National Malaria Policy, March 2005 - Republic of Namibia
(2005; 47 pages)

Resistance of malaria parasites to conventional antimalaria medicines has been reported in many malaria endemic countries. The World Health Organization defines resistance as the ability of a parasite strain to survive, and / or to multiply despite the administration and absorption of a medicine in doses equal to or higher than those recommended but within the limits of tolerance of the subject. The purpose of a national antimalaria policy is to ensure prompt, effective and safe treatment of malaria disease through the selection of optimal regimens for different clinical situations and to minimize the selection pressure for resistance to antimalaria medicines. There are few antimalaria treatments available but these are further restricted by cost, side-effects and complexity of the dosage regimen.

In Namibia, resistance to chloroquine was first detected in the northwestern region in 1984. A survey carried out in Rundu in 1991 showed evidence of chloroquine resistance. This was corroborated by evidence from another study carried out in Outapi, in 1993 though these results cannot be relied upon. During antimalaria medicine efficacy studies, which were carried out at Katima Mulilo, Rundu and Outapi in 2002 to 2003 it was found that adequate clinical and parasitological response was less than 75%. The results of efficacy studies, which were carried out between February and June 2004, in the three sentinel sites, found that total failure of sulphadoxine / pyrimethmine exceeded 25% in Outapi only.

The ultimate goal of malaria control is to prevent mortality, reduce morbidity and avoid the socio-economic loss due to malaria. The four basic malaria control strategies are: to provide early diagnosis and prompt treatment, to plan and implement selective and sustainable preventive measures, including vector control; to detect early, contain or prevent epidemic and to strengthen capacities in basic and applied research. The success in achieving the desired goals depends on strong partnership with all stakeholders, in planning and implementation of malaria interventions.

Based on concrete evidence of marked reduction in the efficacy of commonly used anti-malarial medicines, the Ministry of Health and Social Services undertook a revision of the malaria control policy. This revised policy document contains new recommendations on the antimalaria medicines and treatment regimens, diagnostic tests, chemoprophylaxis for non-immune travelers and intermittent preventive treatment for pregnant women at various levels of health care system. The policy further articulates vector control interventions, roles and responsibilities of different levels of health care system and various sectors and partners. The policy is intended to serve as a guide to health workers and all partners involved in malaria control.

This policy document was developed with contributions from individuals. I thank members of the Malaria Policy Review Committee, the Antimalarial Medicines Efficacy Study Team members, the participants of the Consensus Workshop on the Malaria Policy and the Namibia Institute of Pathology. Finally I thank the World Health Organization and UNICEF for the technical and financial support.

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