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Combating severe malaria in African children
Insights
The Africa Child Survival Initiative-Combatting Childhood Communicable Diseases (CCCD) project improved malaria control in 13 African nations. It integrated malaria management into primary healthcare, enhancing treatment and prevention strategies for children and pregnant women.
Area of Science:
- Global Health
- Infectious Diseases
- Public Health Interventions
Background:
- The Africa Child Survival Initiative-Combatting Childhood Communicable Diseases (CCCD) project, established in 1982, operates in 13 African countries, with 12 being malaria-endemic.
- The project aims to reduce childhood mortality from malaria, diarrhea, and vaccine-preventable diseases.
- Malaria control strategies focus on drug use (primarily chloroquine) for children under five and chemoprophylaxis for pregnant women, aligning with WHO recommendations.
Purpose of the Study:
- To assess the sensitivity of Plasmodium falciparum to chloroquine in children across CCCD countries.
- To evaluate current malaria treatment practices and identify areas for improvement.
- To strengthen malaria control units and integrate interventions into primary healthcare.
Main Methods:
- Drug sensitivity surveillance of Plasmodium falciparum to chloroquine was conducted in 9 of the 13 CCCD countries.
- Baseline surveys were performed in 6 countries to document existing treatment practices.
- The establishment and development of malaria control units and national malaria control plans were tracked.
Main Results:
- In areas with chloroquine-resistant P. falciparum, chloroquine treatment still reduced fever and parasite density in children, preventing severe illness.
- Baseline surveys revealed varied treatment practices, including inconsistent dosing and overuse of injections.
- Research into alternative drug treatments for pregnant women was initiated due to low chemoprophylaxis uptake.
- Malaria control units increased from 4 to 11 in malarious countries, with integrated national malaria control plans developed.
Conclusions:
- The CCCD project has successfully enhanced malaria control infrastructure and strategies in participating African nations.
- Integration of malaria control into primary healthcare and standardized treatment plans have been achieved.
- Despite challenges like drug resistance and varied practices, the initiative demonstrates progress in reducing malaria's impact on child survival.
Abstract:
An initiative to reduce childhood mortality due to malaria, diarrhoea and vaccine-preventable diseases, called the Africa Child Survival Initiative-Combatting Childhood Communicable Diseases (CCCD) project, was started in 1982 and is now operating in 13 African countries, 12 of which are endemic for malaria. The project's malaria control strategy relies on the use of drugs, mainly chloroquine, to prevent severe illness and death in children less than 5 years of age; chemoprophylaxis for pregnant women is also advised to prevent low birth weight in newborns. The strategy is based on WHO recommendations which focus on improved diagnosis and treatment of cases and chemoprophylaxis for pregnant women.In 9 out of the 13 CCCD countries the sensitivity of Plasmodium falciparum to chloroquine in children was investigated and a drug sensitivity surveillance network was established. In areas with chloroquine-resistant P. falciparum, treatment with chloroquine was found to decrease the temperature in febrile children and to greatly reduce the parasite density, thus preventing severe illness and possible death. Baseline surveys in 6 countries have shown a wide range of treatment practices, e.g., use of chloroquine in various doses without standard guidelines and the excessive use of quinine and chloroquine injections in some health units. As pregnant women are often not taking chemoprophylaxis, research has been started on alternative approaches to drug treatment to prevent the adverse effects of malaria on the fetus.Only 4 of the 12 malarious countries had malaria control units when their CCCD programme began and these were concerned mainly with vector control issues; 11 of 12 countries now have such units and a written CCCD malaria plan. These countries have now integrated malaria control activities into primary health care and have begun to implement standardized treatment and prevention practices that are described in their national CCCD malaria plans.