Chala Daba, 25 years old, contracted severe malaria at the end of 2014
He was violently ill, suffering fever, vomiting and headaches. He was in severe pain when he was brought to Tulu Bulu hospital, near to where he lives two hours south of the Ethiopian capital, Addis Ababa. Fortunately, the hospital had supplies of injectable artesunate and staff were trained on how to administer the medicine. Chala tells how he recovered within a couple of days and was soon back at work.
Injectable artesunate has been recommended by WHO since 2011 as the most effective way to treat severe malaria. Today there are around 8 million cases a year, mostly occurring in small children, and is near-100% fatal if left untreated. Ethiopia responded quickly to the WHO recommendations and introduced injectable artesunate into its national malaria plan. However the product wasn’t being widely used as staff were unfamiliar with it and untrained in administering it. This has changed through UNITAID’s investment to facilitate better uptake of the product, including the roll out of a training programme. The UNITAID project is paving the way for the increased use of injectable artesunate in six high burden malaria countries, with the aim of enabling widespread global use down the road.
Injectable artesunate is easy to use once medical staff are trained. It is also reliable and with few side effects. It provides a vastly improved option over the older drug quinine which requires very careful administration to avoid potentially fatal side effects. If all cases of severe malaria were treated with injectable artesunate rather than quinine, 195,000 lives could be saved each year.
Dr Ephrem Bekele, medical coordinator at the Tulu Bulu hospital.
He says that injectable artesunate was not favoured by healthcare workers who preferred to use quinine as they were much more familiar with it. Injectable artesunate was only being used 20% of the time, however, after the training programme run under the UNITAID project, use has been transformed and injectable artesunate is now the first choice and being used 95% of the time.
Dejene Hailu, a pharmacist at the Tulu Bulu hospital, explaining how easy injectable artesunate is to use.
Nuri Dildila, is based in a village a 30-minute walk from the main road and a further 30-minute car ride to the nearest district hospital.
She is one of over 30,000 Health Extension Workers in Ethiopia serving remote populations. Most children who develop severe malaria in Ethiopia live in villages like this, a fair distance from where proper treatment can be carried out. As severe malaria becomes life threatening so quickly (usually within 24 hours), a fast-acting interim solution while children are transported to hospital for proper care can save many lives. UNITAID is also investing in rectal artesunate, a suppository that can buy time and be easily used by community health workers like Nuri. At the moment, there is no WHO-approved product and therefore no large-scale purchasing possible using major donor funding.
