Procuring supplies for children
Malaria medicines
Globally, malaria kills over one million people and causes 300 to 500 million cases of acute illness each year. Malaria is the leading killer of African children, accounting for about 20 per cent of all-case mortality in children under the age of five. Malaria is one of the major public health challenges eroding human development in the poorest countries in the world. It impairs intellectual development and educational attainment. It places a very high burden on health systems. The disease costs Africa more than $12 billion annually. It is believed that it slows economic growth in African countries by 1.3 per cent per year.
In response to widespread resistance of Plasmodium falciparum to monotherapy with conventional antimalarial medicines such as chloroquine and sulfadoxine-pyrimethamine, the World Health Organization (WHO) now recommends combination therapies as treatment policy for falciparum malaria in all countries experiencing such resistance. Artemisinin-based combination therapies (ACTs) are the most highly efficacious treatment regimens available. See WHO treatment guidelines.
The following ACTs are currently recommended by WHO in its treatment guidelines:
- artemether-lumefrantine
- artesunate + amodiaquine
- artesunate + mefloquine
- artesunate + sulfadoxine - pyrimethamine.
Note: Amodiaquine + sulfadoxine - pyrimethamine may be considered as an interim option where ACTs cannot be made available, provided that efficacy of both is high.
Since 2001, a total of 73 countries have adopted one of the WHO recommended Artemesinin-based combination therapies (ACTs), several as first line treatment and a few as second line. In Africa, a total of 27 out of 44 countries, and outside Africa, 20 out of 29 countries which have adopted ACTs are using these medicines in the public sector. Five countries with falciparum resistant to chloroquine have not yet adopted ACTs. UNICEF and its partners are working to encourage remaining countries to change their medicine policy in favour of the new, more effective treatments.
UNICEF and WHO conduct a joint annual tender for antimalarial medicines based on current WHO malaria treatment guidelines. Wherever possible, UNICEF will procure products pre-qualified by the WHO Prequalification Programme. Where no or limited number of prequalified products are available, UNICEF and WHO will carry out a detailed technical evaluation of other antimalarial products available in the global market, in cooperation with relevant partners and regulatory agencies.
In 2007, UNICEF procured approximately $17 million worth of ACTs, representing more than 17 million treatments. This procurement included the new, more effective anti-malaria treatment of ACTs for countries experiencing resistance to older drugs such as chloroquine.
UNICEF has closely followed developments since the US Institute of Medicine recommended a Global Subsidy mechanism for ACTs that would make antimalaria medicines affordable to developing countries. The Global Subsidy, now renamed Affordable Medicine Facility for malaria (AMFm), has received the support of the RBM Board and will be launched in 2008.
For more information on the malaria commodities available through UNICEF Supply Division, please visit the UNICEF Supply Catalogue.
See also:
WHO Malaria Treatment Policies
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UNICEF Supply Catalogue
