Estimating population coverage of artemisinin-based combination therapies (ACT)

Successful malaria control depends on prompt treatment with effective anti-malarial drugs. Although Artemisinin-based combination therapy (ACT) is the recommended first-line treatment for P. falciparum malaria, overall deployment of the treatment has been slow, allowing the continued spread of malaria.

Malaria is a huge problem in sub-Saharan Africa, where for many years it was the leading cause of death for children under five years old. In 2015 there were 15,300 children under 5 in sub-Saharan who died from malaria.

This study breaks new ground, as it is the first to estimate ACT coverage for children under 5 across sub-Saharan Africa. Data was collected from a wide range of surveys between 2003 and 2015, concerning children under 5 who reported a fever within the previous 14 days prior to the survey, had been assessed for P. falciparum infection using a rapid diagnostic test (RDT), and were treated with ACT.  A generalised additive mixed model was used to estimate ACT coverage across the region for the last twelve years.

Results show that the coverage of ACT has increased across sub-Saharan Africa for children under 5, but that it remains unacceptably low. In 2015, only 19.5% of these children were likely to receive treatment. The likelihood of treatment was lower in poorer, rural populations, and those who receive care through the private sector.

ACT Coverage, 2000-2015
ACT Coverage, 2000-2015

This study is more accurate than earlier work since previous studies measured the proportion of children who reported fever in the last 14 days, but did not take into account how many of these children had been tested for malaria infection. The authors suggest that infection status assessed by RDT be used as part of an improved indicator for future studies.

Findings from this important study show that more work is needed at the country level to understand how improvements can be made to health-care and ACT supply so that all children can receive the treatment they need to fight malaria infection, and contribute to efforts to eradicate the disease from this region.

Full Citation

Population coverage of artemisinin-based combination treatment in children younger than 5 years with fever and Plasmodium falciparum infection in Africa, 2003–2015: a modelling study using data from national surveys; Dr Adam Bennett, Donal Bisanzio, Joshua O Yukich, PhD, Bonnie Mappin, Cristin A Fergus, Michael Lynch, Richard E Cibulskis, Samir Bhatt, Daniel J Weiss, Ewan Cameron, Peter W Gething, Prof Thomas P Eisele, The Lancet Global Health , Volume 5 , Issue 4 , e418 – e427

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