MALARIA TREATMENT IN VANUATU - NEW NATIONAL TREATMENT GUIDELINES

In Vanuatu malaria is a major killer, especially of young children. As most deaths occur outside the hospital it is very important to have s imple, clear guidelines on the management of patients with suspected m alaria for the primary health care workers who treat the majority of c ases. Despite the encouragement of early treatment, malaria was the ma jor cause of death in children after the neonatal period in 1988, Duri ng 1989 and 1990 the treatment of malaria in Vanuatu was reviewed with the aim of trying to reduce the morbidity and mortality from the dise ase. New guidelines were included in the Vanuatu Health Workers' Manua l, issued to all nurses, nurse practitioners and doctors in 1991. The major changes were the introduction of immediate slide microscopy, the use of a combination of chloroquine and sulphadoxine-pyrimethamine fo r Plasmodium falciparum malaria and for children under 5 years and pre gnant women, the discontinuation of single-dose primaquine (previously given as a gametocytocidal agent), and the use of a loading dose of q uinine. The constraints of the previous guidelines, the rationale for the changes and the expected improvements resulting from using the new treatments are discussed.