Malaria and children: Progress in intervention coverage - Unicef

Many countries still treat a large proportion of
children with fever with less effective traditional
monotherapies, such as chloroquine, which
are no longer recommended due to increasing
levels of resistance and treatment failures
Box 4 (continued)
23
Malaria and children
2
and robust information for monitoring changes in
malaria-specific mortality.
Some efforts are under way to monitor malaria-specific
mortality in a few subnational areas, with data
collected using other methods, such as verbal autopsies.
For example, a standardized verbal autopsy
questionnaire and field-operating procedures have recently
been developed for use in national surveys,
censuses and sentinel sites. 1 However, further work
is needed to improve these methodologies, and
these methods may present challenges at the national
level. Therefore, the Roll Back Malaria Monitoring
and Evaluation Reference Group recommends a
greater emphasis on monitoring trends in all-cause
under-five mortality and tracking the implementation
of key malaria control interventions through household
surveys.
UNICEF and other partners have developed a mathematical
model to predict the impact of a range of
child survival interventions (including those for malaria)
on mortality among children under age five. 2
The model links coverage of key child survival interventions
with an estimate of each intervention’s efficacy.
Based on these inputs, the model predicts the
proportionate reduction in under-five mortality due
to increasing coverage of key child survival interventions
(including those for malaria) from a baseline
value to a current level. This model is now being incorporated
into a user-friendly software package for
use at the national and global levels and is expected
to become available by the end of 2007.
Notes
1. WHO 2005b; Soleman, Chandramohan, and Shibuya 2006.
2. Jones and others 2003.
Progress in the fight against malaria
Place of treatment
It is important to better understand where children
receive treatment for malaria symptoms,
especially the share of treatment that takes place
at health facilities. Based on 24 sub- Saharan African
countries 42 per cent of children taking antimalarial
medicines received treatment at home
(figure 14). This large proportion underscores
the urgent need to strengthen community-based
treatment programmes and overall health systems
to improve the coverage of antimalarial medicines
in high-burden African countries (box 4). Effective
antimalarial medicines must also be reliably
available through trained private sector providers.
Treatment by drug type
Nearly all high-burden African countries have
seen a rapid and unprecedented change in
national drug policies in recent years. In line
with World Health Organization recommendations,
countries have responded to the decreasing
efficacy of monotherapies for treating malaria
by promoting artemisinin-based combination
therapy for first-line treatment of uncomplicated
malaria, a more effective treatment course (see
map 4).
But many countries still treat a large proportion
of children with fever with less effective
traditional monotherapies, such as chloroquine,
which are no longer recommended due
to increasing levels of resistance and treatment
failures. Across sub- Saharan Africa nearly
60 per cent of febrile children receiving antimalarial
medicines were taking chloroquine at
the time of the surveys. 24 Thus while Comoros,
The Gambia, Ghana and Benin have higher overall
treatment rates than Tanzania and Zambia
(figure 15), a larger proportion of children in
Comoros, The Gambia, Ghana and Benin use
chloroquine, a less effective treatment course.
Data on artemisinin-based combination therapy
use by febrile children are limited. A subset