Rectal artemether may be as good as intravenous quinine

Every year over a million children die of malaria in Africa. In many settings, especially rural ones, most fatalities due to malaria occur outside hospital, although a substantial proportion of these children will have made contact with some level of healthcare in their final illness.1 Of those who arrive at hospital, many are moribund and up to half of malaria deaths in hospitals occur within 24 hours of admission.2 Buying time by being able to start effective treatment for those with severe malaria in the community therefore has the potential to save many lives. Conventional treatment for severe malaria in Africa is intravenous or intramuscular quinine. Providing parenteral treatment with quinine in the community is usually impractical and potentially hazardous. Even in hospitals, staff are often overstretched and have some difficulty managing intravenous quinine safely.

In this issue Aceng et al report …