Home Management of Malaria in the Era of ACTs

The current Newsletter of the Tropical Disease Research (TDR) Program highlights the role home management of fever/malaria can have in reducing the deaths of over one million children annually. TDR notes the value of having child doses prepackaged in order to enhance provision of the correct amount of medicine to children.  The Newsletter quotes Professor Umberto D’Alessandro from the Prince Leopold Institute of Tropical Medicine in Antwerp, Belgium, who said, “There are no data available on the effects of ACT when it is given by mothers to their children without proper diagnosis. It should reduce mortality, but we simply don’t know if it does.”  This has led TDR to support Studies using ACTs in home management settings in Benin, Burkina Faso, Cameroon, Ethiopia, Malawi, Nigeria, Uganda and the United Republic of Tanzania.

Some encouraging preliminary results were published last year from independent work in Ghana. An article by Gyapong et al. reported that, “Adherence of agents and caregivers to the treatment (with Coartem) was 308/334 (92.5%). Delay in seeking care was reduced from 3 to 2 days. No serious adverse drug reactions were reported. Community members were enthusiastic about the performance of the agents.”

Turning research into practice, and thereby making ACTs available in the home, will require several steps.  There are at least two effective strategies for getting malaria medicines for prompt care of children into the home.  One is training and supplying community volunteers, while the second is selling antimalarials in licensed shops, often at subsidized prices. For these strategies to save children’s lives, policy decisions are needed concerning whether ACTs will remain prescription drugs or whether they can be sold in the licensed medicine shops which are near the home.

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