Malaria continues to be the leading cause of death in African children. Of an estimated 781,000 malaria-related deaths reported in 2009, 91% occurred on the African continent, and 85% were among children under the age of five.

The majority of the 225 million cases of malaria reported worldwide in 2009 were uncomplicated (or simple) malaria, and while this represents a significant burden of illness, these cases are, for the most part, non-fatal. However, around eight million simple malaria cases will progress to severe malaria annually.

Patients who have severe malaria show clinical signs of organ damage, which may involve the brain, lungs, kidneys or blood vessels. By definition, all malaria deaths are the result of severe malaria. Uncomplicated malaria is most likely to progress to severe malaria in patients who have not repeatedly been exposed to malaria in the past, and so have not had a chance to develop an immune response against the parasite. For this reason, children are the most vulnerable. Severe malaria has been described as a life-threatening medical emergency and a neglected disease that poses a significant economic burden on most African countries.

Severe malaria has traditionally been treated with quinine. Today, the latest scientific evidence clearly shows that many more children’s lives can be saved by switching treatment from quinine to a more effective drug, artesunate. However, making this switch will require a concerted effort and dedicated support from the international community. Médecins Sans Frontières (MSF) has long been an important provider for malaria diagnosis and treatment and treated over one million cases of malaria in Africa in 2009. In response to the latest evidence, MSF has revised its treatment guidelines for all projects to replace quinine with artesunate, and is working with national ministries of health to be able to introduce artesunate in all countries where MSF works.

This report, based on a review of the latest scientific evidence, coupled with information from MSF’s malaria programmes across Africa, highlights some of the important challenges in making this life-saving switch to artesunate for the treatment of severe malaria especially in children, and provides some recommendations for the way forward.