University of Antwerp leads international research into problem of frequent malaria treatments

"Treatment of recurrent malaria is possible with the same therapy"

Malaria may seem to be on the way out, but in fact it remains a serious problem. International research led by the Global Health Institute at the University of Antwerp, and conducted in partnership with the universities of Kinshasa (DR Congo), Mbarara and Makarere (Uganda), has now demonstrated that patients with recurrent malaria can be treated with the same therapy used the first time around. "This is good news, because there is only one therapy available in almost all African health centres and in the field."

Since the beginning of this century, the number of registered malaria cases has been in decline. Malaria patients have decreased by 37%, and deaths due to malaria are down a dramatic 60%. The disease remains a major problem, however: in 2015, there were 214 million registered cases and 438,000 deaths linked to malaria.

Lack of information

The World Health Organization (WHO) recommends that malaria be treated with artemisinin combination therapy, or ACT. If the disease returns within four weeks, the WHO recommends using an alternative ACT in combination with quinine and an antibiotic. Yet experience has shown that prescribers often lack important information about the patient’s recent medical history – which is why the patient will often receive the same 'first-line’ treatment.

Under the supervision of the Global Health Institute, affiliated with the University of Antwerp, an international team recently carried out a study in Uganda and Congo. "Of the more than 2,000 children we examined in both countries, 571 were re-treated", explain Prof Jean-Pierre van geertruyden and Hypolite Muhindo Mavoko, who wrote his PhD on the subject. "The results showed that re-treatment with the first ACT therapy had the same effectiveness as the therapy for recurrent malaria patients prescribed by the WHO."

Only one available

These findings present a number of opportunities, according to Van geertruyden: "Most African health centres are only able to prescribe the first-line ACT therapy, and their health workers are only familiar with the schedule of this one treatment. Obviously, it is imperative that the medication is administered in the correct dosage. A second, more surprising observation from the study was that the current treatment duration of three days for all available malaria treatments is probably too short and should be extended.  Further research will also need to determine whether re-treatment with the same therapy could lead to resistance in the longer term."

The research was funded by the FWO (Research Foundation – Flanders), VLIR-UOS (Flemish Interuniversity Council – University Development Cooperation), EDCTP (European and Developing Countries Clinical Trials Partnership) and BTC (Belgian Technical Cooperation). The results are presented in detail in The Lancet Global Health.

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