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Fight Against Malaria 2019

The life-saving benefits of pre-referral management


Pierre Hugo

Senior Director, Access and Product Management, MMV

In some countries, there is a — sometimes fatal — time lag before patients with severe malaria can start full treatment at health facilities. That is why ‘pre-referral’ medication is so critical.

Treating patients with severe malaria is a race against the clock. “Severe malaria is the end stage of a terrible disease,” explains Pierre Hugo, Senior Director, Access and Product Management at MMV (Medicines for Malaria Venture), a leading product development partnership in the field of antimalarial drug research and development.

“With severe malaria, if intravenous antimalarial treatment is not administered quickly, critically ill patients may die.” The vulnerable and immune-compromised (children under five and pregnant women) are particularly at risk.

Patients with severe malaria must immediately be referred to a health facility to be treated with injectable artesunate, which is administered into a vein or at least a muscle so it can work very quickly. Tragically, many patients are so ill they die before they get there.

Patient access to health centres is limited

“In some countries, not everyone has immediate access to health facilities,” says Hugo. “Rural areas may be over 30km from the nearest health centre and it can take hours to get there. And when patients with the disease do get there, they may have to wait.”

Time, therefore, is of the essence — and studies have shown that if such patients are first given ‘pre-referral’ rectal artesunate (RAS) 100mg in their own community, ideally administered by community health workers, their risk of disability and death during the journey to a healthcare facility is halved.

Pre-referral medication is a matter of life and death

Administering RAS to children under six years old ‘buys patients time’ until a full course of treatment can begin at a health facility. Simply put, RAS could mean the difference between life and death.

To ensure the availability of RAS at community level, more governments need to recognise its benefits and include it in their treatment guidelines. “RAS 100mg medication is now registered in 16 countries,” says Hugo. “It is a life-saving tool and should be implemented widely. The other critical piece of the puzzle is for those same countries to ensure they have a network of trained community health workers in order to administer it.”

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