Analysis

Access to antimalarial therapy: accurate diagnosis is essential to achieving long term goals

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b2606 (Published 07 July 2009) Cite this as: BMJ 2009;339:b2606

This article has a correction. Please see:

  1. Heidi Hopkins, researcher1,
  2. Caroline Asiimwe, coordinator for malaria diagnostics implementation1,
  3. David Bell, scientist, malaria diagnostics2
  1. 1Foundation for Innovative New Diagnostics (FIND), Kampala, Uganda
  2. 2World Health Organization—Regional Office for the Western Pacific
  1. Correspondence to: H Hopkins heidi.hopkins{at}finddiagnostics.org
  • Accepted 30 May 2009

Increased attention to and funding for malaria promises to improve access to effective treatment, but Heidi Hopkins, Caroline Asiimwe, and David Bell argue that without diagnostic testing much of this effort will be wasted

Health care in malaria endemic areas of Africa is at a crucial tipping point. On the positive side, increased commitment to and funding for malaria control is leading to improved access to effective antimalarial drugs, with over the counter availability and extensive subsidies. However, current efforts do not yet adequately address the need for tools to diagnose malaria accurately and track its incidence. Since presumptive case management leads to dramatic overuse of antimalarial drugs, programmes to improve access will also inevitably lead to further inappropriate treatment for individual patients, increased risk of parasite resistance to antimalarial compounds, and the potential diversion of hundreds of millions of dollars worth of antimalarial drugs to patients who do not actually have malaria. It is vital to make effective antimalarial treatment widely available,1 2 but doing so without equally intensive efforts to improve access to parasite based diagnosis is likely to be counterproductive. Thoughtful implementation of malaria diagnostics has the potential to improve care and resource allocation, with broad public health significance.

Background

Prompt access to treatment with effective antimalarial drugs is essential to the control and elimination of malaria, and to reducing child and adult mortality.3 In recent years, development of resistance to various antimalarial drugs has necessitated a change to artemisinin derivatives as firstline treatment in nearly all endemic countries. Continued use of older drugs to which resistance has developed leads to poor clinical outcomes and heightened mortality.4 Although coordinated efforts have been made to improve the availability of artemisinin based combination therapies and to encourage their correct use, studies show that access is …

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