Rectal artesunate could halve malaria deaths

A new study published by The Lancet’s Online First service has proven that rectal artesunate could halve the rate of malaria death and permanent disability in remote rural areas of Africa and Asia.

The study, led by Dr Melba Gomes of the World Health Organization and her colleagues from the 13 Research Group, examined the effects of the drug on patients with acute malaria in Bangladesh, Ghana and Tanzania.

Artesunate is an anti-malaria drug from the artemisin group of drugs, derivatives of sweet wormwood. It is usually taken as a pill or injected. However, a suppository version has been developed for situations where neither oral treatment nor injections are options. It is intended as an emergency measure to prevent patients from dying in the critical period before they are able to access adequate healthcare.

The study took place in 291 rural villages across the three countries, and 17,826 people with suspected malaria took part. In Africa, all the patients were children aged between six months and six years. But in Asia, half were similarly-aged children and half were older children or adults. The patients were randomly allocated either an artesunate suppository or a placebo. A total of 8,954 were given artesunate and 8,872 a placebo. Most had a drop of blood taken for analysis, and 4,648 samples were found to have no malaria parasites present. These patients were discounted.

The results showed there was no significant difference in death or permanent disability rates of those remaining patients who were able to reach a clinic for injections within six hours. However, many patients were unable to reach a clinic within six hours, and half of these had still not arrived after 15 hours. Among these patients, there were dramatic improvements and rectal artesunate was shown to halve the risk of death or permanent disability. Of the 1,566 artesunate patients without further treatment after six hours, 29 died or were permanently disabled. Of the placebo patients, the figure was 57 out of 1,519.

This new study follows the groundwork done by Professor Sanjeev Krishna and his team at St George’s, University of London in Ghana in 2001.