Standby Treatment vs. Malaria Chemoprophylaxis: Can We Prevent Malaria DeathsWithout the Use of Continued Chemoprophylaxis?

摘要

A global Malaria Control Program (MCP) was implementedrequiring non-immune workers to take malaria chemoprophylaxiswhen traveling to and working in malarial areas. Despiteintense health education efforts, four malaria deaths occurredin workers after they left malarial areas. A Malaria ChemoprophylaxisCompliance Program (MCCP) was added to theMCP to verify the use of approved antimalarial medications inworkers' urine. Results from MCCP tests suggest that there isa high level of medication compliance. Since the inception ofthe MCCP there have been questions regarding possible adverseside affects of taking long-term malaria chemoprophylaxis.An alternative strategy to continued medication usewould be to recommend that individuals carry stand-by treatmentthat could be used for early diagnosed cases. If stand-bytreatment programs could achieve the same level of effectivemalaria control as programs that require long-term chemoprophylaxisthey could reduce the costs of prescribing medicationsto large numbers of workers and the potential for theseindividuals to experience adverse health effects from takingthe medications. The authors conducted an extensive literaturereview and concluded that stand-by treatment alone couldnot be recommended for use in high risk P. falciparum areasunless the non-immune individuals were more fully trained inusing all other protective strategies and supplies for preventionand treatment. We would also need to have access to reliableand updated malaria transmission data for the areas where ouremployees worked and lived before we could adjust chemoprophylacticrecommendations by region and season.