|
|
 |
Prompt, effective treatment of malaria is crucial in the control of malaria and for limiting mortality and
morbidity. The emergence and spread of anti-malarial resistance has limited the achievement of this fundamental component of malaria control globally 1-5, including in Southern Africa 6-10. This will continue to result in
increased transmission, morbidity and mortality, with a significant economic impact on countries with extremely limited resources, unless effective and affordable replacements for
current first line treatments are made available. Currently only chloroquine or sulphadoxine / pyrimethamine (S/P), are generally available as first line therapy in sub Saharan Africa.
Chloroquine resistance is already widespread with high levels of treatment failure and increasing mortality described 2-4,7-10. Although SP was introduced more recently in Africa as first line therapy,
resistance and treatment failure are already prevalent and expected to increase rapidly.6,11 |
|
|
|
|
| |
There is compelling evidence, particularly from South East Asia, that an anti-malarial drug combination
that includes an artemisinin
derivative will reduce transmission and may delay the emergence of resistance, and be cost effective. The principal of using combination therapy is established in the management of tuberculosis and HIV, and should apply equally well to malaria.
|
|
|
| |
|
|
|
|
|
|
|
There is compelling evidence, particularly from South East Asia, that an anti-malarial drug combination that includes an artemisinin
derivative will reduce transmission and may delay the emergence of resistance, and be cost effective. The principal of using
combination therapy is established in the management of tuberculosis and HIV, and should apply equally well to malaria. If the useful lifespan of SP is not prolonged
by use in Combination Anti-malarial Therapy (CAT), few, if any, countries in sub-Saharan Africa will be able to afford deploying the next line therapy (e.g. mefloquine, halofantrine). Since new drugs
under development are likely to be equally or more expensive, the majority of African patients will be without access to effective treatment once SP fails. Escalating morbidity, mortality and economic
burden is inevitable. Clearly, an evaluation of affordable and effective alternative treatment is urgently required in Southern Africa. The combination of an artemisinin derivative with SP appears to
be the most rational alternative currently available. Since the cost of any replacement for SP is likely to be higher, an evaluation of cost effectiveness is critical. The South East African
Combination Antimalarial Therapy (SEACAT) evaluation aims to comprehensively address these critical questions to optimise first line treatment of uncomplicated malaria in Southern Africa. The proposed
study area covers a wide range of transmission intensity, including low transmission areas, where the potential of combination therapy to reduce transmission and the incidence of falciparum
malaria is most likely to be realised. References |
|
|
