Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Artesunate suppositories are cost-effective intervention for severe childhood malaria

30.11.2010
Giving emergency artesunate suppositories to children with suspected severe malaria before referring them for treatment is a cost-effective intervention that can substantially improve the management of childhood malaria in remote African settings, according to a new study led by Boston University School of Public Health [BUSPH] researcher Yesim Tozan, PhD, (link to profile: http://sph.bu.edu/tozan)

The study, which appears online Nov. 29 in The Lancet , builds on previous research that found that the administration of one dose of rectal artesunate by a community health worker to a child with suspected severe malaria significantly reduced the risk of death and permanent disability. In addition to endangering the lives of young children, severe malaria has been associated with a range of developmental deficits.

Rectal artesunate interrupts disease progression by rapidly reducing parasite density, but should be followed by further anti-malarial treatment. Because of this, the team led by Tozan, assistant professor of international health at BUSPH, said: "The success of interventions in the community ultimately depends on whether formal health systems can provide front-line health workers with drugs and other necessary health commodities, regular monitoring and supervision, and linkages to referral systems" for follow-up treatment.

The research team studied a hypothetical cohort of 1,000 newborn babies through five years of age in high malaria transmission settings. The team assessed the costs and cost-effectiveness of artesunate treatment, followed by referral to a health facility, under a variety of intervention uptake and referral compliance scenarios.

The researchers estimated that the full uptake of artesunate treatment and full compliance with referral advice would avert 37 child deaths and 967 disability-adjusted life-years [DALYs] -- a measure which combines years of life lost because of premature death, with years of life lived with disability -- over five years . Across all intervention uptake and referral compliance scenarios, the study reported that the intervention could avert each DALY at a cost of $77 to $1,173.

"Compared with the interventions that target key childhood illnesses in sub-Saharan Africa, pre-referral artesunate treatment is among the most cost-effective, especially if the intervention uptake is moderate or higher," the researchers concluded.

In remote settings in which the start of anti-malarial treatment with injectible drugs is substantially delayed, the 2010 World Health Organization guidelines for treating malaria recommend the use of artesunate or artemisinin suppositories for emergency treatment of patients suspected to have severe malaria, before transfer to a health facility. The use of this intervention remains low, however, in part because of questions about costs and cost-effectiveness.

"This study shows that rectal artesunate is highly cost-effective for saving lives of severely ill patients with malaria living not only at the end of the road, but where there is no road," said Joel G. Breman, MD, senior scientific advisor at the Fogarty International Center of the National Institutes of Health and a co-author on the study.

"There is now full justification to provide community health workers with life-saving rectal artesunate suppositories, training, and instructions for their use and referral follow-up, as part of the essential drug package," he said.

Tozan, who has done extensive research on the social and economic aspects of malaria, said artesunate suppositories are a needed addition to community health workers' arsenals in areas where malaria is a frequent childhood disease.

"Pre-referral artesunate suppositories, if deployed appropriately in communities, address an important treatment gap, due to the weak state of the health-care systems in many malaria-endemic countries," she said.

She said the study's findings "provide strong economic evidence to policy makers who decide which interventions to adopt in resource-constrained areas. Pre-referral artesunate treatment has the potential to get us closer to child-survival targets set by the United Nations and other international agencies."

A 2010 report on the United Nations' Millennium Development Goals notes that "prompt and effective treatment" is critical for preventing life-threatening complications from malaria, particularly in children. The Millennium Development Goals set a target of halting and beginning to reverse the high incidence of malaria by 2015.

The report notes that in the last seven years, many countries have shifted their national drug policies to promote artemisinin-based combination therapies -- a more effective, but also more expensive, treatment course for malaria. Global procurement of these medicines has risen sharply since 2005.

