In many countries in sub-Saharan Africa, large numbers of
children with fever receive antimalarial treatment. Since the
early 2000s, almost all sub-Saharan African countries have
revised their national drug policies to promote artemisininbased
combination therapy (ACT), an efficacious but
expensive treatment course. The vast majority of treated
children, however, still receive drugs like chloroquine, which
is no longer effective in most malaria-endemic areas. Future
surveys are expected to show much higher ACT coverage,
as ACT procurement has increased 30-fold, from just 5 million
treatments in 2004 to 160 million in 2009.
Some countries have begun to scale up the use of diagnostics,
employing microscopy at health facilities and rapid diagnostic
tests. This shift away from presumptive malaria treatment for
all children with fever presents a challenge for interpretation
of data. Discerning trends in antimalarial treatment requires
an understanding of the country context – lower rates of
treatment with antimalarial medicines may indicate better
targeting, such that only those children who have malaria
are treated for it.
Intermittent preventive treatment during pregnancy (IPTp),
which consists of at least two doses of sulfadoxinepyrimethamine
received during the second and third
trimesters of pregnancy, is highly effective in reducing
the prevalence of anaemia and placental malaria infection
among women at delivery. It is thus a vital intervention for pregnant women in endemic areas.
In many countries, there is relatively little difference in IPTp
coverage between urban and rural areas. In Mozambique
and the United Republic of Tanzania, however, pregnant
women in urban areas are much more likely than those in
rural areas to receive IPTp.