Management of malaria and other severe infections in rural Africa and Asia

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1527 (Published 17 March 2010) Cite this as: BMJ 2010;340:c1527
  1. Christopher J M Whitty, professor1,
  2. Toby Leslie, technical director2,
  3. Clare I R Chandler, lecturer1,
  4. Sarah G Staedke, senior lecturer3
  1. 1Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London WC1B 7HT
  2. 2Health Protection and Research Organisation, Street 10, Taimani Road, Kabul, Afghanistan
  3. 3LSHTM and MU-UCSF Research Collaboration/Uganda Malaria Surveillance Project, Mulago Hospital, PO Box 7475, Kampala, Uganda
  1. christopher.whitty{at}lshtm.ac.uk

    Delays to treatment cost lives and quick fixes are not the answer

    The winner of the Research Paper of the Year category in the 2010 BMJ Group Awards was a paper that described the use of pre-referral rectal artesunate (a rapidly effective antimalarial) in patients with severe malaria.1 This remarkable study conducted in Bangladesh, Ghana, and Tanzania randomised 17 826 patients with suspected malaria in rural areas to rectal artesunate or placebo before referral to a health facility. Although mortality did not differ between groups, the composite of death and disability was significantly reduced in people who received artesunate, in an analysis that was restricted to those with confirmed malaria. The effect was largely limited to participants who were delayed for more than six hours before arriving at a health facility, in whom the risk ratio was 0.49 (95% confidence interval 0.32 to 0.77). The findings suggest that in patients with severe malaria in whom treatment is likely to be delayed, pre-referral treatment with rectal artesunate could reduce the risk of mortality and disability.1

    The study was an outstanding logistical feat and clearly confirmed the principle that treatment of severe malaria …

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