Saving more lives with injectable artesunate

Dr Philippe Lukanu Ngwala
Dr Philippe Lukanu Ngwala, General Reference Hospital, DRC

(Interview took place in 2013)

There are around 5.6 million cases of severe malaria every year, leading to an estimated 627,000 deaths, mostly of children under 5 years of age.1 Based on research demonstrating the superiority of injectable artesunate for the treatment of severe malaria over quinine, the previous standard of care, WHO updated its standard treatment guidelines in 2011, recommending injectable artesunate as the preferred treatment.

In response, MMV joined forces with relevant partners to increase the uptake and use of injectable artesunate across the malaria-endemic world. The work began with two countries, Nigeria and the DRC, that together represent 30% of the global population at risk.1 In the DRC, currently, 30% of severe malaria cases are treated with injectable artesunate. The goal is to reach 100% coverage by 2016. To gather the evidence to support this switch and better understand the operational challenges, MMV, Swiss TPH and Kinshasa School of Public Health, undertook a study, known as MATIAS (Malaria Treatment with Injectable Artesunate), to compare injectable artesunate treatment with quinine in four districts in the DRC.

Dr Philippe Lukanu Ngwala, one of the principal investigators of the MATIAS study explains the advantages of using artesunate.

1. What were the main clinical differences you observed between the two treatments in the study?

Overall, we observed fewer deaths with artesunate than with quinine (1.7% versus 3.7%). We also observed fewer side effects with artesunate than with quinine. Side effects with quinine included ringing in the ears (tinnitus) and low-blood sugar (hypoglycaemia). These issues can really limit quinine’s usage in primary health care. Some patients even refuse to take it following resolution of acute symptoms. Third, we observed a quicker reduction in symptoms with artesunate compared to quinine.

2. How did the health-care workers’ perceptions of the two treatments differ?

In general, they found artesunate to be easier and quicker to administer than quinine. This means they win time that can be spent providing care for other patients.

3. Based on your experience, what are the challenges to making a nationwide switch from quinine to artesunate?

The biggest challenge is the cost of medicines, particularly in a low resource context. Although the overall cost of the two medicines is similar when you take into consideration all the factors, such as a shorter hospital stay, the face value of artesunate is higher than quinine, which may be a deterrent. I think without a subsidy, it will be difficult to make a complete switch to injectable artesunate