Simple treatment could prevent many child malaria deaths

Rectal artemether versus intravenous quinine for the treatment of cerebral malaria in children in Uganda: randomised clinical trial BMJ Vol 330,pp 334-6/Editorial: Rectal artemether and intravenous quinine for treating severe malaria BMJ Vol 330,pp 317-8

A simple drug, given to children with severe malaria before they reach hospital, has the potential to save many lives, say researchers in this week’s BMJ. Every year over a million children die of malaria in Africa. The majority of fatalities occur outside hospital, especially in rural areas. For those who do make it to hospital, half of deaths occur within 24 hours of admission.

Conventional treatment, given by injection, is not possible to administer outside hospital, so buying time by starting treatment which is easy to administer in the community is crucial.

Researchers in Uganda compared the effectiveness and safety of conventional treatment (intravenous quinine) with an alternative treatment (artemether, given as a suppository) in 103 children aged between 6 months and 5 years with severe malaria.

They found the two treatments broadly comparable and suggest that rectal artemether could be used to treat severe malaria where qualified staff and equipment for intravenous therapy is not available.

These are encouraging results, say experts in an accompanying editorial. Although a single trial of this size cannot alone be the basis for policy change, rectal artemisinins might be one safe and effective way to reduce the risk of children dying before reaching hospital.

Providing effective antimalarial treatment close to home to reduce delay has the potential to save many lives, they conclude.