Malaria Treatment With Injectable ArteSunate
Malaria Treatment With Injectable ArteSunate
The MATIAS study aims to demonstrate through limited scope implementation studies how
 injectable artesunate may be progressively rolled out nationwide in the Democratic Republic
 of the Congo as the preferred treatment for severe malaria.
In 2010 the AQUAMAT study demonstrated that the treatment of severe malaria with artesunate
 in children reduced the case fatality substantially. An overall reduction of 22.5 % of
 mortality in African children (< 15 years) was reported using injectable artesunate compared
 to injectable quinine for treatment of severe malaria caused by Plasmodium falciparum. These
 results with high quality evidence led to a change in the WHO guidelines for the treatment of
 severe malaria in 2011. The WHO now recommends intravenous artesunate as the treatment of
 choice for severe malaria in children and adults. In early 2012 the Programme National de
 Lutte contre of Paludisme (PNLP) of the DRC with support from the relevant ministry
 departments decided to follow the WHO guidelines and changed the policy for the treatment of
 severe malaria in children and adults from injectable quinine to injectable artesunate.
 However, this process is a complex undertaking, requiring many operational and clinical
 adaptations. In order to support this process, there is a need for on-site operational
 information on the process and consequences of the switch from quinine to artesunate. The
 MATIAS study aims to demonstrate through limited scope implementation studies how injectable
 artesunate may be progressively rolled out nationwide in the Democratic Republic of the Congo
 as the preferred treatment for severe malaria.
Inclusion Criteria:

 Patients (= 2 months old) admitted to one of the study sites and treated for severe malaria
 with IV quinine in the first part of the study and patients treated with IV/IM artesunate
 in the second part of the study will be included. Patients need to fulfill the WHO criteria
 for severe malaria and must be unable to take oral treatment (WHO, 2010, WHO, 2011). In
 addition all participants need to give their informed consent

 Conditions: Positive rapid diagnostic test (RDT) for Plasmodium falciparum HRP2 or lactate
 dehydrogenase and/or a positive blood slide (thick smear). Patient will be considered to be
 positive if one of the two tests is positive. In case of negative result of both tests, the
 patient will not be enrolled in the study and will receive care according to the usual
 routine practice in the hospital/health center in question.

 Definition of severe malaria according to WHO (WHO, 2010): In a patient with P. falciparum
 asexual parasitaemia and no other obvious cause for the symptoms, the presence of one or
 more of the following clinical or laboratory features classifies the patient as suffering
 from severe malaria:

 Clinical features (hospitals and health centers):

 -  impaired consciousness or unrousable coma

 -  prostration, i.e. generalized weakness so that the patient is unable walk or sit up
 without assistance

 -  failure to feed

 -  multiple convulsions - more than two episodes in 24 h

 -  deep breathing, respiratory distress (acidotic breathing)

 -  circulatory collapse or shock, systolic blood pressure < 70 mm Hg in adults and < 50
 mm Hg in children

 -  clinical jaundice plus evidence of other vital organ dysfunction

 Complementary Laboratory findings (hospitals only)

 -  severe anaemia (Hb < 5g/dl, packed cell volume < 15%)

 -  hypoglycemia (blood glucose < 2.2 mmol/l or < 40 mg/dl)

 -  metabolic acidosis (plasma bicarbonate < 15 mmol/l)

 -  serum creatinine > 265 ìmol/l suggesting renal impairment

 Exclusion Criteria:

 Patients with known serious adverse reactions to quinine and artemisinin derivatives or
 patients who have received adequate antimalarial treatment 24 hours before admission will
 not be included in the study.

 Women with known or suspected pregnancy in all trimesters will not be included in the study
 and will be treated with quinine infusions according to the new national DRC guidelines
 (Programme Nationale de Lutte contre le Paludisme, 2012). According to current routine
 procedures determination of pregnancy will be done by medical anamnesis and/ or by a
 positive pregnancy test.