New Study Confirms Efficacy of Malaria Treatment Technique

October 23, 2019

Research from a project in Zambia supported by DAI Global Health along with consortium partners Development Data, Disacare, and Transaid International has confirmed that a pre-referral treatment by community health volunteers can increase survival rates for children with severe malaria.

The World Health Organization (WHO) published in September findings from a 12-month pilot study funded by the Medicines for Malaria (MMV) in Zambia: the MAMaZ Against Malaria (MAM) initiative. Results show that the intervention helped reduce mortality rates for children under five with severe malaria by more than 90 percent.

Photo: MAMaZ Against Malaria

Worldwide, malaria deaths are down 60 percent over recent decades, but progress has stalled in some countries. Children under five now account for most deaths. The fates of severe malaria patients who don’t make it to a healthcare facility are especially dire—90 percent do not survive.

Such deaths are not uncommon in Zambia. Families sometimes do not recognize signs of the illness in their children until it becomes severe. Long distances, a lack of transportation, and costs also prevent them from quickly seeking treatment.

Starting in 2010, a series of health projects in the country trained community health volunteers to address barriers preventing access to essential health services. In 2017, MMV and its partners—DAI, Transaid, Development Data, and Disacare—built on these efforts by launching MAM, an evidence-based effort to help hard-to-reach communities improve their access to malaria treatment.

MAM introduced—and evaluated—an emergency pre-referral treatment for children under six with severe malaria: rectal artesunate suppositories (RAS). Administered by health volunteers, these suppositories can help stabilize patients until they are able to access healthcare facilities to receive the WHO-recommended treatment (injectable artesunate followed by artemisinin-based combination therapy).

While the WHO has encouraged use of RAS for more than 10 years, countries like Zambia have lacked access to sources of the drug that meet international quality standards. Part of MAM’s effort included ensuring adequate drug supply. The project also provided bicycle ambulances for emergency transportation and trained volunteers to administer RAS and formal health workers to give injectable artesunate.

MAM tested these interventions with a pilot project in Sereneje District between 2017 and 2018. The study surveyed health facilities, volunteers, and bicycle ambulance riders at the beginning and end of this period. Researchers also collected data on severe malaria cases and deaths from participating health facilities and a community monitoring system.

Photo: MAMaZ Against Malaria. Rabbecca Chisenga, an emergency transport rider and community health volunteer.

The results were clear: in the previous year, 18 out of 224 children under five identified with severe malaria had died in the district (an 8 percent mortality rate). In the first year of the MAM pilot, only 3 of 618 comparable children with malaria passed away (0.5 percent mortality).

Critical to these lifesaving efforts were 543 community health volunteers trained by the project. MAM supplied the district with 3,000 units of quality-assured rectal artesunate so that all but one of the district’s medical facilities had a 30-day supply (which none of them possessed one year earlier).

The total number of malaria cases in adults and children recorded by Zambia’s Health Management Information System during peak malaria season was 16 percent lower than the preceding year. At the same time, the number of cases reported for children under age five increased by 15 percent, suggesting better identification and treatment of the disease.

Photo: MAMaZ Against Malaria

“These promising results show that providing pre-referral RAS to children with severe malaria can prevent deaths—and that, with adequate training, community health volunteers are capable providers of this service in a rural, under-resourced context,” said DAI’s Paula Quigley, one of the study’s co-authors.

The study also highlights the importance of a comprehensive health systems approach in tackling malaria. Community volunteers were essential in raising awareness about symptoms and treatment with families. Emergency transport riders ensured that children who received RAS could then make it to healthcare facilities for the rest of their treatment.

Staff in participating health facilities received help to improve how severe malaria cases were managed. The District Health Management Team was fully involved with support from the National Malaria Elimination Centre, paving the way for expansion to other districts. Thanks to this comprehensive strategy, the MAM project provides a valuable model for making a technical intervention succeed on a large scale.