Scaling-up injectable artesunate to save more lives from severe malaria

Dr Jimmy Opigo Programme Manager for the National Malaria Control Programme, Uganda

In 2011, WHO-recommended injectable artesunate (Inj AS) as first-line treatment for severe malaria, as it saves more lives than quinine.1,2 In anticipation of this policy change and to help improve access, MMV worked with Guilin Pharmaceutical to enable them in 2010 to become the first company to achieve WHO prequalification for their Inj AS product – Artesun®. Since prequalification, 75 million vials have been dispatched, saving an estimated 450,000 to 500,000 additional young lives compared to treatment with quinine. 

MMV also established a consortium with the Clinton Health Access Initiative (CHAI) and the Malaria Consortium (MC) to implement the MMV-led Improving Severe Malaria Outcomes (ISMO) project, aimed at improving the availability of injectable artesunate (Inj AS) in six high-burden African countries. 

Dr Jimmy Opigo provides his perspective on the impact of the ISMO project.

1. What is the burden of malaria in Uganda?

Malaria is the number one health-care challenge in Uganda. We are the third most heavily burdened country in Africa following Nigeria and the Democratic Republic of Congo. In 2015, there were more than 7 million reported and confirmed cases of malaria.3 The real number of cases, however is much higher, since this does not include those that seek treatment from the private sector, which is around half the population.

2. What impact does this burden have on the people and country?

The impact on the people is huge, particularly for children. In regions of very high transmission, children can get malaria up to 12 times a year and each time they are sick for 3 to 4 days, which leads to a significant amount of time missed from school. Malaria in children also affects adult workers who need to stay at home to look after them. That’s not to mention the adults that also fall sick. In the long-term, it can also cause physical and mental disability, which can have a lifelong effect on quality of life and productivity.

3. How was severe malaria managed in Uganda before the start of the ISMO project in 2013?

For a very long time, quinine was the mainstay. Managing the manual infusion process in a high number of patients, with our level of nursing care, was a huge challenge. Additionally, the curative effect was not as dramatic as with Inj AS. We really very urgently needed to transition to something more efficacious, but also operationally more feasible, given our resource constraints.

4. What has changed in Uganda since the end of the ISMO project?

In the public sector, close to 100% of severe malaria patients now receive Inj AS. As a result, there is less mortality, patients recover more quickly and there is better acceptability of the medicine compared to quinine by health workers and patients.

  1. Dondorp AM et al. “Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial.” The Lancet. 376(9753):1647−57 (2010).
  2. Dondorp A et al. “Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial.” The Lancet. 366(9487):717−25 (2005).
  3. World Health Organization. World Malaria Report 2016 (2016).