The Use Of Rectal Artesunate As A Pre Referral Treatment For Severe P Falciparum Malaria

The WHO Malaria Policy Advisory Group (MPAG) recently reviewed the evidence from a large-scale study in 3 African countries deploying rectal artesunate under real-life conditions. This information note shares the findings of the study and possible implications for the use of RAS as pre-referral treatment for severe malaria, and makes concrete recommendations for countries to consider. The WHO Global Malaria Programme, in consultation with other relevant departments, will conduct a formal evidence review and develop detailed guidance on the conditions under which the use of this tool can be implemented safely and effectively. Such guidance will be shared with countries as soon as it becomes available.

This document is the report of a WHO technical consultation of independent experts convened in October 2022. The aim of the consultation was to conduct a formal evidence review of several studies evaluating the effectiveness of rectal artesunate (RAS) as a pre-referral treatment for severe malaria. In addition to the study published under the Community Access to Rectal Artesunate for Malaria Project, the review included other studies from early-use countries deploying RAS at the programmatic level. The main objective of the technical consultation was to support the development of guidance for the safe and effective implementation of this intervention based on the evidence from areas where RAS has already been implemented.

For more than 50 years, low-cost antimalarial drugs silently saved millions of lives and cured billions of debilitating infections. Today, however, these drugs no longer work against the deadliest form of malaria that exists throughout the world. Malaria deaths in sub-Saharan Africaâ€"currently just over one million per yearâ€"are rising because of increased resistance to the old, inexpensive drugs. Although effective new drugs called "artemisinins" are available, they are unaffordable for the majority of the affected population, even at a cost of one dollar per course. Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance examines the history of malaria treatments, provides an overview of the current drug crisis, and offers recommendations on maximizing access to and effectiveness of antimalarial drugs. The book finds that most people in endemic countries will not have access to currently effective combination treatments, which should include an artemisinin, without financing from the global community. Without funding for effective treatment, malaria mortality could double over the next 10 to 20 years and transmission will intensify.

"The purpose of this document is to provide comprehensible, global, evidence-based guidelines to help formulate policies and protocols for the treatment of malaria. Information is presented on the treatment of uncomplicated malaria, including disease in special groups (young children, pregnant women, people who are HIV positive, travellers from non-malaria endemic regions) and in complex emergency situations and severe malaria."--Publisher's description.

This book details antimalarial suppositories proposed for emergency life-saving treatment of children and adults suffering from severe and cerebral malaria. It stresses the importance of emergency antimalarial therapy to save the lives of patients who cannot take oral antimalarial treatment in rural areas where modern, life-saving therapy is not available. It considers the use of suppositories and oral treatment for MDR malarias, the control of MDR malaria infections, drug discovery, safe delivery, and drug resistant malaria.

Malaria remains an important cause of illness and death in children and adults in countries in which it is endemic. Malaria control requires an integrated approach including prevention (primarily vector control) and prompt treatment with effective antimalarial agents. Malaria case management consisting of prompt diagnosis and effective treatment remains a vital component of malaria control and elimination strategies. Since the publication of the first edition of the Guidelines for the treatment of malaria in 2006 and the second edition in 2010 all countries in which P. falciparum malaria is endemic have progressively updated their treatment policy from use of ineffective monotherapy to the currently recommended artemisinin-based combination therapies (ACT). This has contributed substantially to current reductions in global morbidity and mortality from malaria. Unfortunately resistance to artemisinins has arisen recently in P. falciparum in South-East Asia which threatens these gains. This third edition of the WHO Guidelines for the treatment of malaria contains updated recommendations based on a firmer evidence base for most antimalarial drugs and in addition include recommendation on the use of drugs to prevent malaria in groups at high risk. The Guidelines provide a framework for designing specific detailed national treatment protocols taking into account local patterns of resistance to antimalarial drugs and health service capacity. It provides recommendations on treatment of uncomplicated and severe malaria in all age groups all endemic areas in special populations and several complex situations. In addition on the use of antimalarial drugs as preventive therapy in healthy people living in malaria-endemic areas who are high risk in order to reduce morbidity and mortality from malaria. The Guidelines are designed primarily for policy-makers in ministries of health who formulate country-specific treatment guidelines. Other groups that may find them useful include health professionals and public health and policy specialists that are partners in health or malaria control and the pharmaceutical industry. The treatment recommendations in the main document are brief; for those who wish to study the evidence base in more detail a series of annexes is provided with references to the appropriate sections of the main document.

The essential text for all healthcare professionals wanting a complete, up-to-date practical reference book on medicine in Africa.