CLINICAL GOVERNANCE - ACCESS TO EMERGENCY CARE -'Bicycles revealed as secret weapon in fight to cut deaths from malaria in children'

28 AUGUST 2018 • 11:48 AM

The number of children dying from malaria has been dramatically cut with the introduction of a new drug and bicycle transport to hospital.

In a pilot project in the Serenje district of Zambia, children with suspected severe malaria were given the drug rectal artesunate (RAS) and then transported to a health facility for further treatment.

The combination of the drug and prompt referral cut death rates by 96 per cent, compared to the previous year when the drugs and transport were not available.

During the year-long project just three children died, compared to the 97 that would have been normally expected to die among the 1,215 children that contracted severe malaria during the 12-month period.

Normally 8 per cent of children die from the disease in the district and that was cut to 0.25 per cent during the project.

The majority of deaths from malaria are among children and it is the biggest killer of the under fives in sub Saharan Africa. The most up to date figures show that 300,000 children died from the disease out of a total of 446,000 in 2016.

RAS was first recommended as an emergency treatment for malaria by the World Health Organization more than 10 years ago but there was no approved medicine available until late last year.

During the project, run by Medicines for Malaria Venture, transport charity Transaid and the Zambian National Malaria Elimination Centre, 500 community health volunteers were trained to teach parents about the signs of malaria and administer the malaria drug. Emergency transport riders were also employed to take children to hospital on trailers attached to bikes.

RAS on its own will not save lives but it buys vital time, giving children around 12 hours to get to a health facility - this is crucial in rural areas where health facilities are sparsely located or are difficult to get to.

Another key aspect of the project was ensuring that health facilities had the injectable form of the malaria drug artesunate and 31 health workers were trained to administer this.

Pierre Hugo, senior director for access and product development at Medicines for Malaria Venture, said that giving RAS on its own would not have saved children’s lives.

“Before the project patients weren’t being referred to health facilities or they were being referred or not going because they didn’t have the money or the means to get there,” he said.

Now the sick child and their mother or father are put in a trailer attached to a bicycle and taken to a health facility. The last stage of the journey was previously known as the killing mile because of the number of children who died before they could get life-saving treatment.

Mr Hugo added: “The project has been successful because we had the drug available, had trained healthcare workers, had someone to get them to the facility and, crucially, the health facility had injectable artesunate.”

He said that three more districts in Zambia were working with the government to implement the project which, he said, was replicable in other countries. “The drug has been procured by other countries so that’s really encouraging.

"In fragile states and countries with poor public health infrastructure this is the ideal drug because it gives a much better survival rate by buying that extra time until a patient can get to a health facility,” he said.

Caroline Barber, CEO of Transaid, said: “The number of lives saved is a real testament to how important timely access to healthcare services is and we’re delighted to be able to share such excellent results and are now looking at how this approach can be scaled up across Zambia.”

Joseph Ana

AFRICA CENTRE FOR CLINICAL GOVERNANCE RESEARCH & PATIENT SAFETY

@Health Resources International (HRI) WA.

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