National Guidelines for Diagnosis and Treatment of Malaria, January 2006 - United Republic of Tanzania
(2006; 105 pages)

Abstract

The National Guidelines for Malaria Diagnosis and Treatment are a revised and updated version of similar Guidelines that were issued in the year 2000. The year 2000 version was revised following a major change in drug policy whereby the former first line drug Chloroquine was replaced with Sulfadoxine-Pyrimethamine (SP). The change was also accompanied with the reintroduction of Amodiaquine as second line drug and Quinine retained its position as the drug of choice for treatment of severe malaria. This shift was necessary following research results, which indicated very high malaria parasite resistance to chloroquine that averaged 60%. By then the parasite resistance to Amodiaquine and SP averaged 6% and 10% respectively. The World Health Organization recommends changing a drug when parasite resistance against it reaches 25%. The lesson learnt was that we would have to establish a system to monitor the performance of the drugs as we implement the new policy in order to ensure effective malaria treatment over time.

In a period of five years since the change of policy, monitoring has indicated that malaria parasite resistance to SP has gone up to an average of 25.5% in the sentinel sites (from 7.8 to 60.5%). For Amodiaquine the resistance went up to an average of 11.5% (from 6.3 to 18.2%). A decision for another change was therefore unavoidable.

The Ministry therefore, had to look for a suitable, highly efficacious replacement drug to SP. Currently, new developments in malaria treatment recommend the use of a combination of drugs that contain one of the Artemesinin compounds (ACTs). The Artemesinin class of compounds have exhibited very high cure rates for malaria and so far no parasite resistance against them has been reported. Having them combined with other suitable antimalarial drugs offers new prospects for achieving high cure rates, delay of development of parasite resistance and achieving a much longer therapeutic life.

The Ministry after several drug efficacy studies and other important considerations has come up with these updated Malaria Treatment Guidelines. From now on, Artemether / Lumefantrine (ALu) is the first line drug for treatment of uncomplicated malaria for all age groups with the exception of pregnant women during the first trimester and children weighing below five kilograms whom Quinine would still be the drug of choice. Quinine is second line drug as well as drug of choice for treatment of severe malaria. Sulfadoxine / Pyrimethamine (SP) remains the drug of choice for Intermittent Preventive Treatment (IPT) of malaria in pregnancy. The aim of IPT is to prevent the worst effects of malaria infection in pregnancy rather than to ensure clinical cure and since no suitable alternative to SP is currently available, a drug with lower efficacy is acceptable.

It is expected that adherence to these new guidelines both in the public and private health sectors will eventually lead to much reduced malaria mortality and morbidity. It has to be emphasized that although proper malaria case management is the cornerstone for malaria control, prevention of malaria by mass usage of insecticide treated nets, environmental management and other proven measures has to be undertaken. Therefore, public education is quite important and has to be undertaken...

 
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