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Diagnosis &Treatment Bill Brieger | 09 May 2010 11:17 am

Update on Malaria Management in Nigeria

2010-seminar-of-malaria-society-of-nig-sm.jpgThe Malaria Society of Nigeria is planning a seminar to update members and those concerned about controlling malaria in the country on management of malaria. The event will take place at the Nigerian Institute for Medical Research in Yaba, Lagos, on 12 May 2010 at 10 a.m.

There are many aspects to managing malaria, but to take only one – case management – is a challenge in itself.  The National Malaria Control Program‘s 2010 annual workplan outlines five key activities that need to be accomplished in order to properly treat a person who has suspected malaria:

  • Parasitological confirmation of malaria cases by rapid diagnostic tests (RDT) and scaling up of diagnosis by microscopy
  • Treatment of uncomplicated malaria with an ACT within 24 hours of fever onset through all health care providers (public and private)
  • Expansion of access to free ACTs to community level through local human resources
  • Early recognition and improved management of severe malaria cases
  • Drug efficacy and quality monitoring

To this we should add ‘counseling’ of those receiving ACTs to ensure adherence to the full course of treatment.  As a recent Malaria No More posting noted, “The only pill that works is the pill that’s swallowed.”

The current national malaria treatment policy, guidelines and training materials were adopted in 2005. While these are technically correct in terms of stressing ACTs, but there is still a reliance on clinical or symptomatic diagnosis. While parasitological diagnosis is addressed in the current workplan, it also needs to be disseminated in easy to read guidelines and training materials.

Much has changed in the five years since the last malaria treatment policy and guidelines were adopted including the pressing need to use rapid diagnostic tests in primary health care facilities, the huge multiplication of brands of ACTs on the market, the impending large scale roll out of home management of malaria through community volunteers and patent medicine vendors, and related to the latter, the award of a pilot Affordable Medicines Facility (malaria) grant.

2008-nigeria-dhs-malaria-treatment-2.jpgThese changes are built on an unsteady foundation as documented in the 2008 Demographic and Health Survey. Three years after the national treatment policy had been updated, ACTs were very rarely reported in malaria treatment, as seen in the chart.

An ACT Watch survey in December 2008 of 468 medicine outlets (public and private) found that only 16.7% had the national firstline ACT – artemether-lumefantrin.  In all cases, the most common antimalarials in stock were non-artemisinin drugs.

Increased malaria funding for Nigeria from the Global Fund, DfID, USAID and the World Bank Booster Program should make ACTs and RDTs more readily available if supply and distribution systems are strengthened. This will only be effective if health professionals understand the national malaria treatment policy and the case management implications of proper parasitological diagnosis. We hope that the Malaria Society’s upcoming seminar can contribute toward this goal.

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