Seeking treatment with caution – anti-malarial treatment in the Gambia

Why do some people in sub-Saharan African countries avoid anti-malaria treatment? For non-immune populations, malaria is a frightening disease that tends to be treated immediately. In the Gambia where virtually everybody suffers from multiple malaria episodes during a lifetime only a small fraction of infected individuals (about 20 per cent) look for treatment. Researchers from the Medical Research Council Laboratories in the Gambia investigate this problem.

Malaria kills at least one million people every year. New anti-malarial drugs are becoming available, especially artemisinin (extracted from the dry leaves of sweet wormwood) derivatives which are fast, effective, cheap and safe. However, in order to make an impact on the morbidity and mortality caused by malaria, these drugs must be administered on a large scale. The researchers in their report, 'Treatment uptake by individuals infected with Plasmodium falciparum in rural Gambia', studied the uptake of these drugs in rural Gambia.

During the nine months of the study, the field workers treated for free all those who presented themselves with malaria symptoms in four villages and entered the cases into a database. They also estimated the prevalence of malaria in the population by selecting a group of villagers to provide a blood sample once a month. This was then examined for signs of infection. Finally, they estimated the number of villagers who practised self-treatment. The results of the study were:

• The prevalence of individuals infected with the malaria parasite Plasmodium falciparum peaked in November when on average 61 per cent of individuals were infected. In one village more than 80 per cent of the population was infected with malaria.
• Children between the ages of five and ten were more frequently infected.
• Although variable across the four villages, requests for treatment were low overall even though the treatment was offered in each village for free within easy walking distance. Only 20 per cent of those infected sought treatment within one month (14 days before or after a positive blood sample had been collected).
• A larger number of people sought treatment during the months of October and November, coinciding with the "malaria season".
• Self-medication was very low. Only 2.5 per cent of those interviewed had done so during the previous season.

The policy implications of the study include:

• Many infections go untreated because of their sub-clinical nature (they present no symptoms). These infected individuals continue to transmit malaria.
• New ways of reaching people with asymptomatic (without obvious symptoms) infections are necessary because (a) they may later suffer from long-term effects such as anaemia and (b) they transmit the disease.
• Presumptive treatment in high-risk populations might be one approach to reducing morbidity and mortality related to malaria.
• It is necessary to carry out further qualitative studies to understand the health beliefs and barriers to treatment uptake.
• More research is needed to obtain more information on how many people infected with malaria are completely unaware of the infection and how many feel unwell but do not seek treatment.

Source(s):
'Treatment uptake by individuals infected with Plasmodium falciparum in rural Gambia, West Africa', Bulletin of the World Health Organisation 80 (10): 790-796, by L. Seidlein et al., 2002

Funded by: UK Medical Research Council Laboratories, The Gambia

id21 Research Highlight: 26 March 2003

Further Information:
Lorenz von Seidlein
Medical Research Council Laboratories, The Gambia
and International Vaccine Institute
Republic of Korea
PO Box 14
Kwanak, Seoul
Republic of Korea

Contact the contributor: lseidlein@ivi.int

Medical Research Council Laboratories, Gambia

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'Sticking with it: linking patient information and chloroquine adherence in rural Ghana'

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