Considering the Complexities of Coartem Use

Two current articles in Tropical Medicine and International Health show that the use of artemether-lumefantine as the only pre-qualified, life saving artemisinin-based combination therapy (ACT), faces serious challenges.  Ashley et al. report that attempts to improve adherence by reducing the somewhat complicated 3-day, 6-dose regimen of coartem to once a day treatment were less effective. The problem was inadequate absorption of lumefantrine.  They concluded that the present regimen be maintained and that the diet includes fat to enhance absorption.  In a related article, some of same authors found that the small amount of fat in soya milk was needed to enhance lumefantrine bioavailability and absorption.

In light of the fact that the more complicated 6-dose regimen is required, another article by Conteh et al. stresses the importance of good communication between providers of malaria medicines and consumers to improve adherence.  Poor communication often meant that caregivers delayed in giving the crucial first dose to their children.

 Mamiro et al. report that poor and rural African children often suffer stunting and malnutrition.  A key need is for greater energy density in their diets, including fats/oils.  They also found that malaria was associated with such stunting.  If higher consumption of dietary oils is needed to make artemether-lumefantrine more effective, communication between providers and their clients will also need to include dietary counseling relevant to the low income status of most of the children at risk.

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