could be given even when the child was unconscious or vomiting, which is not the case for oral medicines.

The trial, which began in July last year, was conducted at Zambia’s Serenje district in partnership with Zambia’s National Malaria Elimination Centre.

Hugo said that the trial aimed to increase access to quality-assured artesunate at the community level and to reduce deaths from severe malaria in children under six by improving case management of severe malaria in children.

“By improving access to key severe malaria medicines and improving case management, the project was able to reduce mortality from untreated severe malaria and save the lives of many children, thereby benefitting these children as their families and communities,” Hugo said, adding that the project built the capacity of intervention communities and health facilities to control severe malaria in children.

Willis Akhwale, founder and executive director of  Kenya-based Continental Public Health Consulting and a malaria control specialist, says that the results indicate a significant public health impact if the intervention is rolled out.

“A 96 per cent reduction of severe malaria case fatality rate, especially in children less than five years of age through community case management of malaria, will be ground breaking,” Akwhale says.

But Akhwale, adds that most deaths arising from severe malaria are due to anaemia, which requires blood transfusions and administration of intravenous fluids at health facilities.

Thus, it is prudent that this strategy is deployed alongside a well-functioning referral system and better equipped primary health care facilities, Akwhale explains.

“Access to health facilities remains a barrier to quality health care in most countries with a high burden of malaria,” he adds.


Cover image credit: A woman sits with her child as a health worker takes a finger prick blood sample Copyright: Panos

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