New Malaria Treatment Guidelines

Six of 12 malaria victims identified in Exuma who were undergoing treatment for the parasitic disease were to have completed that treatment yesterday, health officials reported. The situation has sparked widespread concern on the quaint island which is one of the most popular destinations in The Bahamas.

Officials have secured the assistance of the Pan American Health Organization [PAHO].

Malaria is spread through the bite of the female anopheles mosquito. It is a leading cause of death and illness in children and adults in tropical countries and mortality, currently estimated at over a million people per year and has risen in recent years.

The WHO suggested in its report that the discovery and development of artemisinin derivatives in China have provided a new class of highly effective antimalarials, and have already transformed the chemotherapy of malaria in South-East Asia.

Artemisinin-based combination therapies (ACTs) are now generally considered the best current treatment for uncomplicated falciparum malaria, the report said.

Artemisinin is an antimalarial agent extracted from the dry leaves of the Chinese herb Artemsisia annua or wormwood. It acts rapidly and potently against the malarial parasite, including some drug-resistant strains. Without significant side effects, it quickly reduces fever and lowers the blood levels of the parasite. This help to keep small outbreaks of malaria from becoming epidemics and to quell ongoing epidemics. In a malaria epidemic in the early 1990's in Vietnam, artemisinin reduced the death rate by 97%.

To decrease the risk of resistance, artemisinin is taken as part of a "cocktail." It was first isolated in 1965 by Chinese military researchers.

The affordable and widely available antimalarial chloroquine that was in the past a mainstay of malaria control is now ineffective in most falciparum malaria endemic areas, and resistance to sulfadoxine–pyrimethamine is increasing rapidly, researchers have found.

"Malaria control requires an integrated approach comprising prevention including vector control and treatment with effective antimalarials," noted the WHO report.

"Much of the world’s symptomatic malaria is treated in peripheral health centres or remote villages, where facilities are limited," it added.

The Guidelines on the Treatment of Malaria report was intended to provide simple and straightforward treatment recommendations based on sound evidence that can be applied effectively in most settings. Officials have committed to a regular review and updating of the guidelines.

"Cost is a factor that has been taken into consideration in antimalarial treatment policy and practices. However, there are increasing international subsidies for antimalarials. Efficacy (both now and in the future) and safety have therefore taken precedence when making the recommendations," the report stated.

After examination, all of the persons in Exuma who had clinical evidence of malaria, blood specimens were taken and sent to Nassau for evaluation and where necessary victims were admitted to hospital, Health Minister Dr. Bernard Nottage reported to the media this week.

He also reported that patients who were not ‘sick’, had the blood samples taken and remained in Exuma pending the results of their tests.

In the meantime medical teams are going house to house in the areas where the known patients live and work, and are paying special attention to the travel history of all affected persons and others around them who may have traveled.

In an attempt to speed up this process, the health ministry has secured the services of additional laboratory technologists with the assistance of PAHO to enable investigators to carry out their reading of smears on location in Exuma.

Health officials at the WHO even pointed out that there are some epidemiological overlaps between malaria and HIV/AIDS which is most apparent in areas with generalized HIV/AIDS epidemics and stable malaria.

Sub-Saharan Africa carries a high burden of both diseases, thus co-infection is common in many areas. In the most severely affected countries (Central African Republic, Malawi, Mozambique, Zambia and Zimbabwe), more than 90% of the population are exposed to malaria and the prevalence of HIV infection in adults.

In contrast, southern Africa, which has a relatively low burden of malaria, is the worst affected subregion for HIV infection with prevalence as high as 30%. The frequent malaria epidemics in southern Africa may, however, increase the risk of dual infection.

In Latin America and the Caribbean, some overlap of malaria and HIV/AIDS occurs in the general population in Belize, Brazil, El Salvador, Guatemala, Guyana and Honduras.