Cost-effective, life-saving intervention for severe childhood malaria

LONDON - A new study has suggested that giving emergency artesunate suppositories to children with suspected severe malaria before referring them for treatment is a cost-effective intervention.

The research, led by Boston University School of Public Health (BUSPH) researcher Yesim Tozan, builds on previous research that found that the administration of one dose of rectal artesunate by a community health worker to a child with suspected severe malaria significantly reduced the risk of death and permanent disability.

In addition to endangering the lives of young children, severe malaria has been associated with a range of developmental deficits.

Rectal artesunate interrupts disease progression by rapidly reducing parasite density, but should be followed by further anti-malarial treatment.

Tozan, assistant professor of international health at BUSPH, said, “The success of interventions in the community ultimately depends on whether formal health systems can provide front-line health workers with drugs and other necessary health commodities, regular monitoring and supervision, and linkages to referral systems” for follow-up treatment.

The research team studied a hypothetical cohort of 1,000 newborn babies through five years of age in high malaria transmission settings. The team assessed the costs and cost-effectiveness of artesunate treatment, followed by referral to a health facility, under a variety of intervention uptake and referral compliance scenarios.

They estimated that the full uptake of artesunate treatment and full compliance with referral advice would avert 37 child deaths and 967 disability-adjusted life-years [DALYs] — a measure which combines years of life lost because of premature death, with years of life lived with disability-over five years .

Across all intervention uptake and referral compliance scenarios, the study reported that the intervention could avert each DALY at a cost of 77 dollars to 1,173 dollars.

“Compared with the interventions that target key childhood illnesses in sub-Saharan Africa, pre-referral artesunate treatment is among the most cost-effective, especially if the intervention uptake is moderate or higher,” the researchers concluded.

Half of the world’s population is at risk of malaria, with an estimated 243 million cases leading to nearly 863,000 deaths in 2008.

The study appears online Nov. 29 in The Lancet. (ANI)