Providing timely access to pre-referral treatment for severe malaria: how ready is the market in sub-Saharan Africa?

20 Mar 2015
Africa Health

Ioana Ursu and Meghan Kumar, on behalf of Medicines for Malaria Venture, discuss recent progress and challenges in the fight against malaria

Major progress has been achieved in reducing the incidence of malaria in sub-Saharan Africa, yet 584 000 deaths each year are attributed to severe malaria, 75% of which are those of children under the age of 5.1 The recommended intravenous (IV) or intramuscular artesunate (IM) treatment2 for severe malaria is often not available at the first point of care for sick patients. In such cases, the World Health Organization (WHO) recommends the use of rectal artesunate (RAS) suppositories administered at community level followed by referral to a higher-level facility, thus ‘buying time’ for caregivers to reach facilities within 6-12 hours’ travel time.3

However, pre-referral treatment for severe malaria is not yet prioritised by most national malaria control programmes (NMCPs) in Africa. In addition, the lack of a pre-qualified (PQ) RAS product has impeded procurement by large donor organisations like the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the United Nations Children’s Fund or President’s Malaria Initiative, which together procure a significant percentage of malaria commodities.

With funding from UNITAID, Medicines for Malaria Venture (MMV) is currently working with two manufacturing companies, Cipla Limited and Strides Arcolab Limited, to prepare dossiers for RAS submission to WHO for pre-qualification before the end of 2015.....

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  1. World Health Organization. World Malaria Report 2014. WHO, 2014; Geneva, Switzerland.
  2. World Health Organization. Management of severe malaria: a practical handbook (3rd edition). WHO, 2012; Geneva, Switzerland.
  3. Gomes, et al. Pre-referral rectal artesunate to prevent death and disability in severe malaria: a placebo-controlled trial. Lancet 2009; 373:557-66.