But antimalarial treatment coverage varies widely across African countries, ranging from 67 percent in some areas, to just 1 percent of children under five with fevers receiving any type of antimalarial drug in other regions, the report says. In fact, the proportion of febrile children under five receiving any antimalarial medication exceeded 50 percent in just eight of 37 African countries that provided data from 2005 to 2009.

Half of the world's population is at risk of malaria, with an estimated 243 million cases leading to nearly 863,000 deaths in 2008. Of those, 767,000, or 89 percent, occurred in Africa.

Funding for the new study came from The Disease Control Priorities Project, Fogarty International Center, the US National Institutes of Health; and the Peter Paul Career Development Professorship at Boston University, awarded to Tozan in 2008 to pursue her research into the consequences and treatment of childhood malaria.

Besides Tozan and Breman, other authors of the study include: Eili Y. Klein, Sarah Darley, Rajashree Panicker and Ramanan Laxminarayan of the Center for Disease Dynamics, Economics and Policy.

More information on the study is available by contacting Tozan at tozan@bu.edu, or (617) 414-1209.

A link to the study is available here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61460-2/abstract

Lisa Chedekel | EurekAlert!
Further information:
http://www.bu.edu

More articles from Studies and Analyses:

nachricht Rutgers-led innovation could spur faster, cheaper, nano-based manufacturing
14.02.2018 | Rutgers University

nachricht New study from the University of Halle: How climate change alters plant growth
12.01.2018 | Martin-Luther-Universität Halle-Wittenberg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Demonstration of a single molecule piezoelectric effect

Breakthrough provides a new concept of the design of molecular motors, sensors and electricity generators at nanoscale

Researchers from the Institute of Organic Chemistry and Biochemistry of the CAS (IOCB Prague), Institute of Physics of the CAS (IP CAS) and Palacký University...

Im Focus: Hybrid optics bring color imaging using ultrathin metalenses into focus

For photographers and scientists, lenses are lifesavers. They reflect and refract light, making possible the imaging systems that drive discovery through the microscope and preserve history through cameras.

But today's glass-based lenses are bulky and resist miniaturization. Next-generation technologies, such as ultrathin cameras or tiny microscopes, require...

Im Focus: Stem cell divisions in the adult brain seen for the first time

Scientists from the University of Zurich have succeeded for the first time in tracking individual stem cells and their neuronal progeny over months within the intact adult brain. This study sheds light on how new neurons are produced throughout life.

The generation of new nerve cells was once thought to taper off at the end of embryonic development. However, recent research has shown that the adult brain...

Im Focus: Interference as a new method for cooling quantum devices

Theoretical physicists propose to use negative interference to control heat flow in quantum devices. Study published in Physical Review Letters

Quantum computer parts are sensitive and need to be cooled to very low temperatures. Their tiny size makes them particularly susceptible to a temperature...

Im Focus: Autonomous 3D scanner supports individual manufacturing processes

Let’s say the armrest is broken in your vintage car. As things stand, you would need a lot of luck and persistence to find the right spare part. But in the world of Industrie 4.0 and production with batch sizes of one, you can simply scan the armrest and print it out. This is made possible by the first ever 3D scanner capable of working autonomously and in real time. The autonomous scanning system will be on display at the Hannover Messe Preview on February 6 and at the Hannover Messe proper from April 23 to 27, 2018 (Hall 6, Booth A30).

Part of the charm of vintage cars is that they stopped making them long ago, so it is special when you do see one out on the roads. If something breaks or...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

2nd International Conference on High Temperature Shape Memory Alloys (HTSMAs)

15.02.2018 | Event News

Aachen DC Grid Summit 2018

13.02.2018 | Event News

How Global Climate Policy Can Learn from the Energy Transition

12.02.2018 | Event News

 
Latest News

Fingerprints of quantum entanglement

16.02.2018 | Information Technology

'Living bandages': NUST MISIS scientists develop biocompatible anti-burn nanofibers

16.02.2018 | Health and Medicine

Hubble sees Neptune's mysterious shrinking storm

16.02.2018 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>