Editorial: Should artemisinin‐based combination treatment be used in the home‐based management of malaria?

Abstract

Most cases of uncomplicated malaria are managed outside the formal health sector with drugs bought from shops or kiosks. This is especially true in poor low-literacy populations with inadequate access to health services. The practice of self-medication can be an advantage as a shorter delay between onset of disease and effective treatment has been linked to a lower risk of death (D’Alessandro et al. 1997). A study in Ethiopia reported a 40% reduction in under-5 mortality when providing to mothers simple training and antimalarial drugs for the treatment at home of their children. But the intervention was implemented in an area where a community-based primary health care programme had been operating the health system for over 20 years and the community health workers distributing the drugs had been frequently supervised. Therefore these results should be interpreted with caution when considering elsewhere the implementation of a similar strategy. The African leaders at the Abuja Summit on Roll Back Malaria (RBM) held in April 2000 endorsed the laudable goal of having by 2005 at least 60% of African malaria patients on prompt access to affordable and appropriate treatment within 24 h of the onset of symptoms. RBM has ever since promoted home-based management of malaria (HBM) as ‘a simple and effective intervention that puts malaria drugs into the hands of mothers and community based caregivers’. (excerpt)