Guidelines for the Diagnosis and Treatment of Malaria in Botswana, September 2007
(2007; 56 pages)

Abstract

Chloroquine was the recommended drug for treatment of uncomplicated malaria in the whole country until mid 1990’s. There were anecdotal reports of apparent increase in chloroquine treatment failures, especially after the 1993 malaria epidemic. Between 1994 and 1997 several chloroquine sensitivity and review studies established that parasite resistance to chloroquine and chloroquine treatment failures had reached unacceptable levels. Drug resistance is defined by WHO as the ability of a parasite strain to survive, and/or multiply despite the administration and absorption of drug in doses equal to or higher than that recommended but within the limits of tolerance of the subject. A decision was taken after wide consultations to replace Chloroquine with Sulphadoxine-Pyrimethamine (SP) as first line treatment for uncomplicated malaria. This was achieved successfully in 1996 in the Chobe sub-district and in 1998 in the entire country. Quinine (Qn) has remained the recommended drug for severe malaria or treatment failures with first line drugs; and so far no documented significant Qn resistance is known.

Over a period of years, previous reports from the districts indicated that patients were still responding very well to SP as first line treatment for uncomplicated malaria. However, the 2006 SP efficacy studies revealed failure rates of 9%. The findings from the 2006 efficacy studies are in conformity to sub-regional and global situation as regards SP resistance. In view of this level of resistance, and the regional move towards malaria elimination, a decision was taken in 2007 to change the first line drug policy from SP to ACTs.

In response to increasing resistance to SP, other countries in the region have changed their treatment policies to Artemisinin-based Combination Therapy (ACTs) following WHO recommendations. To date almost all the countries in the sub region have adapted ACT policy. Artemisininbased Combination therapy is defined as the simultaneous use of two or more blood schizonticidal drugs with different biochemical targets in the parasites and independent modes of action. Artemisinin-based combination therapy is an antimalarial combination therapy with an artemisinin derivative as one component of the combination.

Artemisinin-based Combination Antimalarial Therapy is preferred over other combinations not containing artemisisnins for the following reasons:

  • Rapid and sustained reduction of the parasite biomass
  • Reduction of gametocyte carriage thus breaks the malaria parasite’s life cycle.
  • Rapid resolution of clinical symptoms.
  • Safety profile is high.
  • Excellent tolerability, well tolerated compared to other antimalarials.
  • AL is a fixed dose combination treatment enhancing compliance.
  • High cure rates (more than 95 %).
  • Minimizes emergence of resistance...
 
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