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Anti-malarial drug programme helps protect children in Mali

In Mali, around one in every six deaths among children under five is caused by malaria.

According to the World Health Organization (WHO), there were over 1.6 million reported cases of the disease in 2009. Now the country has begun trialling the use of anti-malarial drugs during the three to four months of the year (between July and October) when malaria cases are at their highest.

In a new mass pilot programme, around 170,000 children are being given a three-day course of amodiaquine and sulfadoxine/ pyrimethamine, which is known by the brandname Fansidar. In the past, the use of Fansidar for prevention was not recommended, since in some areas the malaria parasite rapidly built up a resistance to the treatment. There was also some concern that children needed to develop their natural immunity to malaria, otherwise attacks in adulthood could be more dangerous.

But while these concerns have held back using preventative strategies in the past, the WHO is currently advising that Fansidar can be used in combination with another anti-malarial such as amodiaquine and where drug programmes only run seasonally ie. for only a few months of the year. Speaking to the news agency IRIN, a malaria expert at the London School of Hygiene and Tropical Medicine said the use of such drugs was “a highly effective strategy [when] targeted at the peak period of risk when over 80% of malaria attacks occur in countries like Mali”.

The programme is being overseen by Médecins Sans Frontières (MSF), who have already reported a decline of 75% in cases of uncomplicated malaria and a 60% drop in malaria-related hospitalisations a week after the first distribution of the medication in the Koutiala district in the southeast. Nurses and community health workers have been administering the first doses at fixed sites or door-to-door in smaller villages and then teaching mothers how to give the remaining doses.

However, health workers and MSF staff have stressed that this intervention must go hand in hand with other prevention activities such as the use of insecticide treated nets (ITNs). In Mali, around 90% of households have at least one ITN. And in some districts insecticide spraying is also used to control mosquito numbers.

Given the early success of the pilot programme, the Malian Ministry of Health aims to extend the scheme to four other areas - Kita, Kolonkani, Bankass and San - in 2013 and across the whole country in 2014. According to the director of the National Programme to Fight Malaria, the funding is currently available to do this, though unfortunately there are no guarantees for the future. After a coup in March, the country is still waiting for democratic elections and the north is no longer under government control.

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