Zambia trial cuts severe malaria deaths by 96 per cent

A woman sits with her child as a health worker takes a finger prick blood sample
A woman sits with her child as a health worker takes a finger prick blood sample Copyright: Panos

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  • Pilot trial shows suppository form of artesunate can slash severe malaria deaths
  • Success down to drug formulation, better knowledge of disease also reported
  • Large-scale rollout in well-functioning health systems could be ‘ground-breaking’

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[KISUMU, KENYAI] A suppository form of the common antimalarial artesunate has dramatically cut child deaths from severe malaria in a trial in rural Zambia, one of the organisations behind the programme has said.

According to the WHO’s world malaria report published in 2017, three million of Zambia's entire population of nearly 17 million people were diagnosed with malaria in 2016, with about seven per cent of the cases progressing to severe malaria during which patients may become unconscious.

Children under five years old are the age group most susceptible to the severe form of the disease due to a lack of immunity. If left untreated, severe malaria can quickly become fatal.

During a 12-month trial, the suppository formulation of the common antimalarial artesunate slashed deaths from severe malaria from eight per cent to 0.25 per cent.

“By improving access to key severe malaria medicines and improving case management, the project was able to reduce mortality from untreated severe malaria”

Pierre Hugo, MMV

According to the researchers, who announced the findings this week, the trial was successful because the suppository formulation means the drug could be given even when the child was unconscious or vomiting, which is not the case for oral medicines.

The suppository formulation was given to children who were assessed before referral to a health facility.
Knowledge of severe malaria danger signs at a community level improved significantly, with more than 85 per cent of community health volunteers knowing three or more danger signs at endline compared to less than 50 per cent at baseline,” explained Pierre Hugo, a director at the Swiss-based not-for-profit Medicines for Malaria Venture (MMV), in an interview with SciDev.Net.

Although WHO guidelines for the treatment of malaria have included recommendations for the use of the suppository form of the drug, known as rectal artesunate suppository (RAS), for over ten years, until recently there was no quality-assured RAS product on the market.
In the past this has forced malaria-endemic countries to choose from drug supplies that did not meet international standards.
To address this, the MMV is collaborating with two Indian pharmaceutical companies, Strides and Cipla, to secure WHO prequalification of RAS as part of a project funded by the international malaria initiative UNITAID.
Hugo explained that the trial aimed to increase access to quality-assured artesunate at the community level and to reduce deaths from severe malaria in children under six by improving case management of severe malaria in children.
As part of the trial, trained community health volunteers administered the drug to all children from six months to six years old with severe malaria cases and referred them to health facilities. An emergency transport system set up as part of the trial was used by 70 per cent of the patients, the researchers added.
The trial, which began in July last year, was conducted at Zambia’s Serenje district in partnership with Zambia’s National Malaria Elimination Centre.

“By improving access to key severe malaria medicines and improving case management, the project was able to reduce mortality from untreated severe malaria and save the lives of many children,” Hugo said, adding that the project built the capacity of intervention communities and health facilities to control severe malaria in children.

These results show that rolling out the suppository formulation on a larger scale could have a significant public health impact, according to Willis Akhwale, founder and executive director of Kenya-based Continental Public Health Consulting and a malaria control specialist.

“A 96 per cent reduction of severe malaria case fatality rate, especially in children less than five years of age through community case management of malaria, will be ground breaking,” Akwhale says.

But he adds that most deaths arising from severe malaria are due to anaemia, which requires blood transfusions and administration of intravenous fluids at health facilities — so the drug needs to be deployed alongside a well-functioning referral system and better equipped primary health care facilities.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.