Policy brief on improving access to artemisinin-based combination therapies for malaria in Central African Republic

    Publication year: 2010

    In the Central African Republic (CAR) malaria is a major public health problem and hampers socioeconomic development. It accounts for 40 percent of complaints and 10 percent of deaths in health facilities (15;17). Pregnant women, who make up 4 percent of the population, and children under 5 years of age, who represent 17.3 percent, are the groups most vulnerable to malaria owing to their low levels of immunity. For many years, uncomplicated malaria was treated with chloroquine, amodiaquine, and a sulfadoxine-pyrimethamine combination. Resistance to these drugs has developed since 1986, as several studies have documented (3;8;9). Between 2002 and 2004, there was a steady increase in resistance to 40.9 percent in the case of chloroquine and 22.8 percent in the case of sulfadoxine-pyrimethamine. Following the recommendation of the World Health Organization, the national health authorities reviewed the national malaria management guidelines and opted for the use of artemisinin-based combination therapies (ACTs) as the front-line drug instead of the formerly recommended sulfadoxine-pyrimethamine combination (10–14). Several factors limit implementation of the revised national malaria management guidelines, including (i) unavailability of ACTs in CAR owing to high cost and supply problems; (ii) nonadherence of health professionals, community health workers, and licensed dispensers (private-sector and community-based pharmacies); and (iii) continued availability of antimalarials formerly used in single-drug therapy. Any strategy designed to facilitate access to treatment must take account of the rural poor who are particularly ill served by the health system. It is this problem of accessibility that is being addressed by the home management of malaria (PECADOM) strategy. This is a community-based strategy that enlists the participation of community health workers, mothers, and traditional practitioners in the home management of uncomplicated malaria. It relies on the services provided by the private, formal, and informal health sectors. Home management complements and extends the outreach of public health services (1;2;5).