Malaria Treatment Policy Change and Implementation: The Case of Uganda

Miriam Nanyunja,Mugagga Kaggwa,Charles Katureebe,Frederick Kato,Joaquim Saweka,Juliet Nabyonga Orem

doi:10.4061/2011/683167

Miriam Nanyunja, Mugagga Kaggwa + Show 4 more

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https://doi.org/10.4061/2011/683167

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Abstract

Malaria due to P. falciparum is the number one cause of morbidity and mortality in Uganda where it is highly endemic in 95% of the country. The use of efficacious and effective antimalarial medicines is one of the key strategies for malaria control. Until 2000, Chloroquine (CQ) was the first-line drug for treatment of uncomplicated malaria in Uganda. Due to progressive resistance to CQ and to a combination of CQ with Sulfadoxine-Pyrimethamine, Uganda in 2004 adopted the use of ACTs as first-line drug for treating uncomplicated malaria. A review of the drug policy change process and postimplementation reports highlight the importance of managing the policy change process, generating evidence for policy decisions and availability of adequate and predictable funding for effective policy roll-out. These and other lessons learnt can be used to guide countries that are considering anti-malarial drug change in future.

Highlights

Malaria is the number one cause of morbidity and mortality in Uganda
Artemether-Lumefantrine (AL) was adopted as the first-line treatment for uncomplicated malaria, with Artesunate-Amodiaquine (AS/AQ) as an alternative first-line [10]. This paper describes this last policy change process, factors put into consideration prior to adoption of this policy, the roll-out of the policy, 5-year experience of implementation of the new policy, and the lessons learnt, to guide other countries that consider malaria treatment policy change
We reviewed unpublished reports and minutes of several meetings that were held to gain consensus on the medicine to adopt as first-line for treatment of uncomplicated malaria, the reports of the task force that was constituted to guide the implementation of the new policy and its subcommittees, the minutes of the different meetings held by the subcommittees and the task force, as well as the documentation of the malaria treatment policy change process that summarized the whole process step by step and included some of the key reports as attachments

Summary

Introduction

Malaria is the number one cause of morbidity and mortality in Uganda. It is highly endemic in 95% of the country, and the remaining 5% of the country is prone to malaria epidemics [1]. Effective malaria case management, using efficacious and effective antimalarial medicines, is one of the recommended strategies for malaria control [2]. By 2000, the parasitological resistance to CQ had increased significantly, ranging from 50% in different sites, and clinical failure following CQ treatment in Uganda had increased to about 38% [4], exceeding the WHO recommended threshold of clinical failure of 25%, beyond which policy change is recommended in the shortest time possible [5]. After several technical discussions and considerations, the firstline antimalarial medicine for uncomplicated malaria was changed from CQ only, and a new interim policy with a combination of CQ and Sulfadoxine-Pyrimethamine (CQ/SP) as first-line treatment was adopted. Between 2001 and 2004, the efficacy of CQ/SP reduced significantly, with treatment failure ranging

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