Malaria treatment in remote areas of Mali: use of modern and traditional medicines, patient outcome

Abstract

Summary Use of official health services often remains low despite great efforts to improve quality of care. Are informal treatments responsible for keeping a number of patients away from standard care, and if so, why? Through a questionnaire survey with proportional cluster samples, we studied the case histories of 952 children in Bandiagara and Sikasso areas of Mali. Most children with reported uncomplicated malaria were first treated at home (87%) with modern medicines alone (40%), a mixture of modern and traditional treatments (33%), or traditional treatment alone (27%). For severe episodes (224 cases), a traditional treatment alone was used in 50% of the cases. Clinical recovery after uncomplicated malaria was above 98% with any type of treatment. For presumed severe malaria, the global mortality rate was 17%; it was not correlated with the type of treatment used (traditional or modern, at home or elsewhere). In the study areas, informal treatments divert a high proportion of patients away from official health services. Patients' experience that outcome after standard therapeutic itineraries is not better than after alternative care may help to explain low use of official health services. We need to study whether some traditional treatments available in remote villages should be considered real, recommendable first aid.

Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT

“…2 Local communities in Mali use herbal preparations as the first treatment for more than 80% of malaria episodes. 3 Argemone mexicana (AM) decoction was selected as the most promising from 160 traditional recipes. [3][4][5] plant is all the more interesting because it is widespread throughout the tropics (including Latin America and Asia).…”

“…3 Argemone mexicana (AM) decoction was selected as the most promising from 160 traditional recipes. [3][4][5] plant is all the more interesting because it is widespread throughout the tropics (including Latin America and Asia). After completion of toxicological studies, a dose-escalating clinical study showed a dose response, no serious adverse events and a sharp decline in parasitaemia (from a geometric mean of 14 859 at day 0 to a geometric mean of 174 parasites per mcl at day 4) although generally without total parasite clearance.…”

Argemone mexicana decoction for the treatment of uncomplicated falciparum malaria

“…It is also used as an antimalarial in several African countries, including Benin, Mali and Sudan. Its in vitro efficacy against P. falciparum has been confirmed by several studies (Adjobimey et al, 2004;Diallo et al, 2006;Simonsen et al, 2001). No previous clinical studies have been conducted to determine its safety and efficacy in human patients.…”

“…Currently, a mixture of three herbs called 'Malarial' is marketed as an antimalarial (Diallo et al, 2004) but it has never been tested in children under the age of 5 years. This study was undertaken to provide data that could support the development of a new MTA as well as official recommendations on the use of local resources in situations where standard modern drugs are lacking despite all possible efforts.…”

“…An ethnobotanical and retrospective treatmentoutcome clinical study in the Sikasso and Bandiagara regions of Mali led to the recognition of the widespread use of plants by local communities in the management of malaria and identified a number of plants used (Diallo et al, 2006). Patients were asked about their recent experience of clinical outcomes following the use of diverse treatments for malaria, and the plants with the best outcomes were also tested in vitro at the Swiss Tropical Institute in Basel.…”