When does treatment become control?

The introduction of Artesunate-Amodiaquine in M’lomp village, Senegal has been monitored over time by Sarrassat and colleagues.Their efforts were motivated by experiences in Thailand, South Africa and Zanzibar, where a decrease in malaria morbidity was observed following the introduction of artemisinin-based combination therapy (ACT).

mali-as-aq.JPGDecreased incidence has been postulated as an effect of artemisinin-based medicines’ ability to kill gametocytes and reduce transmission (Drakeley et al.; Nosten et al.; Carrara et al.; Barnes et al.; Battarai et al.).

Sarrassat’s team also observed a decrease in the incidence rate and repetitiveness between 2001 and 2002. They were worried that lower rainfall might also have contributed to the findings, especially since treatment coverage was less than ideal.

Ultimately Sarrassat et al. concluded that, “In sub-Saharan countries, in order to optimize the impact on malaria morbidity, ACT deployment must be supported, on the one hand, by a strengthening of public health system to ensure a high ACT coverage and, on the other hand, by others measures, such vector control measures.”

A home management strategy has been one recommendation to improve the ability of health systems to increase ACT coverage. Generally though timely procurement and supply procedures are required to make ACTs available for the whole population at risk. In order to do this, health systems need strengthing as Sarrassat suggests.

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