BYGIDEON DZANDO

BSC.NURSING

Malaria is an endemic disease in sub-

saharan Africa.

Malaria is a major cause of illness and death

in Ghana, especially among children and

pregnant women

In 2012, malaria accounted for 38.9% of all

OPD illnesses and 38.8% of all IP of all

admissions.

Ministry of Health Ghana in its mid term strategic plan

document consider malaria as a priority disease which

must be addressed in order to meet Millennium

Development Goals 4,5 and 6.

Case mgt has remained one of the main strategic

interventions for malaria control in Ghana.

The T3 (TEST,TREAT AND TRACK) initiative has

been initiated recently to replace the existing

presumptive mode of treatment.

The effectiveness of the T3 initiative however

depends on Anti malaria drugs which must be safe ,

effective, available, affordable and acceptable, thus

the need for an up to date evidence base Anti malaria

drug policy to suit Global trends and the nation’s

context

Prevent deaths and complications arising from malaria

Shorten clinical episodes of malaria

Reduce consequences of placental malaria infection

and maternal associated anaemia through

chemoprophylaxis and intermittent preventive

treatment during pregnancy.

Delay the spread of resistance to anti malaria

medications.

The use of Arteminisin based combination for

chemoprophylaxis ant treatment was agreed on through

an informal consultation with WHO in Geneva in the

year 2000.

In 2002,Treatment failure to chroloquine was rated

between 6%-25% and total parasite clearance was

rated below 50%.(MOH)

In 2004,the drug policy changed from Chroloquine to

Artesunate Amodiaquine for uncomplicated malaria.

Adverse effects and negative publications in a section of the mass media led to loss of confidence in the policy by some health care providers.

In 2007,there was a policy review which made

provision for search for alternatives for A/A in mgt of

uncomplicated malaria while Inj. Quinine and

Artemether were recommended for treating severe

malaria.

Sulphadoxine pyremetamine was also encouraged for

use as prophylaxis in pregnancy.

Owing to the developing research in science and

medicine, growing evidence that could influence the

choice of one medicine over another and lessons drawn

from practitioners,

The minister reconstituted the Anti malaria Drug Policy

Working Group and inaugurated it on 23rd August 2012

to review the existing Drug policy.

Evidence that, inj. Artesunate is superior to injection

quinine in managing severe malaria and WHO

recommendation for its use

Unconfimed reports of abortions after the use of oral

quinine in the 1st trimester of pregnancy

Conflicting reports on preference of practitioners

between A/A and a/L as first line treatment for

uncomplicated malaria.

Growing concerns about resistance to the use of

Arteminisin mono-therapy, adverse drug reactions and

compliance to seven days quinine therapy

Recent recommendations by WHO on seasonal malaria

chemo-prevention

OBJECTIVE

To provide prompt safe, effective and appropriate

anti malaria treatment to the entire population

THE T3 MUST BE ADHERED TO

The three Arteminisin combination remains the best

choice.

Artesunate Amodiaquine is the drug of choice. (choice

for children below five years at home).

Alternative drugs are: A/L AND Dihydroarteminisin

piperaquine

1st trim: Oral Quinine or

Oral Quinine + Clindamycin.

2nd trim: Oral Quinine,

oral quinine + clindamycin,

AA

A/L

Alternative ACT, AL, AA or DHTP which has not been

given as first line treatment can be given.

Oral quinine can be used if ACT are contraindicated.

(10mg/kg body weight) + Tetracycline or Doxycycline

or Clindamycin.

ACT’S can be used in pregnancy (1st trim) if need be.

Quinine,AA or AL (2nd trim)

Requires parenteral treatment initially and then

continue with orals if the condition permits.

NB: Children who do not respond to ACT,s within 24

hours be tepid sponged, given supp. arteminisin and

referred to a bigger health facility.

Parenteral Artesunate shall be used as the medication of

choice, followed by a full course of an ACT if client

can tolerate oral medication

ALTERNATIVE: Injection Quinine

1ST TRIM: Start with Injection Quinine ,switch to oral

quinine if client can tolerate oral medication.

2nd and 3rd trim: Inj. Artesunate is the recommended

drug of choice.

IPT shall be commenced after first Quickening (16th week).

Shall be provided as an antenatal package with haematinics and antihelmentics

The medicine shall be administered under DOT.

Drug of choice shall remain SULPHADOXINE (500MG) +PYREMETAMINE (25MG).

Screening must be done to exclude G6PD deficiency or

allergy to sulphonamides

ALTERNATIVE RX:

Prognoquil for 1st trim non immune women

HIV/AIDS positive women shall receive monthly doses

of S.P,EXCEPT when they are taking co-trimoxazole.

Folic Acid should not be given with SP as it counteracts

its efficacy.