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Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance
consumer. And in many cases, the printed information is of no use whatsoever because the consumer is illiterate.
Difficulties reading antimalarial instructions are well documented (Ansah et al., 2001; Okonkwo et al., 2001; TDR/RBM, 2002). In addition, verbal instructions are often inadequate. In Zambia, many children suffering from malaria did not receive the appropriate 3-day course of chloroquine because their caregivers did not receive adequate instruction on how to administer the drug (Baume et al., 2000). In Uganda, only 38 percent of children received chloroquine in compliance with instructions given by health workers or drug shop attendants (Nshakira et al., 2002). Obviously, consumers can only use antimalarials correctly if they receive a full explanation from a health care provider or drug seller, or appropriate written and graphic labeling accompanies the drug.
Good labeling, in fact, is a minor added expense for producers that yields an excellent return on investment. In a three-armed Nigerian study of antimalarial treatment with chloroquine syrup, the addition of a pictorial insert plus good verbal instructions doubled adherence with the correct dosing regimen (Okonkwo et al., 2001). The pictorial insert added only US$0.01 per patient to the base cost of US$.30 for the syrup.
At the Abuja Summit in April 2000, African heads of state agreed that, by 2005, 60 percent of malaria sufferers should have prompt access to affordable, appropriate treatment within 24 hours of the onset of symptoms (WHO, 2000). This recommendation coincided with increasing interest in extending malaria treatment closer to home, or even within the home. Although there is, at present, no single accepted definition of home-based malaria therapy, the general idea is to greatly improve access to efficacious medicines at the most peripheral levels, and to increase community members’ knowledge about how to use antimalarial medicines properly (Bloland et al., 2003).
In fact, unsupervised home treatment with antimalarials has been a common practice in certain African countries and settings for many years (Breman and Campbell, 1988; Deming et al., 1989; Ahorlu et al., 1997; Nshakira et al., 2002), especially where local residents are dissatisfied with formal health services. In a recent study in Kenya, home treatment with an antimalarial drug was given to 47 percent of children under 5 years (for 32 percent, this was their only antimalarial treament), 43 percent were taken to a health facility, and 25 percent had no antimalarial treatment (Hamel et al., 2001). In Mali and Nigeria, 76 and 71 percent of mothers, respectively, managed their child’s illness at home with antimalarial drugs (Thera et al.,