Presumptive Treatment Of Malaria Research Articles

Issues of measuring and improving the treatment of malaria in sub-Saharan Africa

This paper, using focus group discussions and questionnaires in Enugu State, Southeast Nigeria, examines the implications of consumer malaria perceptions and behaviour for measuring the disease burden and improving its treatment. The results show that, because peoples' understanding of the disease was related to its symptoms, this could lead to overestimation of the economic burden of malaria, based only on surveys without diagnostic confirmation. Survey-based estimations of the burden of malaria should control for the different local terminologies of malaria, and health personnel should be aware of these in order to improve the appropriate use of antimalarial drugs in presumptive treatment of malaria.

Presumptive malaria treatment in immunisation programmes

Courses of malaria treatment given intermittently to asymptomatic individuals known as intermittent presumptive treatment (IPT) is gaining momentum as evidence accumulates that this strategy can reduce malaria infections and anaemia. In infants the withdrawal of malaria prophylaxis has been associated with a rebound increase in clinical malaria so will IPT be safe? The paper by David Schellenberg and colleagues in today’s Lancet provides reassurance that rebound infection is probably not a major problem with IPT in infants. The researchers found that IPT given with routine immunisations to infants at the ages of 2 3 and 9 months conferred a 36% protective effect against clinical malaria compared with placebo in children followed up from the age of 10 months to 2 years. IPT reduces episodes of clinical malaria and severe anaemia during the first year of life12 but a surprising result from this study is that the effect of IPT lasts for at least one further year. This result is well beyond the few days that would be explained by a direct effect of anti-malaria drugs and suggests that IPT influences biological interactions. (excerpt)

Accessibility of Insecticide Treated Bed Nets and Intermittent Presumptive Treatment of Malaria to Mozambicans obtaining Healthcare in Southern Malawi: A Case Study of International Disease Control and Equity in Health

This qualitative study utilizing in-depth interviews was carried out to determine whether the Malawian public health system provides equitable access to malaria prevention and treatment facilities for Mozambican nationals attending health care services in three Malawian border districts of Nwanza, Mulanje and Nsanje. Majority of Malawian health workers reported non-discrimination of Mozambican nationals accessing insecticide-treated bed nets (ITNs) and presumptive intermittent treatment for malaria among pregnant women attending antenatal care. In one district however, nets provided by one non-goverbnmental organization were reported to being provided to Malawians only, thus excluding Mozambicans on instruction from the non-governmental organization (NGO) who had supplied the nets. Both Malawian and Mozambican nationals were required to present the ‘Health passport' in order to access ITNs and presumptive intermittent treatment of malaria from the health facilities. For effective prevention and control of malaria in border of Malawi and Mozambique, there is need for the collaboration between governments, including national malaria control programs, non-governmental organizations and civil society. Key Words: insecticide-treated bed nets; border districts, malaria Mary Slessor Journal of Medicine Vol.4(1) 2004: 76-80

Occupational Plasmodium falciparum malaria following accidental blood exposure: A case, published reports and considerations for post-exposure prophylaxis

A French nurse presented Plasmodium falciparum malaria 10 d after a needlestick while sampling blood in a source patient with malaria. As did the source patient, the nurse recovered fully although diagnosis was delayed and her malaria severe. We proceeded to a thorough description of the transmission profile of P. falciparum following occupational needlestick. A review of the literature found 21 published reports of occupational malaria including our own, documenting 22 P. falciparum infections. One of these was lethal. The mean incubation time to fever onset was documented in 21 reports including our own and is 11.60 +/- 3.38 d (median 12.0, range 4-17 d). The incubation period was compatible to that found in experimental anopheline bites or transfusion malaria. The transmission profile cites a pathogen which may be more easily transmissible by occupational exposure to blood than human immunodeficiency virus (HIV) or hepatitis C virus (HCV). Undiagnosed malaria in non-immune health care workers can be lethal. Presumptive treatment of malaria is widely available and well tolerated. Clinicians should consider P. falciparum malaria when faced with a febrile patient who has or may have been exposed to biological fluids. Further research is needed in the field of P. falciparum prophylaxis following accidental exposure to a malaria patient's blood.

Intermittent Presumptive Treatment for Malaria

Intermittent Presumptive Treatment for Malaria

Oportunidad en el diagnóstico y tratamiento de la malaria en comunidades periurbanas de la Amazonía peruana

Objectives: To assess the Ministry of Health’s (MINSA) capacities to timely diagnoses and treat malaria in the communities from the outskirts of Iquitos city. Materials and methods: Febrile patients suspected to have malaria and evaluated by health care workers were interviewed. Information obtained from interviews was contrasted with patient treatment forms and records of thick smear results from the health centers within jurisdiction. Results: There was an average difference of three days between sampling and obtainment of thick smear result by the health worker. 71 out of 200 febrile interviewees (35%) had a positive thick smear result. Health care workers started presumptive treatment in 28 (39%) of these cases, but it was adequate to the species only in 19 (26%). Likewise, health care workers started presumptive treatment for malaria in 13 (10%) febrile subjects with negative thick smears. Conclusions: Patients with malaria from the outskirts of Iquitos have to wait an average of 3 days to obtain adequate treatment. Patients seek to be treated in a timely manner, but delays are due to the organization of services.

Chloroquine self-treatment and clinical outcome of cerebral malaria in children.

