Malaria Control During Mass Population Movements and Natural Disasters (2003) / Chapter Skim
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6. Curative Services: Malaria Therapy and Case Management
6. Curative Services: Malaria Therapy and Case Management
Pages 57-79
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From page 57... ...
As mentioned previously, the choice of drugs used for uncomplicated severe malaria at different levels of the health care system must be based on relevant data regarding drug resistance patterns and expected efficacy. Occasionally, sufficient information can be obtained from the host country or existing literature; however, specific drug efficacy studies conducted with standard methods in the population being served are the best way to determine the most appropriate drugs to use.
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From page 58... ...
In Africa, for instance, clinical diagnosis of malaria is most commonly used, both in complex emergency situations and stable populations. Rapid diagnostic tests have rarely been used operationally in complex emergencies.
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From page 59... ...
Although laboratory-based diagnosis is typically more expensive and labor intensive than clinical diagnosis, it has been shown to be cost effective in some settings and can potentially lower actual malaria treatment costs by reducing the amounts of antimalarial drugs that are used. This is especially true in settings where inexpensive antimalarials, such as chloroquine and sulfadoxine/pyrimethamine, can no longer be used because of high levels of drug resistance.
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From page 60... ...
stained thick blood smears · Quantitative Buffy Coat (QBC; Becton-Dickinson) Rapid diagnostic stick test based on PfHRP-II (various tests and manufacturers)
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From page 61... ...
,e; Will not diagnose nonfalciparum malaria, 0.80-1.00 World Health although subsequent-generation tests will Organization ieve be able to do this.
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From page 62... ...
dollars per test performed; reflects only the cost of expendable materials unless otherwise noted. treated with chloroquine alone or chloroquine and primaquine, reducing overall malaria treatment costs while ensuring appropriate treatment of falciparum malaria.
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From page 63... ...
The technique uses microhematocrit tubes precoated with flourescent acridine orange stain to highlight malaria parasites. With centrifugation, parasites are concentrated at a predictable location.
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From page 64... ...
Newer-generation antigen detection tests are able to distinguish between falciparum and nonfalciparum infections, greatly expanding their usefulness in areas where nonfalciparum malaria is transmitted frequently. Finally, there is growing concern about the stability, shelf life, and reliability of these tests under field conditions.
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From page 65... ...
Since sample collection is exceedingly easy (a dried blood spot on filter paper) , collaboration with an outside agency or ministry of health that does have this capacity would allow its use for monitoring patterns of resistance to chloroquine or sulfadoxine/pyrimethamine in an emergency setting, particularly in areas where in viva studies would be difficult to conduct.
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From page 66... ...
Treatment of Uncomplicated lR falciparum Malaria The choice of an optimal treatment regimen for uncomplicated malaria depends on local drug resistance patterns, acceptability (in terms of safety, side effects, ability to use during pregnancy, ability to treat young children) , and cost.
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From page 67... ...
In specific areas of low transmission in Southeast Asia, ART combination therapy appears to have slowed the development of drug resistance and possibly decreased malaria transmission (Price et al., 1997; Nosten et al., 20001. Although the combination of ART and mefloquine has been used extensively and successfully in refugee camps in Thailand (as well as in stable populations in parts of Southeast Asia)
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From page 68... ...
Treatment of Nonfalciparum Malaria Chloroquine remains a highly effective treatment for nonfalciparum infections in most areas ofthe world. In areas where nonfalciparum malaria infections are relatively common, distinguishing nonfalciparum infections from falciparum infections could result in cost savings, especially if treatment of falciparum infections is expensive.
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From page 69... ...
Severe deficiency (<10 percent residual enzyme activity) is seen in some people of Mediterranean and Asian decent; moderate deficiency (10 to 60 percent residual activity)
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From page 70... ...
Treatment of Severe Falciparum Malaria Treatment of severe P? falciparum malaria should be with immediate administration of parental quinine or quinidine, beginning with a loading dose and followed by 8 to 12 hourly maintenance doses (World Health Organization, 2000a, 2000b)
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From page 74... ...
The choice of an appropriate first-line treatment for malaria in pregnant women should be based on local drug resistance patterns and the underlying level of immunity of the population. Treatment of otherwise uncomplicated malaria during pregnancy generally follows the recommendations for treatment of uncomplicated malaria in nonpregnant individuals.
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From page 75... ...
, a definitive statement on their safety in pregnancy cannot be made. Nonetheless, artemisinin derivatives, alone or in combination with another safe drug, offer one of the few highly effective treatment options during pregnancy in areas where multidrug-resistant malaria occurs (McGready et al., 19981.
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From page 76... ...
Hemoglobin Color Scale compares the color of a blood spot on filter paper with a standardized color scale. The copper sulfate method measures the ability of a drop of blood to float or sink in copper sulfate solutions of known specific gravity to determine hemoglobin concentration.
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From page 77... ...
This respiratory distress is due to an underlying severe metabolic acidosis (English et al., 1997; World Health Organization, 2000a; Day et al., 20001. Furthermore, severely anemic patients with or without respiratory distress had improved survival only when transfusions were given within the first 24 to 48 hours of admission.
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From page 78... ...
Discussions should include the consideration of treatment policies, local drug resistance patterns, acceptability, availability, cost, and other operational factors when establishing malaria treatment guidelines. · Obtain specific local information regarding current drug resistance patterns from standardized drug efficacy trials, the host country's data, and other sources of technical information (such as malaria country profiles from Roll Back Malaria in order to choose the optimal first-line treatment guidelines.
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From page 79... ...
· Train clinical staff in the recognition and proper treatment of severe malarial disease and important malaria-related complications, such as anemia. · Establish a referral system to facilitate the transfer of severely ill patients from peripheral health posts to central facilities capable of providing proper management.
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