One-year-old Inness Kalunga, from Mupula in Zambia, fell very ill in November 2017.

“My baby had fever, with severe vomiting and diarrhoea. She refused to breast feed or eat anything,” explained Inness’ mother, Silvia Mwape.

With no improvement by the next morning, Silvia became increasingly worried and took Inness to their local Community Health Volunteer. Because of Inness’ symptoms, the Health Volunteer suspected a severe case of malaria and immediately gave her a quality-assured rectal artesunate suppository (RAS) to buy precious time in the fight against the parasite. Inness also had a rapid diagnostic test that confirmed she had malaria.

“We were rushed to Kabamba Rural Health Centre, 30 km away, by bicycle ambulance. The Health Volunteer came with us too,” Silvia explains. “We only reached the facility hours later, around 17:30. The nurse confirmed Inness’ case of malaria and she was given an artesunate injection, the most effective and rapid cure for severe malaria."


Kabamba Rural Health Centre's team and bicycle ambulance. Photo credit: Transaid

Soon after the treatment, Silvia noticed an improvement in Inness’ condition; “she could stand up by herself again, and became more interested in what was going on around her”.

The next day, Inness was able to eat without vomiting, and began playing and running about. She was discharged later that afternoon. Silvia was then provided with an oral treatment that combines an artemisinin component and a partner anti-malarial drug, along with paracetamol and multivitamins to take home and complete Inness’ malaria treatment.

Ensuring the availability of quality-approved products to treat severe malaria rapidly after symptom onset is a crucial part of improving the case management and survival of patients in Serenje District, Zambia, where the burden of malaria falls heavily, particularly on the very young.

Thankfully, baby Inness was able to receive pre-referral treatment with RAS that bought precious time before a higher-level facility was able to provide intravenous treatment several hours later – this combination of approaches helped save her life.


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WHO-preferred first-line treatment for severe malaria is injectable artesunate (Inj AS), which must be administered intravenously or intramuscularly by well-trained healthcare workers, typically in a higher level facility such as a district hospital. However, the first point-of-care for many young patients with severe malaria is a community healthcare volunteer or a local health post where Inj AS is not available and healthcare workers are not qualified to administer it.

Given that severe malaria can kill within 24 hours if left untreated, and travel times to hospital can be long, a single dose of rectal artesunate suppositories (RAS) can buy precious time for severely ill young children unable to take oral medicines. After this intervention, they should be referred to a facility where they can receive Inj AS.

To support RAS’ uptake, in July 2017, MMV joined forces with international development organisation Transaid, in collaboration with the National Malaria Elimination Center (NMEC) of Zambia on a project known as MAMaZ1 Against Malaria (MAM).

The project, implemented by a consortium of partners,2 aims to improve severe malaria case management at facility level as well as support patient referral from the community to a health facility. These approaches include the use of bicycle ambulances to transport patients as well as community theatre involving song and dance to create awareness of malaria danger signs.

1 MAMaZ: Mobilising Access to Maternal Health Care in Zambia programme was led by Health Partners International (2010-2013, funded by DFID) and MORE MAMaZ, led by Transaid (2014-2016, funded by Comic Relief).

2 Implemented by a consortium of partners – Transaid, Health Partners Zambia (HPZ), and the Zambian organisations Development Data and Disacare together with MMV.

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