Trial: Malaria Chemoprevention Protects Children

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The non-governmental organization Doctors Without Borders, or Medecins Sans Frontieres, has launched a new, malaria prevention campaign in several countries in sub-Saharan Africa aimed at protecting the illnesses’ most vulnerable population – children under the age of five. During the campaigns at the height of malaria season – from July to October – young children will be offered so-called chemoprevention drugs.

Small children are at highest risk of dying from malaria, a mosquito-borne parasitic illness that claimed the lives of some three-quarters of a million people in 2012, most of them children and babies in sub-Saharan Africa.

Doctors Without Borders, or MSF, is planning to roll out mass seasonal malaria chemoprevention campaigns, known as SMCs, in the Sahel sub-region to prevent new cases of the disease in countries where malaria is widespread. These nations include Senegal, Gambia, Niger, Burkino Faso and Mali.

In a 2013 SMC trial in Niger, the organization treated more than 200,000 children between the ages of three and 59 months with chemoprevention drugs.

Trials of the chemoprevention strategy in the last two years have shown a reduction of up to 83 percent in simple malaria cases; there’s a similar percentage reduction in the number of cases of severe malaria.

Estrella Lasry, tropical medicine adviser for the group, says the campaign was launched at the urging of the World Health Organization.

“And what we do is we give drugs once a month that protect and they protect the children for about a month during those four months of high transmission,” said Lasry.

In Niger, during a trial in 2013, the anti-malaria compounds were made available in remote locations at health facilities, in the homes of village chiefs and in areas where public health workers go door-to-door.

The organization deployed some 2,000 community health care workers to educate families about the benefits of chemoprevention and to encourage them to take their children to a distribution site.

Lasry says MSF chemoprevention campaigns do not use artemisinin-based drugs that are currently the “gold standard” to treat malaria infection.

“We try to use different drugs so that even if we can potentially cause resistance, we are not causing resistance to the most effective drugs we have for treatment,” she said.

If they find malaria in any of the children, Lasry says they treat it. But she says there’s a shortage of rapid diagnostic tests in Niger, for example, hampering efforts to treat malaria in endemic regions.

While not a “miracle cure,” officials say prevention drugs complement other malaria control strategies, including insecticide-treated bed nets.

Source: VOA News

Médecins Sans Frontières Calls for Switch from Quinine to Artesunate

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After the revision of World Health Organization (WHO) guidelines yesterday,  international medical humanitarian organization Médecins Sans Frontières (Doctors Without Borders) calls for a drug proven to reduce deaths in children suffering from severe malaria to be immediately rolled out in African countries.

In its new report, entitled “Making the Switch,” Médecins Sans Frontières (MSF) calls on African governments to follow new World Health Organization (WHO) guidelines, and switch from the far less effective quinine to artesunate, which could avert nearly 200,000 deaths each year. MSF also calls on WHO and donors to support governments so this urgent treatment change can happen quickly.

“When children arrive at the clinic with severe malaria, they often are having convulsions, vomiting or at risk of going into shock, and you just want to be able to give them effective treatment quickly,” said Veronique De Clerck, Medical Coordinator for MSF in Uganda. “For decades, quinine has been used in severe malaria, but it can be both difficult to use and dangerous, so it’s time to bid it farewell.  With artesunate, we now have a drug that saves more lives from severe malaria, and is safer, easier and more effective than quinine.”

Quinine has to be given three times a day in a slow intravenous drip that takes four hours, a treatment that is burdensome for both patients and health staff. Artesunate, in contrast, can be given in just four minutes, by giving a patient an intravenous or intramuscular injection.

A landmark clinical trial in late 2010 concluded that the use of artesunate to treat children with severe malaria reduces the risk of death by nearly a quarter.  The study, carried out in nine African countries, found that for every 41 children given artesunate over quinine, one extra life was saved.  Because of the complexities of administering quinine, children in the trial who were assigned to receive quinine were almost four times more likely to die before even receiving treatment.

MSF participated in the trial through its research affiliate Epicentre, with a research site in Uganda. MSF has since changed its own treatment protocols and now plans to work with national health authorities to roll out artesunate in its projects over the coming months.

The evidence is overwhelming, but MSF’s report stresses that change will not happen on its own. While WHO has now issued new guidelines recommending artesunate for treating severe malaria in children in Africa, it needs to also develop a plan to help countries make this switch.  African governments must urgently change their treatment protocols and donors must send a clear signal to countries that they will support the additional cost where needed.  Artesunate is three times more expensive, but the difference in cost of US$31 million each year for a global switch is very little for the nearly 200,000 lives that researchers say could be saved.

“We’ve been here before—when WHO changed its treatment recommendations for simple malaria in 2001 it took years for countries to actually make the switch, and shockingly, in some countries the far inferior drugs are still being used ten years on,” said Dr. Martin De Smet, who coordinates MSF’s malaria work.  “With severe malaria, WHO needs to make sure that the change is much less sluggish, so lives can be saved immediately.  There’s simply no excuse not to make the switch now.”

MSF provided malaria treatment to around one million people in 2010.  Severe malaria kills over 600,000 African children under the age of five annually.  Each year, around eight million simple malaria cases progress to severe malaria, where patients show clinical signs of organ damage, which may involve the brain, lungs, kidneys or blood vessels.

More information: Full MSF Report (PDF)

Source: MSF