There’s growing debate about the provision of ACTs, the artemisinin combination therapies, that are so effective in the treatment of Malaria.
Some, most notably The Affordable Medicines Facility-malaria (AMFm), are keen that such treatments become more readily available and accessible to the poor. One would think that such an aim is a good one, a bit of a ‘no-brainer’ but, as I’m learning, things are not always that easy.
There are others raising concerns, such as:
WHO recent guidelines state that malaria treatment has to be based on diagnosis by rapid diagnostic tests (which are both cheap and readily available). This guideline is ignored by AMFm, which will “train” shopkeepers to distribute ACTs to any parent who requests them.
Historical evidence clearly demonstrates that poor people cannot pay for a full course of cheap medicines. Chloroquine was an effective and cheap anti malaria medicine. Despite its low cost, poor people often bought incomplete courses. This was one of the reasons that (the) malaria parasite developed resistance to chloroquine and now the drug is virtually ineffective. AMFm aims to sell ACTs at a similar price to chloroquine but it is unclear what measures will be in place to ensure that ACTs will be protected from a similar fate.
At International Medical Foundation we are also of the view that treatment must be ‘evidence-based’ and we are seeking to find ways to make this work in our community programmes.
We are exploring how we can work with Village Health Teams in the community to achieve some of the successes seen already in Ethiopia and Zambia, as outlined by Dr Mohga Kamal-Yanni of Oxfam in the blog posting linked below:
WHO used to promote a programme of training community health workers on “integrated childhood illness management”. This meant that trained workers could diagnose and treat common childhood illnesses including pneumonia, diarrhoea and malaria.
You can read more of this by clicking on the image below to access Sarah Boseley’s blog at The Guardian.
not a good move, i think microbiological test crucial before using Coartemer. At the moment its nearly all thats left in Uganda. Inappropriate use will make this drug resistant . We saw so much bad prescribing even from doctors that our plan in Lira of getting volunteer health workers (who look after 20-30 households) trained to test and treat is much safer.
Hi Richard,
I couldn’t agree more. We are keen to make sure that the VHTs are trained to get tests done before starting treatment but as you may have heard there are those that are proposing and pushing for start treatment first, then maybe (just maybe) test. We need to do some further study of the home fever management strategy.
You mention the blood slides, what’s your view on the use of the Rapid Tests?
K.
Hi Kevin nice to hear from you.Its hard to convince people over here that malaria is the worst medical problem I came across in Uganda and I didn’t realise till we went to Lira.
Keep up the good work
Kevin I agree there is no point in starting treatment then test afterwards-there will have been interference with the microbes even with resistance.True the manpower to test every sample is lacking-and treatment should not be delayed awaiting tests.For evidence based medicine best to take the sample first -slides can be examined later. I do not think the rapid tests are reliable enough to be used by people other than doctors to decide initiation of treatment-there will be false positives and false negatives.