Gilbert Kokwaro

“ The provision of an appropriate formulation of ACT for infants and young children, who bear the greatest burden of malaria, presents a particular challenge. Administering anti-malarials to infants and small children can be difficult, stressful, and time consuming. Many malaria tablets need to be crushed and mixed with food or water to ease administration to young children, and the bitter taste can cause children to spit out the crushed tablets and, therefore, possibly not receive an optimal dose that will cure the malaria infection. ”

“ Malaria causes an average loss of 1.3% of economic growth per year in Africa [ [3] .
The growing prominence of vector control
The success of malaria control measures in some highly-endemic countries, such as Rwanda, Zambia, Zanzibar, Sao Tome & Principe, The Gambia and Kenya has led to reductions in deaths from malaria of 50% or more [1] . In these countries, the widespread use of LLINs and IRS, together with treatment of uncomplicated Plasmodium falciparum malaria with artemisinin-based combination therapy (ACT) , have all contributed to the reported reductions in malaria. ”

“ Addressing the continuing challenges presented by malaria in the years ahead will require responsive strategies such as innovative vector control methods, widespread implementation of biological diagnosis prior to treatment with effective anti-malarials, and close monitoring of local malaria epidemiology to identify areas of resurgence. ”

“ Asymptomatic carriers of P. falciparum are likely to be essential for maintaining the cycle of infection in areas of high malaria transmission. Treatment of asymptomatic carriers could help reduce disease transmission by depleting the reservoir of parasites available for infection of mosquitoes. In comparison with non-artemisinin regimens, treatment with artemisinin derivatives has been shown to result in lower gametocyte carriage rates [22] , [23] , and reduced infectivity of treated individuals [ [24] . ”

“ Educating healthcare workers and patients about the prevention and treatment of malaria is another challenge in the management of the disease. Novartis has an ongoing commitment to developing initiatives, such as educational materials and training courses for healthcare workers, and the communities they serve; examples include a malaria case management programme for nurses in Zambia, and the development of educational materials for healthcare workers and mothers/caregivers, which have been translated into several African languages and are distributed free of charge to countries on request. ”

“ Rapid treatment of malaria cases with a treatment that quickly reduces the parasite load and is also strongly gametocidal can help reduce the rate of malaria transmission.
Artemisinin derivatives are extremely potent anti-malarials with a rapid onset of action, and when administered in combination with anti-malarial drugs with slower elimination rates (e.g. lumefantrine) , short courses of treatment (three days) have proved to be highly effective [9] . The less effective single-drug treatments increase the chance of parasites evolving and becoming resistant to the treatment ”

“ This revised approach to malaria diagnosis may also have an impact on patients' perceptions of anti-malarial therapies. Patients will have greater confidence in a therapy if it is shown to work quickly and effectively. If an ACT is administered for a non-malarial infection, the patient will not feel satisfied as the drug will not improve their symptoms. The patient may, therefore, be less likely to adhere to an ACT regimen in the future if an actual diagnosis of malaria is made, due to their previously negative experience with that drug. ”

“ Widespread deployment of LLINs has proved a very successful contribution to malaria control strategy. In Rwanda, Ethiopia, and Zanzibar, the mass distribution of insecticide-treated bed nets and nationwide adoption of ACT resulted in substantial declines in malaria-related deaths [25] , [26] . However, the impact of LLINs distribution can be lost if vulnerable populations do not use the nets or re-purpose them. A study in western Kenya found that 30% of bed net recipients did not adhere to net use [ [27] , [28] . ”

“ Malaria continues to be a significant public health issue and a major hindrance to economic growth. Sustained control and management of malaria presents significant challenges. Effective interventions are available; these include widespread implementation of effective vector control measures such as LLINs and IRS, and prompt and effective treatment with ACT following accurate diagnosis. ”

“ There are currently no international guidelines or treatment algorithms for the management of negative tests results. Adequate training, supervision and follow-up are essential to achieving a change in perceptions and practice. ”