Impacts Of Antimalarial Drugs On Malaria
YAHYA AHMED BOUKER HAWBANI
Introduction The burden of managing malaria is lowering worldwide but it is still a threat in the African region. Understanding the current practices for malaria management can help to determine the gaps that need to be filled in order to achieve effective malaria management in Africa. This systematic review focuses on the actions implemented for malaria management in Africa. These include identification of the current malaria management practices, availability of antimalarial drugs, and evaluation of the affordability and quality of the available drugs. Methods A comprehensive literature search was undertaken on online scientific databases such as PubMed and Cochrane. The following search terms were utilized - ‘malaria’, ‘management’, ‘Africa’, ‘antimalarial drugs’, ‘antimalarial’, and ‘quality’. The studies were limited by years of publication (2015-2020), and stringent inclusion and exclusion criteria were pre-specified to screen for and select the most relevant research articles. The quality of the data available was assessed using Critical Appraisal Skills Programme (CASP) tool. The PRISMA guidelines were adhered to for this systematic review. Results The findings of this systematic review address four main themes - the quality of management of malaria in the African region, the management of malaria in pregnancy in the African region, the assessment of diagnostic tests for malaria in the African region, the effectiveness of specific interventions as regards the incidence and management of malaria, and the availability of, and adherence to anti-malarial drugs in the African region. Conclusion There is a lack of standardisation and harmonization of the indicators and metrics of health quality where the management of malaria is concerned. There are variations in what is construed to be the full malaria case management pathway, the importance of counselling during the prescription process is inappropriately understated. There is a lack of knowledge when it comes to managing malaria in pregnancy, and pregnant patients are not acknowledged as high-risk patients. There is also inconsistency regarding the intermittent preventive treatment policy for malaria in pregnancy; only 39 out of 47 African countries have such a policy. Although RDTs have a moderate performance vis-à-vis the gold standard microscopy test, their cost-effectiveness has not yet been definitively determined. While antimalarial are widely available in both public and private sectors, their price mark-up remains a financial barrier to the community, especially in hard-to-reach rural areas. Finally, an increasing mobile phone penetration throughout the African region suggests that mobile health solutions could address the top reasons for non-adherence to anti-malarial therapy; namely, forgetfulness and a lack of health literacy.