Malaria treatment, over-diagnosis and protecting ACTs

28 Jun 2010
Africa Fighting Malaria
News out on Friday from Cambodia reports that efforts to control emerging ACT drug resistance is paying off. Dr. Duong Socheat, head of Cambodia's National Center for Malaria Control, reports that the results from their work have been very encouraging. Containing ACT drug resistance is crucially important as we currently have no effective replacement for ACT. For this reason, progress in Cambodia should be welcome news, but we should also be concerned about the growing evidence of over-diagnosis of malaria in Africa. As malaria prevention has been scaled up, there is growing evidence of over-treatment of malaria as fewer and fewer cases of fever are likely to be malaria. This is highlighted in a recent paper by Joseph Okebe and others in the Malaria Journal. Access to ACTs remains very low in most highly malaria endemic countries, yet as AFM pointed out in Lancet Infectious Diseases attempts to increase access to ACTs through the AMFm may just exacerbate over-treatment and could increase the risk of drug resistance. Improved diagnosis is the key, but when does it make sense to spend scarce resources on rapid diagnostic tests (RDTs)? Some guidance is given by Emelda Okiro and Robert Snow, again in the Malaria Journal, whose research finds that there is "a predictable relationship between parasite prevalence in the community and risks of infection among febrile children implying that mapped estimates of parasite prevalence can be used to guide diagnostic strategies in Africa."