Antimalarials

Malaria: Also  a major  cause  of anaemia, low birth weight, premature birth, infant mortality & contributes synergistically with HIV/AIDS to morbidity & mortality

Malaria   remains a major global  problem, exacting an  unacceptable  toll  on the  health and economic welfare of the world’s poorest communities. During the past decade, malaria also  resurged or increased  in intensity in  South-East Asia after interruption of eradication  efforts, and re-emerged in  several  Central Asian and  Transcaucasian countries.

Increasing  availability of  artemisinin-based combination therapy (ACT), a new and  highly  effective treatment against falciparum malaria, is expected to improve treatment outcomes within the next few years.

Vivax malaria resurged in Central Asia  and Transcaucasia, and falciparum malaria re-emerged in Tajikistan during the 1990s. South-East Asia has the highest rate of drug resistance in the world, and multidrug resistance has contributed to the re-emergence of malaria in  many areas, especially along  international borders. Since 1998, all countries in the region  have been  routinely monitoring drug resistance. Out of 9  countries in this  region, 6 have  adopted ACTs as a national  policy  for  first-line  treatment  of  uncomplicated  falciparum  malaria. In a  high-risk  area of  Malaysia,  ITN distribution and improved diagnosis and treatment services offered by primary health-care   volunteers reduced malaria incidence 28-fold between 1995 and 2003.

Based on  demonstrated  chloroquine  resistance, 8  of the 9 Amazon countries have recently changed  national drug policies to use ACTs for the treatment  of falciparum  malaria. The  estimated cost  for  supporting  the minimal set of malaria interventions required to effectively control malaria is around US$ 3.2 billion  per year for the 82 countries with the highest burden of malaria (US$ 1.9 billion for Africa and US$ 1.2 billion elsewhere).

The Global Fund to Fight AIDS, Tuberculosis and  Malaria (GFATM), which  began disbursement for malaria control in 2003, is an important international funding source. The GFATM disbursed more than US$ 200 million in 2003–2004 to 28  countries  in Africa, 15 countries in Asia  and  4  countries in  the Americas. Approved  commitments  for  malaria control  for 2005–2006 total US$ 881 million. The  demand  for ACTs has increased rapidly  since the  GFATM  began disbursing funds to countries.

Malaria is also a major cause of anaemia in children and pregnant women, low birth weight, premature birth and infant mortality. In  endemic  African  countries,  malaria  accounts  for 25–35% of all  outpatient  visits, 20–45% of  hospital admissions  and 15–35% of hospital deaths, imposing a great burden on already  fragile health-care systems. Malaria contributes synergistically with HIV/AIDS to morbidity and mortality in areas where both infections are highly prevalent, such as in Africa south of the Sahara.

An  increasing  number of  countries  adopted  ACTs  as their national policy and have started  procuring  artemether– lumefantrine with most procurements in dosages for young children.