A severe malaria outbreak has broken out in Ethiopia and MSF is extremely concerned by the high death tolls in several villages. In addition, the duration and intensity of the outbreak are being exacerbated by the current first-line treatment, which is failing in many cases. Consequently, MSF is requesting permission to use artemisinin-based combination therapy (ACT), as recommended by the World Health Organisation (WHO).
Ethiopia is facing its worst outbreak of malaria since 1998. High rates of malaria infections are being reported in the Amhara, Oromia, Southern Nations, Nationalities and People Regional state (SNNPR) and Tigray regions.
MSF is seeing dramatic increases in the number of patients coming to clinics in parts of Oromia and SNNPR regions with malaria symptoms. At one Buge clinic in SNNPR, figures show an increase from less than 100 malaria consultations in September to more than 800 within the first two weeks of November.
Lab tests in these regions, show that the vast majority of malaria cases are due to plasmodium falciparum, a potentially deadly form of the parasite.
The current situation is particularly worrying because the drugs currently used by the Ministry of Health, and supplied by UNICEF, with donor support, are failing in many cases. The current first-line treatment is either Sulfadoxine-Pyrimethamine alone (SP) or SP with chloroquine.
Retrospective mortality assessments, conducted in Damot Gale in SNNPR region from the end of October through the end of November, have shown high mortality rates in some villages. A crude mortality rate (CMR) of more than 1 person, per 10,000 people, per day (1/10,000/day) is considered the threshold of an emergency. In four villages where data was collected and verified, MSF found mortality rates ranging from 3.5-11/10,000 people/day. A significant number of patients who had died in the villages had taken the current first-line treatment, indicating treatment failure.
Considering MSF's experience and data, the organisation is requesting permission to use the most effective malaria treatment available today, artemisinin - containing combination therapy (ACT) - to save lives during this outbreak.
Recent examples elsewhere in Africa demonstrate that ACT has yielded extraordinary clinical results in curing patients and minimizing the transmission of the disease. MSF has field experience in the use of ACT in many other countries in Africa and has used the medicines to respond to emergencies in Kenya and Sudan.
The Ethiopian Government is aware of the problem of resistance to current first-line drugs and, in collaboration with the WHO, is conducting a nation-wide resistance study and clinical trials with the ACT Coartem. Results are expected in March 2004.
However the outbreak is happening now and an authorization from the Ministry of Health to use ACT would help reduce the numbers of new cases and reduce deaths. MSF hopes the authorisation will be forthcoming.