topnaman | Malaria blog

The evidence just keeps piling up with this new report from Africa Fighting Malaria and a series of papers in Malaria Journal (1, 2, and 3). Not only is the availability and cost falling short of goals as we’ve discussed (here, here, here and here), the patient-centered outcomes which actually matter, are likely far worse. In addition to flaws [...]

Truly beautiful studies – well designed, well thought, even examined cost and service delivery – were recently conducted for regular, presumptive antimalarial treatment (using SP and amodiaquine) of children in Mali and Burkina Faso in settings where treated bed-nets are already in use (PLoS Medicine – open access!). The intervention was effective at reducing clinical burden – [...]

No. According to a recent report by the Evidence to Policy Initiative (funded by the Gates Foundation which in turn also supported the ACT subsidy idea) . The conclusions are no surprise (see here and here for previous discussions on the idea of selling subsidized artemisinin combination therapy in pharmacies). The summary points were: Pilots [...]

The Affordable Medicines Facility for malaria (AMFm, previously introduced here) may go down as one of the largest failures in public health history. Subsidizing effective antimalarials (namely artemisinin-combination therapies) for sale through private vendors (largely the wide-spread pharmacy/drug kiosk) is an untested idea for increasing access – yet is backed by more than $225 million [...]

It worked. Really well. Vivax malaria can relapse from liver stages (hypnozoites) adding to patient burden and further transmission. In tropical settings, upwards of 50-80% of patients may relapse within 1-3 months of the primary infection. Treating the dormant liver stages, which are unaffected by standard therapies, requires 14 days of treatment with primaquine. Adherence [...]

Rapid diagnostic tests for malaria (and other diseases) can extend diagnosis to remote areas. This is sorely needed. Beyond benefits against the disease at hand, the introduction of diagnostics along with associated systems of quality assurance can strengthen the overall health system (previously discussed here). A major barrier for expanding the use of rapid tests [...]

Today, the Affordable Medicines Facility for Malaria was unveiled in Norway (great NY Times piece) with an initial $225 million. The subsidy program aims to increase the availability of affordable artemisinin combination therapies (ACT) – the recommended first line treatments for malaria – through private drug shops. Many people in some countries self-treat with antimalarials [...]

My friend Atanu Dey at Deeshaa.org often speaks of the fallacy of implementing technological solutions to overcome fundamentally non-technological problems. While Atanu usually invokes this paradigm in reference to India’s primary education challenge, I believe the same concept is relevant to public health efforts. Many public health problems today are non-technological, i.e. we have effective [...]

Studying health delivery means figuring out which techniques work for getting the interventions to the people who need them the most. It means studying how to scale effective techniques, and studying how we can speed up policy making processes. Sounds simple doesn’t it? Unfortunately, its rarely done and certainly without the scientific rigor we apply [...]