Malaria continues to be the leading cause of death in African children. Of an estimated 781,000 malaria-related deaths reported in 2009, 91% occurred on the African continent, and 85% were among children under the age of five.
WHO ran a landmark medical trial last year and found that the majority of the 225 million cases of malaria reported worldwide in 2009 were uncomplicated (or simple) malaria, and while this represents a significant burden of illness, these cases are, for the most part, non-fatal. However, around eight million simple malaria cases will progress to severe malaria annually. Unfortunately, children are considered the most vulnerable.
Patients who have severe malaria show clinical signs of organ damage, which may involve the brain, lungs, kidneys or blood vessels. It has been described as a life-threatening medical emergency and a neglected disease that poses a significant economic burden on most African countries.
Quinine, the current choice of medication, was first used against malaria in the 17th Century. It is still routinely used to treat severe malaria even though revised guidelines by the Work Health Organisation recommend a more effective and safer drug – artesunate.
The WHO trial showed that the use of artesunate for the treatment of severe malaria in children reduces deaths by nearly a quarter compared to quinine. It is also a lot less painful and complex to deliver than Quinine, taking just a few minutes and giving far fewer side effects.
MSF comment that countries in Southeastern Asia have already switched to artesunate for the treatment of severe malaria – now is the time for African governments to follow the recently revised WHO advice and switch too.
Although it may seem a no-brainer, the problem is money. Artesunate is around 3 times more expensive than quinine on a unit basis, so on the surface it seems to be costing African countries more. Further analysis quickly shows that those costs are quickly recouped by shorter stays in hospital, but as with many things, it can be hard to get some countries to recognise the cost saving further down the line.