WHO, the Global Fund, and medical malpractice in malaria treatment

Attaran, Amir; Barnes, Karen I.; Curtis, C. F.; D’Alessandro, Umberto; Fanello, Caterina; Galinski, Mary R.; Kokwaro, Gilbert; Looareesuwan, Sornchai; Makanga, Michael; Mutabingwa, Theonest K.; Talisuna, Ambrose; Trape, Jean François; Watkins, William M.

doi:10.1016/s0140-6736(03)15330-5

Cited by 198 publications

(129 citation statements)

References 22 publications

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“…[1][2][3] More than 40 countries in Africa have now adopted ACT as their first line treatment recommendation for uncomplicated malaria. 4 Beyond the difficulties of changing national treatment policies, a key bench mark of successful policy implementation, and thus effectiveness, is that the recommended drugs are available at the point of care.…”

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confidence: 99%

Malaria Drug Shortages in Kenya: A Major Failure to Provide Access to Effective Treatment

Kangwana¹,

Memusi²,

Snow³

et al. 2009

The American Journal of Tropical Medicine and Hygiene

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Abstract. A key bench mark of successful therapeutic policy implementation, and thus effectiveness, is that the recommended drugs are available at the point of care. Two years after artemether-lumefathrine (AL) was introduced for the management of uncomplicated malaria in Kenya, we carried out a cross-sectional survey to investigate AL availability in government facilities in seven malaria-endemic districts. One of four of the surveyed facilities had none of the four AL weight-specific treatment packs in stock; three of four facilities were out of stock of at least one weight-specific AL pack, leading health workers to prescribe a range of inappropriate alternatives. The shortage was in large part caused by a delayed procurement process. National ministries of health and the international community must address the current shortcomings facing antimalarial drug supply to the public sector.The widespread failure of chloroquine and sulfadoxine pyrimethamine (SP) in the treatment of malaria in Africa during the late 1990s resulted in a turbulent public health debate, which led to universal acceptance that mono-therapies that failed to cure up to one in four patients should be replaced by highly efficacious artemisinin-based combination therapy (ACT). 1-3 More than 40 countries in Africa have now adopted ACT as their first line treatment recommendation for uncomplicated malaria. 4 Beyond the difficulties of changing national treatment policies, a key bench mark of successful policy implementation, and thus effectiveness, is that the recommended drugs are available at the point of care. [5][6][7] In most countries, ACTs are supplied only to the public, formal health sector managed by the government and its mission sector partners. In 2006, Kenya implemented a change in malaria treatment policy in all public facilities from SP to the ACT artemetherlumefantrine (AL), largely supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). 7 Two years after AL introduction, we carried out a crosssectional survey to investigate AL availability in government facilities. From August 18 through October 2, 2008, 164 facilities (115 dispensaries, 30 health centers, and 19 hospitals) were assessed in seven districts in Nyanza, Western, and Coast Provinces, Kenya, that were highly endemic for malaria. At each facility, information was collected on the availability of AL packs for the four patient weight groups either through direct review of stock cards or through phone interviews. Health workers were also asked what they prescribed in the absence of AL.One (25.6%) of four of the surveyed facilities had none of the four AL weight-specific treatment packs in stock, with such complete stockouts more common in dispensaries (30.4%) than in health centers (20.0%) and hospitals (5.3%). Furthermore, three (75.0%) of four facilities were out of stock of at least one weight-specific AL pack (Table 1 ). It was particularly worrying that packs for the youngest age group, the group most at risk of malaria mortality, were absent...

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confidence: 99%

Malaria Drug Shortages in Kenya: A Major Failure to Provide Access to Effective Treatment

Kangwana¹,

Memusi²,

Snow³

et al. 2009

The American Journal of Tropical Medicine and Hygiene

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“…These issues have led to vigorous debate about whether ACTs should become standard treatment for malaria in endemic countries. Even if supplies were unlimited, most African countries do not have the financial resources to purchase ACTs 4,5 .…”

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confidence: 99%

An attack on all fronts

Klausner

Alonso

2004

Nature

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“…7 However, the adoption and implementation of this policy recommendation was slow until, in 2004, research and control communities called for urgent action. 8 All sub-Saharan African countries now recommend artemisinin-based combination therapy as the first-line regimen for uncomplicated malaria. 9 This transition necessitated a huge commitment and concerted efforts from national malaria control programmes and donors.…”

Section: Introductionmentioning

confidence: 99%

Mitigating the threat of artemisinin resistance in Africa: improvement of drug-resistance surveillance and response systems

Talisuna

Karema

Ogutu

et al. 2012

The Lancet Infectious Diseases

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Artemisinin-resistant Plasmodium falciparum malaria has emerged in western Cambodia and has been detected in western Thailand. The situation is ominously reminiscent of the emergence of resistance to chloroquine and to sulfadoxine-pyrimethamine several decades ago. Artemisinin resistance is a major threat to global public health, with the most severe potential effects in subSaharan Africa, where the disease burden is highest and systems for monitoring and containment of resistance are inadequate. The mechanisms that underlie artemisinin resistance are not fully understood. The main phenotypic trait associated with resistance is a substantial delay in parasite clearance, so far reported in southeast Asia but not in Africa. One of the pillars of the WHO global plan for artemisinin resistance containment is to increase monitoring and surveillance. In this Personal View, we propose strategies that should be adopted by malaria-endemic countries in Africa: resource mobilisation to reactivate regional surveillance networks, establishment of baseline parasite clearance profiles to serve as benchmarks to track emerging artemisinin resistance, improved data sharing to allow pooled analyses to identify rare events, modelling of risk factors for drug resistance, and development and validation of new approaches to monitor resistance.

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WHO, the Global Fund, and medical malpractice in malaria treatment

Cited by 198 publications

References 22 publications

Malaria Drug Shortages in Kenya: A Major Failure to Provide Access to Effective Treatment

Malaria Drug Shortages in Kenya: A Major Failure to Provide Access to Effective Treatment

An attack on all fronts

Mitigating the threat of artemisinin resistance in Africa: improvement of drug-resistance surveillance and response systems

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