The recommended treatments for malaria in areas with resistance to single drugs are combination treatments, preferably artemisinin combination therapy (ACT) (WHO 2001a, 2001b, 2003a, 2005).
Cures for malaria are largely designed for adults; the pills are often bitter and too big to swallow for children, who account for most of the more than one million people killed each year by the mosquito-borne disease, malaria experts say.
Bill Brieger adds:
Three challenges that are not mentioned in the article include –
- For one, when drugs are made available for free or at reduced cost only for children, there will be leakage into wider use as health workers or medicine shop keepers will provide multiple packets of the child drugs to satisfy their adult clients/customers.
- A second unmentioned challenge is the tendency to overprescribe malaria drugs, especially among adults. The answer to this is case management that includes diagnosis using a laboratory, but more likely rapid diagnostic tests, which can be used at the primary care level.
- Finally there is the issue of compliance. Artemisinin-based combination therapy generally is taken twice a day for three days. If medicine providers do not counsel clients on the need for full compliance children may swallow only a few doses and not only fail to be cured but also contribute to drug resistance.
Malaria case management is a complicated process that begins with the drug manufacturer and ends in the home. All partners along the way must be [vigilant] if children’s lives are to be saved.