Treating severe malaria with a suppository saves lives in rural areas
8 December 2008
Most malaria deaths occur in young children in rural areas. An acute episode of malaria can become so severe that the patient cannot swallow or keep down oral treatments. If the patient is several hours' travel from a clinic where injections can be given, they are at risk of dying or suffering permanent disability.
An international trial, conducted in Bangladesh, Ghana and Tanzania, has now found that administering just one rectal suppository with the malaria drug artesunate halved the risk of death or disability for patients more than six hours away from a clinic (the risk was reduced from 4 per cent to 2 per cent). The dose does not cure severe malaria, but it buys more time to get patients to a clinic to receive life-saving treatment.
The study was conducted in 291 rural villages and involved training 417 residents with little or no previous medical knowledge to assess patients, administer treatment and refer patients to hospitals or clinics. They were also trained to follow up on patients after their return home.
Coauthor of the report Professor Nick White, Wellcome Trust Principal Research Fellow and Chairman of the Trust’s South-east Asia Programme, said: “We’ve shown that children with severe malaria who are hours from a health clinic and are too ill to take their medicine by mouth can be given a single, simple suppository. This knocks down the malaria parasites in the blood and buys life-saving time to get the children to a clinic for proper diagnosis and full treatment. The suppository costs about 10 pence to make and can be easily administered by people in the community.
“Worldwide there are 10 million deaths of children under five every year. One million of these are from malaria, of which about 90 per cent are in rural Africa. Every death could be prevented by prompt treatment using existing drugs, but it’s difficult to treat all children fast enough, especially in rural areas. This gel capsule helps get over the lack of health infrastructure. You’re buying time with a cheap rectal suppository and, if you’re several hours away from a clinic, it can be the difference between life and death.”
In a commentary accompanying the 'Lancet' paper, Dr Lorenz von Seidlein of the Joint Malaria Project, Tanzania, and Dr Jacqueline L Deen, Joint Malaria Project, Tanzania and Vaccine Institute, Kwanak-gu, Seoul, Korea, said: “If there are a handful of important papers every decade that will influence the way malaria is treated, this study is one of them.”
The trial was conducted by the Study 13 Research Group and involved researchers from organisations including the World Health Organization, the University of Oxford, St George’s, University of London, and the Wellcome Trust.
Image: A mosquito (Anopheles stephensi) full of blood; Hugh Sturrock/Wellcome Images