Chloroquine is widely used as self-medication for presumptive treatment of malaria despite the existence of parasite resistance to the drug. Recent studies suggest that tumour necrosis factor-alpha (TNF-alpha) overproduction probably has a causal association with poor outcome in cerebral malaria. In addition, chloroquine has been shown to have inhibitory action on TNF-alpha synthesis. The present study aimed at evaluating chloroquine/TNF-alpha interaction in 90 children hospitalized for severe malaria in a malaria-endemic zone. TNF-alpha and chloroquine varied in the same range on admission, but there was an inverse correlation between the two: the higher the chloroquine level, the lower the TNF-alpha level. Parasite resistance to chloroquine in vitro was high. The clinical course in the patients was uneventful, save for two fatal cases and one survivor with neurological sequela. The above data suggest beneficial effects of chloroquine self-medication with respect to anti-TNF-alpha action. Rational use of this tool should be encouraged.

A strategy for evaluating the mortality impact of child survival programmes in Africa: Combatting Childhood Communicable Diseases Project.

The Mortality and Use of Health Services surveys were designed to measure the mortality impact of the Combatting Childhood Communicable Diseases programmes which are based on childhood vaccinations, prenatal immunization against tetanus, home-based use of oral rehydration therapy, and presumptive treatment of malaria. The survey design includes pretest and post-test surveys in programme and non-programme areas. The questionnaires are designed to collect information on use of health services and on pregnancy histories to provide retrospective reporting of child mortality. When combined with data from surveillance systems (particularly information on cases of measles cases seen at clinics and health centres), these data should provide reasonable estimates of programme impact.

Relative Contribution of Bacteraemia and Malaria to Acute Fever Without Localizing Signs of Infection in Under-five Children

Six-hundred-and-forty-two previously healthy children aged 1 month to 5 years with fever of acute onset, without localizing signs of infection, were prospectively recruited over 1 year. Sixty-three per cent had malaria, 4 per cent bacteraemia, and 7 per cent malaria and bacteraemia. Neither infection was identified in 27 per cent. Malaria was the predominant infection irrespective of season, temperature on presentation, or age (except under 6 months). Although Gram-negative bacteraemia was overall commoner than Gram-positive bacteraemia, Staphylococcus aureus was the commonest single organism (43 per cent) in bacteraemic patients. The prevalence of malaria increased with age while that of bacteraemia decreased with age (P < 0.0005). The prevalence of an identifiable infection increased with the temperature on presentation (P < 0.025). It is concluded that although malaria is the predominant infection in previously healthy under-5 children with acute fever without specific localizing signs of infection, bacteraemia (alone or associated with malaria) occur with an importantly high frequency. It is recommended that while presumptive treatment for malaria is justified in such children, evaluation for bacteraemia should be given consideration.

Community participation in malaria surveillance and treatment. I. The Volunteer Collaborator Network of Guatemala.

The Volunteer Collaborator Networks (VCNs) of Latin America are one of the oldest and most successful examples of community participation in malaria control. They are made up of unpaid community volunteers, known as Volunteer Collaborators, who are selected by their neighbors and are trained and supervised by a member of the National Malaria Service (NMS). When a febrile patient visits the home of a Volunteer Collaborator, the volunteer worker takes a thick blood smear, completes a patient report form, and administers a presumptive treatment for malaria. The blood smear is examined in an NMS laboratory, and if malaria parasites are found, a radical or curative treatment is forwarded to the Volunteer Collaborator so that it can be administered to the patient. There is no charge for either the blood smear or the antimalarial medication. The VCN of Guatemala was established in 1958. Currently, more than 5,000 Volunteer Collaborator posts are operating throughout the malarious areas of the country. The volunteers range in age from 12 to 76 years old and 61% are men. Approximately 15% have no formal education, and only 27% have a sixth grade or higher education. The median length of service is 35 months (range three months to 26 years); 33% have worked for five or more years. Male Volunteer Collaborators had significantly lower turnover rates than females, as did married Volunteer Collaborators when compared with single volunteers. An inverse relationship was noted between the amount of education a Volunteer Collaborator had and his length of service. With modifications tailored to meet the objectives of a malaria control program and the local epidemiologic setting, the VCN can serve as an excellent model for community participation in malaria case detection and treatment in other regions of the world. In particular, in areas where the primary goal of the malaria program is to prevent mortality and morbidity through the provision of readily accessible, appropriate drug therapy, VCNs are an attractive alternative to self-medication and an effective adjunct to treatment of malaria at health posts which are often located at a considerable distance from the patient's village. Experience gained with this system can be valuable in developing approaches to community involvement in other efforts to improve the health of villagers in developing countries.

Amodiaquine fails to cure chloroquine resistant Plasmodium falciparum in the Punjab

We evaluated amodiaquine as a replacement drug for treating falciparum malaria in an area of Pakistani Punjab where chloroquine-resistant Plasmodium falciparum has recently emerged. Amodiaquine appeared to be 4 to 8 times more effective than chloroquine when P. falciparum isolates were tested in vitro. However, the recrudescence rate was greater than 50% after oral treatment with 20 mg/kg amodiaquine given over two successive days. This lack of therapeutic response from amodiaquine may have been due to selection of resistant parasites in the villages where the study was perfoormed through extensive use of chloroquine for presumptive malaria treatment during the preceding 18 months. We conclude that amodiaquine is not a suitable replacement for chloroquine for treating falciparum malaria in our study area despite in vitro sensitivity data suggesting that it would be efficacious. Baseline in vitro sensitivity to mefloquine is also reported.