November 30, 2010
Providing rectal artesunate in community settings can be a highly cost effective malaria treatment for children who do not have access to formal health facilities, according to a new study in the Lancet. The research team was led by Yesim Tozan at the Boston University School of Public Health, and co-authored by four researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP).
Malaria caused an estimated 243 million clinical episodes in 2008, resulting in 863,000 deaths, most of which occurred in children in Africa. Even when children survive the illness, severe childhood malaria can result in a range of persistent developmental and learning disabilities. Children in rural areas are particularly at risk, since they can quickly become desperately ill, unable to take medication by mouth and far from a place where they can be treated with a potentially life-saving injection. In these cases, one option that has been proven to save lives is giving an effective malaria drug artesunate in a rectal suppository.
The Lancet analysis built on existing research to determine how the availability and use of rectal artesunate would affect a hypothetical group of 1,000 newborn babies through five years of age, living where malaria is common. The team assessed the costs and cost-effectiveness of the treatment, followed by referral to a health facility.
The researchers found that treatment with rectal artesunate could save as many as 37 children from dying and save 967 disability-adjusted life-years [DALYs] — a measure that combines the effects of death and disability — over five years.
The study capitalized on the fact that rectal artesunate can be administered by health workers in rural communities. With minimal training, these known community members can be available quickly, can effectively deliver the intervention, and can then refer the child to the nearest facility for follow-up and treatment with diagnosis and appropriate treatment. Pre-referral artesunate suppositories, if deployed appropriately in communities, address an important treatment gap, due to the weak state of the healthcare systems in many malaria-endemic countries, said lead author Tozan.
With, at best, slow development of health infrastructure, interventions in the community setting could be vital in reducing the impact of childhood malaria. The grand challenge in malaria is to save children who would otherwise die of severe malaria because they can t get to a treatment facility in time, said Ramanan Laxminarayan, Director of CDDEP and a co-author of the paper. This study shows that investing in rectal artesunate available close to the home can be an effective strategy to save lives unnecessarily lost to malaria.
A link to the full study is available here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961460-2/abstract
Photo credit: flickr: jairo [gyro]
