How to battle malaria: Africans not getting the best medication.

Malaria continues to be a huge problem for most of Africa leading, tragically, to many unnecessary deaths as well as impacting the continent's productive output when workers fall ill. Yet malaria is largely a preventable and treatable disease, and just as the distribution of bed nets has had a real impact on the number of cases of this disease, so have new medicines for its treatment have shown real promise. Yet, remarkably, the roll out of new effective drugs has been painfully slow. In particular, the use of Arteminisin-Combination Therapy (ACT) has been delayed even though ACT is a much more efficient drug than those currently in use across Africa.

As well as being a much faster acting drug than the older drugs like chloroquine, they work better because the malaria parasite has not built up resistance to their action.

The problem is that although ACTs are now widely accepted to be the best anti-malarial drugs available, they are not getting to those Africans that need them most because of bureaucratic bottlenecks.

Dr Prudence Hamade, a malaria expert at Medecins Sans Frontieres, has said that "almost all the global players involved in tackling malaria have made firm commitments to ACTs on paper and the World Health Organisation has officially recommended that countries switch to using ACTs as soon as older malaria drugs fail to work well".

She has also commented that "43 out of 53 African governments have re-written their national malaria policies and agreed to use ACTs as their 'first-line' treatment. The Global Fund to Fight Aids, TB and Malaria has pledged nearly $2bn to malaria programmes, and other big donors have also promised huge sums of money. It's all there on paper, but way to little is happening on the ground."

It boils down to speeding up the WHO certification process so that governments know which type of these new ACTs they should order. They must choose those that are the most appropriate for the resistance patterns in their country. We also need more education at the community level so that patients understand the new treatment regimes, which differ markedly from older drugs like quinine.

I hope that the use of the correspondence columns in your highly respected journal might raise awareness of these issues and help speed the introduction of these new drugs across the continent and thereby help save many, many lives.

Dr Sam Aharon

Mt Elgon, Kenya