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Brigg Reilley, MPH, Doctors Without Borders, 333 7th Ave, 2nd Floor, New York, NY 10001, 212-655-3793, brigg.reilley@newyork.msf.org
Purpose: Malaria is the leading cause of death for children under five in Africa, and the number of annual cases is rising. Continued use of ineffective drugs, despite high levels of resistance, is leading to increased treatment failure. Médecins Sans Frontières (MSF) will review why implementation of artemisinin-based combination therapy (ACT) should be accelerated.
Methods: Resistance to choloroquine (CQ) and sulfadoxine-pyrimethamine (SP) was documented in fifteen MSF projects throughout twelve countries in sub-Saharan Africa.
Results: MSF recorded an average of 69.1% resistance to CQ (range: 40-94%) and an average of 30% resistance to SP (range: 10-70%.) Despite the WHO requirement that countries initiate protocol changes when treatment failure reaches 25%, only two countries and two provinces have begun the change to ACT. Artemisinin derivatives clear parasites quickly, have few side effects, and slow malaria transmission. There have been no known cases of resistance to artemisinin despite centuries of use in China. While the cost of artemisinin combination therapy is higher (US$1.50) than monotherapy using CQ or SP (US$0.10), the most common antimalarial protocols, prices for ACT are likely to drop to US$0.50-$0.80 with bulk purchases. Current reluctance to implement ACT by international donors and endemic countries is perpetuating treatment failure and increased rates of mortality and morbidity.
Recommendations: ACT must be implemented quickly to successfully treat malaria in sub-Saharan Africa. Donors must stop funding ineffective drugs and support the implementation of ACT to sustain supply and reduce prices; endemic countries must increase the resources they allocate to fighting malaria; and the WHO must push for the implementation of its own recommendation to switch to ACT.
Learning Objectives: At the conclusion of the session,the participant will be able to
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.