Newer drug combinations for malaria

doi:10.1136/bmj.328.7455.1511

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Guy Barnish (gbarnish@liverpool.ac.uk), senior lecturer,
Imelda Bates (ibates@liverpool.ac.uk), medical officer,
James Iboro (jiboro@yahoo.com.au), medical officer

Malaria Knowledge Programme, Liverpool School of Tropical Medicine, Liverpool L2 5QA
Malaria Knowledge Programme, Liverpool School of Tropical Medicine, Liverpool L2 5QA
Mount Hagen Hospital, Western Highlands Province, Papua New Guinea

May be impractical unless diagnostic accuracy can be improved

Resistance of parasites to cheap, first line malaria drugs is a major obstacle to reducing the more than one million deaths due to malaria each year worldwide. Comparing the number of parasitologically confirmed cases of malaria with those that are presumptively diagnosed reveals shockingly high rates of overdiagnosis at peripheral and community levels where self treatment is routine.1 If more expensive drug treatments are introduced, this degree of misdiagnosis of malaria cannot be condoned or sustained.

Misdiagnosis of malaria in poorer countries

In sub-Saharan Africa more than 80% of individuals with malaria self treat fevers with antimalarial drugs without seeking help from the formal health sector.2 Sixty per cent of children with fever in Kenya, and 83% in Togo, were treated at home with a malaria drug.3 4 Clinical signs alone are also used at primary healthcare facilities, which lack laboratories for malaria diagnosis. This approach is sensitive but not specific, so that in areas with intermittent malaria transmission it is common for three quarters of febrile patients to be advised to take …