Rectal artesunate testing and delivery

WHO-TDR has played a pioneering role in developing the indication for pre-referral artesunate. It has developed a New Drug Application for rectal artesunate, and provided the evidence of benefit and efficacy of pre-referral treatment through a large scale placebo-controlled trial involving over 17 000 patients in Bangladesh, Ghana and Tanzania. The trial demonstrated that "if patients with severe malaria cannot be treated orally and access to injections will take several hours, a single inexpensive artesunate suppository at the time of referral substantially reduces the risk of death or permanent disability."

Currently, TDR has implementation research on:

  • The feasibility of assessing, diagnosing and referring patients with malaria at all levels of severity (funded by the European Commission) in Malawi, Burkina Faso, Uganda & Nigeria. The work includes pharmacokinetics and cost-effectiveness studies of an integrated approach, partnering with the Centres for Disease Control in the US and Malawi, and with the World Health Organization’s Integrated Management of Childhood Illness programme. There are complementary protocols with Medicines Sciences for Health (in Democratic Republic of Congo) and we partner with Maastricht University and Oxford University on the economics component.
  • The long-term developmental impacts among African children who survived malaria after treatment has begun. TDR is working with investigators in Tanzania, Bangladesh and Ghana on a new, two year grant provided by Grand Challenges Canada.
  • An assessment of more than one dose of rectal artesunate for children who cannot reach a management facility within 24 hours.
For more information, please contact:

Melba Gomes
E-mail:gomesm@who.int