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18 November 2017
PLATFORM2013: Cameroon’s Anti-malaria campaign Print
Monday, 13 January 2014 09:59

University of Yaoundé 1’s feature in PLATFORM2013 discusses how treatment policies for uncomplicated malaria in Cameroon have changed four times since 2004, and how, to reach the goal of universal malarial treatment coverage, policy changes must take into account evidence from field-based studies to win the battle against malaria.

Researcher: Prof. Wilfred F Mbacham | Coordinator, Graduate Programme for Life Sciences | University of Yaoundé 1 | Cameroon.

[Portrait: Vice-Chancellor Prof. Maurice Aurélien Sosso]

Research in Context
At the University of Yaoundé 1 research is fuelled by two drives: the quest for a fundamental understanding of systems, and the application of results for development,” said Vice-Chancellor Prof. Maurice Aurélien Sosso when discussing Research Uptake.

By forging bidirectional, intercontinental synergies and cooperation, the UYI’s three-fold mission entails teaching, research and contribution to development. These intersect with a desire to professionalise, consolidate and modernise the University of Yaoundé 1’s current operations and the definition of eleven strategic development objectives Research Uptake results. Of these, the seventh strategic objective is to improve the health of Cameroonians. To this end, the University of Yaoundé 1 is committed to establishing evidence that supports the best uncomplicated malaria treatment options in Cameroon. Prof. Mbacham, alongside other ace malarialogists at the UYI, make a technopole of expertise that has provided information to reshape policy in the development of national therapeutic guidelines, and is using reverse epidemiology to explore new questions on how to improve on the management of uncomplicated malaria. These questions will directly affect how treatment will subsequently be administered and would not have been possible without field experience.”

Evidence on safety and efficacy corroborate Cameroon’s change of policy
A study that began in Cameroon in 2004, at the time of a malarial-treatment policy change to artemisinine-based combination therapy, has today extended to 51 health institutions, involving 6 000 patients and has generated 13 million bytes of data. This study was to evaluate the safety and efficacy of monotherapy with amodiaquine (AQ), sulphadoxine-pyrimethamine (SP) or their combination (AQ-SP) for the treatment of uncomplicated plasmodium falciparum malaria in children in Cameroon. Results demonstrated a failing efficacy to AQ and SP of 60–75%. Subsequently, an investigation of the Artemisinine Combination Therapy (ACT) was pursued with a demon- stration that the safety and cure rates of the various combination therapies (Artesunate-Sulpho- methoxypyrazone Pyrimethamine, Artemether-Lumefantrine, Dihydro-Artemisinine-Piperaquine and Artesunate-Amodiaquine) were above 95%, thereby justifying that the change in policy was necessary in reducing morbidity and deaths due to malaria.

An important finding in the field was the observation that Cameroon was in flagrant violation of “Appropriate Treatment” as defined by the World Health Organisation (WHO), which requires that patients who are malaria parasite-negative should not be treated with Artemisinine Combination Therapy. A cross-sectional cluster survey was conducted in Cameroon among individuals of all ages who sought treatment for a fever, which is a known symptom of malaria.

The percentage of patients that were prescribed or received an ACT differed significantly, depending on the type of facility where they had sought treatment: 65% of patients at public facilities, 55% of patients at private facilities and 45% of patients at medicine retailers. Of all of these only 50% were parasitologically-confirmed malaria cases.

Physician and caregiver habits limit anti-malaria universal coverage
Malaria rapid diagnostic tests (RDTs) have been presented as a means to operationalise the new WHO guidelines published in 2010, which restrict the use of anti-malarials to parasitologically confirmed malaria cases only.

With Cameroon’s plan to introduce the RDTs to replace microscopy or clinical diagnosis of malaria at health facilities, a three-arm intervention trial was conducted in 49 health facilities in the Yaoundé and Bamenda environs. As part of this intervention, clinicians enacted malaria management as a clinical practice. These enactments of malaria treatment contrasted with evidence-based guidelines emanating from the WHO, which assume that the presence of the malaria parasite is the central driver of malaria treatment practice. What the role-plays revealed was a more complex – even holistic – process behind clinical treatment decisions, which involved attention to pathophysiology, but also included accommodating the patient’s treatment wishes, looking after their own medical reputations, and utilising tests and medicines for their therapeutic effects as symbols in the process of care. Studying this treatment process was insightful in discovering some of the reasons why ACTs were being over or wrongly prescribed.

By bringing RDTs into this complex malaria treatment process, we successfully demonstrated that there was a significant change, from 68% to 40%, of physicians who refrained from prescribing of an ACT or antimalarial if the rapid diagnostic test was negative, because they were trained to attend to the aspects of holistic care. What this study made very clear, was that if RDTs are to be taken up in routine care, public health policy-makers and practitioners need to pay careful attention to the values and priorities of health workers and patients, and make sure these are taken into account when compiling evidence-based guidelines, training processes and treatment policies.

A willingness to change or reverse epidemiological (the science of the study of patterns, causes and effects of health and disease conditions in defined populations) paradigms has been useful in generating new operational directives for the National Malaria Control Programme (NMCP). The researcher, Prof. Mbacham, advises the Clinton Health Access Initiative in Cameroon and serves as the executive director of the Multilateral Initiative on Malaria, a pan-African organisation for the promotion of research excellence and control in Africa. In Cameroon he also serves as the executive secretary for the Cameroon Coalition Against Malaria (CCAM), an advocacy group that has mentored parliamentarians to be aware of the changing patterns of malaria and policy options. Prof. Mbacham has been able to use reverse epidemiology to explore new questions on how to improve on the management of uncomplicated malaria through the generation of new biomarkers of disease progression. Options for quantitative RDTs are being explored, while the multiplex diagnosis of origins of fevers are being developed into fundable proposals. These questions will directly affect how treatment will subsequently be administered and would not have been possible without field experience.

Join the Research Uptake Conversation

If this piece of evidence-based development research from SSA is of use to you, please continue the Research Uptake Conversation by contacting University of Yaoundé.

Website: www.uy1.uninet.cm

DRUSSA Research Uptake Leader at University of Yaoundé 1
Professor Maurice Aurélien Sosso
Rector
sossomaurice@yahoo.fr

DRUSSA Research Uptake Champion at University of Yaoundé 1
Professor Emmanuel Tonye
Vice-Rector of Research
Research Cooperation and Relations with Business World
tonyee@hotmail.com

PLATFORM2013 writer / researcher at University of Yaoundé 1
Professor Wilfred Mbacham
Coordinator, Graduate Programme for Life Sciences
wfmbacham@prd-college.eu

Read this article on pages 19 and 20 of PLATFORM2013 – a print and digital publication from the DRUSSA Universities in Sub-Saharan Africa [SSA] – aimed at accessibly communicating evidence-based development research with the goal of deepening its reach and impact in the region. 

Follow the PLATFORM2013 blog campaign daily until 16 January 2014. You’ll find the blog schedule on PLATFORM2013 articles from the DRUSSA Universities here

Twitter @DRUSSAfrica #PLATFORM2013 #ResearchUptake

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