KwaZulu Natal: province-wide implementation of ACT

The right question is not "if" ACT can be effectively implemented in Africa, but "how" it can be best implemented.

The introduction of artemisinin-based combination therapy (ACT) in South Africa's KwaZulu Natal province has already had a dramatic affect on public health in the region.

The implementation of artemether/lumefantrine (Coartem) in February 2001, together with improved vector control measures, resulted in a dramatic reduction in malaria in the province: the number of malaria cases dropped from 41,786 in 2000 to 9,443 in 2001 (78% reduction). Between 2000 and 2001, admissions to Manguzi hospital in KwaZulu Natal for malaria were cut by 82% and the number of reported malaria deaths decreased by 87%.

These remarkable improvements in malaria control and public health reflect the combined effect of residual household spraying with an effective insecticide in both KwaZulu Natal and southern Mozambique, and the replacement of sulphadoxine-pyrimethamine (SP), a drug that had become ineffective because of parasite resistance, with an effective ACT as the first-line treatment of uncomplicated malaria.

These early results from KwaZulu Natal are very encouraging. The same malaria control approach will soon be implemented in the Namaacha district of southern Mozambique which will enable the gathering of data in a higher intensity transmission area.

The South East African Combination Antimalarial Therapy (SEACAT) evaluation is working with national malaria control programmes to assess where and how best to implements ACT as first-line treatment.

They are working in South Africa, Mozambique, and potentially Swaziland.

The evaluation involves monitoring therapeutic efficacy, resistance, gametocyte carriage, drug safety, treatment seeking, drug use (especially drug availability and patient adherence), distribution and intensity of malaria transmission, and the costs and cost-effectiveness of implementing ACT.