Averting a malaria disaster in Africa: where does the buck stop?

The serious threat posed by the spread of drug-resistant malaria in Africa has been widely acknowledged. Chloroquine resistance is now almost universal, and resistance to the successor drug, sulfadoxine-pyrimethamine (SP), is growing rapidly. Combination therapy has been suggested as being an availa...

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Bibliographic Details
Published in:Bulletin of the World Health Organization 2004-05, Vol.82 (5), p.381-384
Main Authors: WHITTY, Christopher J. M, ALLAN, Richard, BURGESS, Craig, MUTABINGWA, Theonest K, WISEMAN, Virginia, OCHOLA, Sam, NAKYANZI-MUGISHA, Maria Veronicah, VONHM, Benjamin, MWITA, Mahemba, MIAKA, Constantin, OLOO, Aggrey, PREMJI, Zul
Format: Article
Language:English
Subjects:
Africa
Africa - epidemiology
Animals
Antimalarials - economics
Antimalarials - pharmacology
Antimalarials - therapeutic use
Artemisinins - economics
Artemisinins - pharmacology
Artemisinins - therapeutic use
Biological and medical sciences
Combination therapy
Disease Outbreaks - prevention & control
Drug Costs
Drug resistance
Drug Resistance, Multiple
Drug therapy
Drug therapy, Combination
Epidemiology
Financing
Financing, Organized
Health policy
Health Policy & Services
Human protozoal diseases
Humans
Infectious diseases
Malaria
Malaria, Falciparum - drug therapy
Malaria, Falciparum - economics
Malaria, Falciparum - epidemiology
Medical research
Medical sciences
Parasitic diseases
Patient acceptance of health care
Plasmodium falciparum - drug effects
Prevention
Protozoal diseases
Public health
Vector-borne diseases
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Summary:The serious threat posed by the spread of drug-resistant malaria in Africa has been widely acknowledged. Chloroquine resistance is now almost universal, and resistance to the successor drug, sulfadoxine-pyrimethamine (SP), is growing rapidly. Combination therapy has been suggested as being an available and potentially lasting solution to this impending crisis. However, the current cost of combination therapy, and especially that of artemisinin combination therapy (ACT), is potentially a serious drawback, even if a significant part of its cost is passed on to the end-user. If the question of cost is not successfully addressed this could lead to adverse results from the deployment of combination therapy as first-line treatment. These adverse effects range from an increase in potentially fatal delays in infected individuals presenting to medical services, to exclusion of the poorest malaria sufferers from receiving treatment altogether. Urgent steps are needed to reduce the cost of combination therapy to the end-user in a sustainable way if it is to be usable, and some possible approaches are discussed.
ISSN:0042-9686
1564-0604
DOI:10.1590/S0042-96862004000500012