This document outlines Ghana's national anti-malaria drug policy. It notes that malaria is a major public health problem in Ghana, especially among children and pregnant women. The policy aims to provide prompt, safe, and effective treatment for all cases of malaria. It endorses the "TEST, TREAT, AND TRACK" initiative to diagnose and treat malaria based on testing rather than presumptively. The policy recommends artemisinin-based combination therapies as first-line treatment and identifies appropriate medications for uncomplicated malaria, severe malaria, and malaria in pregnancy based on the latest evidence and WHO guidelines. It also provides guidance on intermittent preventive treatment in pregnancy.

1. BY
GIDEON DZANDO
BSC.NURSING

2.  Malaria is an endemic disease in sub-saharan
Africa.
 Malaria is a major cause of illness and death
in Ghana, especially among children and
pregnant women
 In 2012, malaria accounted for 38.9% of all
OPD illnesses and 38.8% of all IP of all
admissions.

3.  Ministry of Health Ghana in its mid term strategic plan
document consider malaria as a priority disease which
must be addressed in order to meet Millennium
Development Goals 4,5 and 6.
 Case mgt has remained one of the main strategic
interventions for malaria control in Ghana.
 The T3 (TEST,TREAT AND TRACK) initiative has
been initiated recently to replace the existing
presumptive mode of treatment.

4.  The effectiveness of the T3 initiative however
depends on Anti malaria drugs which must be safe ,
effective, available, affordable and acceptable, thus
the need for an up to date evidence base Anti malaria
drug policy to suit Global trends and the nation’s
context

5.  Prevent deaths and complications arising from malaria
 Shorten clinical episodes of malaria
 Reduce consequences of placental malaria infection
and maternal associated anaemia through
chemoprophylaxis and intermittent preventive
treatment during pregnancy.
 Delay the spread of resistance to anti malaria
medications.

6.  The use of Arteminisin based combination for
chemoprophylaxis ant treatment was agreed on through
an informal consultation with WHO in Geneva in the
year 2000.
 In 2002,Treatment failure to chroloquine was rated
between 6%-25% and total parasite clearance was
rated below 50%.(MOH)
 In 2004,the drug policy changed from Chroloquine to
Artesunate Amodiaquine for uncomplicated malaria.

7.  Adverse effects and negative publications in a
section of the mass media led to loss of
confidence in the policy by some health care
providers.

8.  In 2007,there was a policy review which made
provision for search for alternatives for A/A in mgt of
uncomplicated malaria while Inj. Quinine and
Artemether were recommended for treating severe
malaria.
 Sulphadoxine pyremetamine was also encouraged for
use as prophylaxis in pregnancy.

9.  Owing to the developing research in science and
medicine, growing evidence that could influence the
choice of one medicine over another and lessons drawn
from practitioners,
 The minister reconstituted the Anti malaria Drug Policy
Working Group and inaugurated it on 23rd August 2012
to review the existing Drug policy.

10.  Evidence that, inj. Artesunate is superior to injection
quinine in managing severe malaria and WHO
recommendation for its use
 Unconfimed reports of abortions after the use of oral
quinine in the 1st trimester of pregnancy
 Conflicting reports on preference of practitioners
between A/A and a/L as first line treatment for
uncomplicated malaria.

11.  Growing concerns about resistance to the use of
Arteminisin mono-therapy, adverse drug reactions and
compliance to seven days quinine therapy
 Recent recommendations by WHO on seasonal malaria
chemo-prevention

12. OBJECTIVE
 To provide prompt safe, effective and appropriate
anti malaria treatment to the entire population

13.  THE T3 MUST BE ADHERED TO
 The three Arteminisin combination remains the best
choice.
 Artesunate Amodiaquine is the drug of choice. (choice
for children below five years at home).
 Alternative drugs are: A/L AND Dihydroarteminisin
piperaquine

14.  1st trim: Oral Quinine or
Oral Quinine + Clindamycin.
 2nd trim: Oral Quinine,
oral quinine + clindamycin,
AA
A/L

15.  Alternative ACT, AL, AA or DHTP which has not been
given as first line treatment can be given.
 Oral quinine can be used if ACT are contraindicated.
(10mg/kg body weight) + Tetracycline or Doxycycline
or Clindamycin.
 ACT’S can be used in pregnancy (1st trim) if need be.
 Quinine,AA or AL (2nd trim)

16.  Requires parenteral treatment initially and then
continue with orals if the condition permits.
 NB: Children who do not respond to ACT,s within 24
hours be tepid sponged, given supp. arteminisin and
referred to a bigger health facility.

17.  Parenteral Artesunate shall be used as the medication of
choice, followed by a full course of an ACT if client
can tolerate oral medication
 ALTERNATIVE: Injection Quinine

18.  1ST TRIM: Start with Injection Quinine ,switch to oral
quinine if client can tolerate oral medication.
 2nd and 3rd trim: Inj. Artesunate is the recommended
drug of choice.

19.  IPT shall be commenced after first Quickening
(16th week).
 Shall be provided as an antenatal package
with haematinics and antihelmentics
 The medicine shall be administered under
DOT.
 Drug of choice shall remain SULPHADOXINE
(500MG) +PYREMETAMINE (25MG).

20.  Screening must be done to exclude G6PD deficiency or
allergy to sulphonamides
 ALTERNATIVE RX:
 Prognoquil for 1st trim non immune women
 HIV/AIDS positive women shall receive monthly doses
of S.P,EXCEPT when they are taking co-trimoxazole.
 Folic Acid should not be given with SP as it counteracts
its efficacy.