UN health body issues first-ever guidelines on procuring safe malaria medicines

A communal malaria test, Khanh Phu, Viet Nam

9 March 2010 – The United Nations World Health Organization (WHO) today issued new guidelines for malaria treatment, marking the first time the agency has released guidance on procuring safe and effective medicines to treat the disease.

The agency warned that if not used properly, artemisinin-based combination therapy, known as ACTs, which have transformed treatment in recent years, could become ineffective.

“The world now has the means to rapidly diagnose malaria and treat it effectively,” said Robert Newman, Director of WHO’s Global Malaria Programme (GMP).

Half of the world’s population is at risk of contracting malaria. Every year, there are 250 million new cases, resulting in 860,000 deaths, the overwhelming majority of which are among African children.

In Africa, it also affects over 50 million pregnant women and is responsible for 10 per cent of all maternal mortalities every year.

The second edition of the Guidelines for the Treatment of Malaria provides evidence-based recommendations for countries on both diagnosis and treatment.

The main changes in this edition from its first, which was published in 2006, are the emphasis on testing before treatment and the addition of a new ACT to the list of recommended treatments.

“WHO now recommends diagnostic testing in all cases of suspected malaria,” Dr. Newman said. “Treatment based on clinical symptoms alone should be reserved for settings where diagnostic tests are not available.”

In 2008, less than 25 per cent of suspected malaria cases were tested in 18 of the 35 African countries which reported results.

Rapid Diagnostic Tests (RDTs), which use a dip stick and a drop of blood, have recently been developed, which can replace microscopy. These new tests can reliably find the malaria parasites in the blood and can be carried out at all levels of the health system, including in community settings.

WHO said that moving towards universal diagnostic testing of malaria is a critical step forward in the fight against the disease since it will allow for the targeted use of ACTs by those who actually have malaria.

The aim, the agency said, is to reduce the emergency and spread of drug resistance, with better management of malaria helping to tackle other problems, like childhood illness and child survival.

The new guidelines are also the first time they have included a 16-step checklist on the selection and procurement of ACTs.

“Pharmaceutical markets in malaria-endemic countries are often unregulated and national authorities need practical help to assess the quality of malaria medicines before they buy them,” said Andrea Bosman, Coordinator of the Medicines and Diganostics Unit at WHO’s GMP, warning that there are too many medicines of varying quality on the market.

Low-quality medicines impact the health and lives of patients, damage health services’ credibility and can boost resistance to treatment, WHO cautioned.

“These guidelines will help countries select and procure effective medicines of good quality and save lives by improving the way patients are diagnosed and treated,” said George Ki-Zerbo, Malaria Programme Manager at the WHO Regional Office for Africa, located in Brazzaville, Republic of Congo (ROC).

Last month, dozens of African leaders met in the Ethiopian capital, Addis Ababa, to address the challenges facing the continent in the effort to meet the UN target of ensuring universal access to malaria control measures by the end of this year.

More than two dozen heads of State convened the first working session of the African Leaders Malaria Alliance (ALMA) during the annual African Union (AU) summit.

ALMA was launched during the General Assembly in September to provide a forum to ensure efficient procurement, distribution, and utilization of malaria control interventions; facilitate the sharing of effective malaria control practices; and ensure malaria remains high on the global political agenda.

As much as 40 per cent of health-care spending in endemic countries goes to malaria, costing the continent around $12 billion a year, according ALMA.

The 26-nation ALMA coalition said that in the past 12 months alone at least 90 million long-lasting, insecticidal mosquito nets were delivered in Africa, and overall 200 million such nets have been distributed to 400 million people in sub-Saharan Africa, where virtually all malaria deaths occur.

“The world is closer than ever before to ending malaria deaths,” said Secretary-General Ban Ki-moon’s Special Envoy for Malaria Ray Chambers, with the WHO’s 2009 World Malaria Report indicating that more than one-third of malaria-affected countries have documented reductions in cases of more than 50 per cent.

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