First use of intravenous Artesunate in Liberia and effect on patient mortality relative to Quinine

Objectives:  Intravenous (IV) Artesunate has become first line treatment for complicated malaria, reducing mortality by up to 35% relative to IV Quinine. The World Health Organization (WHO) changed its guidelines favoring IV Artesunate back in 2010, but at the beginning of 2012, IV Artesunate was still not used in Liberia. 

In April 2012, the Clinton Foundation worked with the Liberian Ministry of Health to bring IV Artesunate into Liberia’s two busiest pediatric centers, Redemption and James Davies Junior (JDJ). The Foundation reached out to the International Rescue Committee, which had supported care at the hospitals since 2010, to pilot IV Artesunate use.

We report on outcomes of a new IV Artesunate standard for complicated malaria at JDJ four months after introduction.  We look at adherence to policy and effect on mortality rate.

Methods:  We determine the mortality rate of children 1-16 years old admitted to JDJ, July-October 2012, with the diagnosis of malaria with a documented positive rapid diagnostic test (RDT) or malaria smear.  We compare this rate with the same period one year earlier.  We note the proportion of deceased patients who were administered IV Artesunate versus other anti-malarials.

Results:  There were 67 deaths out of 707 patients admitted to JDJ for malaria July-October 2011, to give a malaria mortality rate of 0.095.  There were 48 deaths out of 811 patients admitted to JDJ with malaria July-October 2012 to give a malaria mortality rate of 0.059—a reduction of 37.5% (p=0.009). July-October 2012, 78% of patients were treated with IV Artesunate and 22% with intramuscular (IM) Artemether. July-October 2011, 0% of patients were treated with IV Artesunate, 92% with IM Artemether and 3% with IV Quinine.

Conclusion:  We decsribe how treatment of a killer disease like malaria can be changed quickly and effectively towards a new standard of care