New malaria treatment gets under way

Kenya's health ministry is distributing the more effective malaria treatment, artemisinin-based combination therapy (ACT), to public health centres in areas prone to epidemics, a senior official said on Friday. The drug will be used to treat patients free of charge in a bid to tackle resistance of the disease to other formulations, said Willis Akhwale, head of the division of malaria control in the ministry. ACT would now become the first-line treatment for malaria because it was the most cost-effective control method available, he added. The ACT roll-out is being funded with a US $34 million five-year grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Akhwale said. "With this support we are procuring an adult treatment dose for $2.40 and a pediatric dose for $0.90," said Akhwale. About 10.5 million malaria patients will benefit from the new treatment each year. The drug distributed in Kenya is Artemether Lumefantrine, known as Coartem, he added. "The basic objective of a first-line treatment is prompt and effective treatment. We must have an effective treatment, one with high efficacy, one which is able to clear the [malaria] parasite," Akhwale, a malaria expert, told IRIN. Some health professionals have criticised the change-over from sulphur-based drugs to ACT on the grounds of cost, but Akhwale dismissed such criticism as baseless. ACT is said to be 10 to 15 times more expensive than other anti-malarials. "Malaria is a major public health problem among the rural poor. You do not want to go into a rural area and give medicine that is not going to work - with all that poverty, with the difficulty of access to health facilities. It would be quite unethical to do that when you know there is actually a drug that would perform better than the one you are using," he said. "Other than look at cost, I think the more rational thing to look at is the cost-effectiveness of the treatment. If you use a more effective medicine, fewer people are admitted to hospital, therefore you reduce the cost of in-patients, which is a constraint on the health budget. You are also reducing the cost to households because if you use a drug that is not working then it means one has to keep going to seek medical treatment," said Akhwale. Akhwale said stocks of ACT would be available in all public health centres and dispensaries in 16 districts prone to malaria epidemics in the next three months. Training of health workers on effective dispensation preceded distribution of the drugs, he said, adding that emphasis was also being placed on proper diagnosis to avoid wastage. An estimated 20 million of Kenya's 32 million people live in malaria-prone areas. The disease is one of the leading causes of morbidity and mortality, particularly among children younger than five. It contributes 30 percent of outpatient hospital attendance and constitutes 19 percent of all admissions, according to the ministry of health. Malaria claims 34,000 Kenyan children, most of them younger than five, annually. ACT is not recommended for use on babies weighing less than five kilogrammes, but new-born babies in malaria epidemic areas rarely suffer from the disease, primarily because they still carry their mothers' immunity. In the event of malaria infection among children weighing less than 5 kg, oral quinine is the recommended treatment. The use of ACT is also not recommended for women during the first trimester of pregnancy; they should also be treated with quinine. Sulphur-based malaria treatments had, however, not been banned and would continue to be used to prevent and treat malaria among pregnant women, Akhwale said, adding that treatment efforts would be implemented along with malaria-control methods, including distribution of bed nets and indoor residual spraying to kill mosquitoes. Artemisinin was developed from a Chinese herb to counter the malaria parasite's growing resistance to earlier treatments, including chloroquine. Malaria experts have recommended that artemisinin be used in combination with other effective anti-malarials. The result is a treatment that has proven 90 percent effective in tests conducted on nearly every continent. ALSO SEE: Killer Number One: The fight against malaria IRIN In-Depth jn/mw