Maximizing the Effective Use of Artemisinin Combination Therapy in Sikasso Region, Mali
Increasing mortality from drug-resistant falciparum malaria is a cause of great concern, especially in sub-Saharan Africa. Resistance of Plasmodium falciparum to chloroquine is now widespread in Mali, with rising rates of treatment failure. The government of Mali has recently decided to switch to artemisinin combination therapy (ACT) as first-line treatment for malaria. This project will adapt intervention elements, such as treatment guidelines, job aids, and outreach materials, to be used in the introduction of ACT at the community level. Operational aspects of the introduction of artemisinin combination therapy at the community level will then be investigated. Specifically, we will evaluate the appropriateness of use of ACTs by community health workers, including the levels of over-treatment of malaria, the prescription and dispensing of correct doses of ACTs, and the counseling given by health workers to encourage appropriate drug use. The levels of correct administration of ACT drugs in the home when prescribed for children with a presumptive diagnosis of malaria; and, the determinants associated with administration of a full course of antimalarial medicine will also be investigated. The study will provide information regarding the ability of community health workers to appropriately dispense antimalarial combination therapies, and make recommendations on the types of training and supervision that are needed when artemisinin combination therapy is introduced for routine use at the health facility and community levels.