Can children actually get their malaria drugs?

The Wall Street Journal quotes Novartis Chief Executive Daniel L. Vasella as saying, “In the end the only drug that matters is the drug that is swallowed.” The article goes on to explain how Novartis has developed a form of Coartem that is “Dispersible, that is small, cherry-flavored and dissolves easily,” as a way to ensure that the dispensed medicine is actually swallowed. The article also addresses other flavors that may be tried.

Much progress has been made in packaging malaria drugs for different age groups, especially children, when before there were only standard adult doses than had to be divided – a challenging task for many parents. The alternatives for children were more expensive syrups that were not always stable in tropical climates.

The article also addresses other challenges to ensuring children get their drugs. “But efficient channels to distribute the products are rare, giving rise to what health workers call ‘pile-up’ of drugs trying to reach villages and health clinics.” Efficient distribution is essential since artemisinin based medications have a relatively short shelf life and can expire within 18 months of arriving in a country.

Another challenge is cost. Medicines bought through Global Fund Grants are generally made available free for children in public or NGO clinics. Pilot programs are underway to see how subsidized price antimalarials can be made available through the private sector which may actually account for 50% or more of actual malaria treatments provided.

Three challenges that are not mentioned in the article include –

  • For one, when drugs are made available for free or at reduced cost only for children, there will be leakage into wider use as health workers or medicine shop keepers will provide multiple packets of the child drugs to satisfy their adult clients/customers.
  • A second unmentioned challenge is the tendency to overprescribe malaria drugs, especially among adults.  The answer to this is case management that includes diagnosis using a laboratory, but more likely rapid diagnostic tests, which can be used at the primary care level
  • Finally there is the issue of compliance.  Artemisinin-based combination therapy generally is taken twice a day for three days. If medicine providers do not counsel clients on the need for full compliance children may swallow only a few doses and not only fail to be cured but also contribute to drug resistance.

Malaria case management is a complicated process that begins with the drug manufacturer and ends in the home. All partners along the way must be vigilent if children’s lives are to be saved.

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