Médecins Sans Frontières (MSF) has urged donors to help Sierra Leone introduce a new cocktail of drugs incorporating the agent artemisinin to overcome local resistance to traditional malaria treatments.
The French-based medical relief agency said malaria was getting worse in the poor West African country because of its continuing dependence on cheap anti-malarial drugs such as chloroquine and fansidar that were no longer effective.
It appealed to donors to help the government introduce new Artimisinin Combination Therapy (ACT) drugs, because although they were more expensive, they were much more effective.
Francesco Checchi, an epidemiologist at Epicentre, MSF’s epidemiological unit in France, said the prevalence of malaria in Sierra Leone had reached a critical stage.
“Proportionally to the number of inhabitants, Sierra Leone is one of the countries with the highest prevalence rates in the world”, he told IRIN by telephone from Paris.
The development of a strong resistance to the traditional first line treatments chloroquine and fansidar has rendered these treatments almost ineffective.
“A study carried out throughout Sierra Leone in 2002 and 2003 found out that resistance to treatment reached, in some instances, up to 79 percent of the cases treated”, Checchi said.
The study found that resistance to chloroquine was highest in the capital Freetown, where it reached 60 percent, and in the rural east of the country where it reached 79 percent.
Resistance to fansidar was lower but still significant, averaging 24 percent in Freetown and 46 percent in the east.
On the basis of these findings, the Sierra Leone government decided in March to change its malaria treatment protocol - which sets out which drugs should be used as a first line treatment for non-accute cases. It introduced a series of ACT drugs that eradicate the symptoms of malaria within three days.
“Changing the malaria treatment protocol is the most immediate answer to malaria-related mortality,” Giuseppe Scollo, MSF’s desk officer in charge of operations in Sierra Leone told IRIN by telephone from Freetown.
ACT treatments combine a series of anti-malarial drugs including artemisinin, a relatively new medicine which is derived from a plant grown in China. Artemisinin can be used by itself to treat malaria, but doctors hope that by using it in combination with other more established drugs it will take the disease longer to develop a resistance to all of them.
The problem is that ACT treatments cost on average ten times more than the traditional chloroquine treatment.
However, as life savers, they are still relatively cheap.
Checchi said the average cost of administering a diagnostic test to establish whether an adult patient had malaria and following this up with ACT treatment was about US$2.0 to $2.50.
For children the cost was considerably lower, he added.
The Sierra Leonean government has asked the Global Fund to fight AIDS, tuberculosis and AIDS to provide the extra money needed to switch to ACT treatments.
MSF urged other donors to back the move too.
“Donors should support the Sierra Leonean government. Treatment should be free or at reduced cost,” Checchi said. "After all, the treatment is not that expensive. In a country such as Sierra Leone, it would not cost more than a few million dollars.”
Sierra Leone’s humid tropical climate makes the country particularly prone to malaria. Furthermore, its healthcare system virtually collapsed during the ten-year civil war that devastated the country between 1991 and 2001.
Various studies have shown the mosquito-transmitted disease to be one of the main health problems in the country and the biggest single cause of death among children under five.
A study by the Ministry of Health last year found that 42 percent of child deaths occurring in hospital were attributed to malaria. The same study showed that 11% of nursing mothers who died in hospital were also killed by the disease.
Scollo noted that: “In 2003, in the MSF Hospital at Kailahun, on the border with Guinea, 65 percent of paediatric admissions and more than half of external consultations were due to malaria.”
The World Health Organisation (WHO) estimates there are at least 300 million acute cases of malaria in the world each year which result in more than a million deaths.
“Around 90% of these deaths occur in Africa, mostly in young children,” the organisation says on its website.
WHO says the disease is the leading cause of mortality in African children under-five. It accounts for 20 percent of all infant deaths on the continent.
Malaria is also the biggest drain on the public health budgets of African government’s. WHO estimates that malaria accounts for 40 percent of all public health expenditure and up to half of all hospital admissions in areas where the disease is particularly rife.
The United Nations has declared 25 April to be Africa Malaria Day.