Malaria Treatment Policy Change and Implementation: The Case of Uganda
Table 2
How the decision to select the first-line treatment was reached.
Combination
Decision
Comments
Artemether/Lumefantrine (3 days-course)
Possible
Shown good efficacy in Uganda, Kenya, Tanzania and other African countries; good effectiveness in Uganda; coformulated tablets, prepacked in treatment courses for specific age groups
Artesunate (3 days) + Amodiaquine (3 days)
Possible
Shown good efficacy in Uganda; co-packaged; provider and consumer acceptance of Amodiaquine was low hence co-packaging instead of coformulation could encourage administering Artesunate and leaving Amodiaquine, some resistance to the combination already documented in Uganda
There was already high resistance of P. falciparum to SP in Uganda and in the sub-region; and already some resistance to Artesunate—SP combination in Uganda
According to WHO recommendations this combination should be an interim policy recommended where ACTs cannot be immediately deployed and where parasite resistance to both AQ and SP is still low. Already in Uganda there was high resistance of P. falciparum to SP. There was also high probability of cross-resistance between AQ and CQ, reducing further the efficacy of AQ+SP combination. Already one site (Tororo) showed parasitological resistance to AQ+SP combination of 32.5%
Artesunate (3 days) + Mefloquine (MQ) AS/MQ
Rejected
Not recommended by WHO for high transmission areas.
