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[afro-nets] Implementation Research on Home Management of Malaria

Implementation Research on Home Management of Malaria
using Artemisinin-based Combination Therapy (ACT)
UNDP/WORLD BANK/WHO Special Programme for Research and Training 
in Tropical Diseases (TDR)
Call For Letters Of Intent
Home management of malaria (HMM) is a key Roll Back Malaria 
(RBM)strategy of providing access to prompt, appropriate and ef-
fective treatment especially for children in Sub-Saharan Africa 
(SSA). In these countries treatment for uncomplicated malaria is 
rarely sought at health facilities, self-treatment at home is 
common, but often inappropriate or delayed. This contributes to 
an estimated death toll of over 1 million children per year. The 
essence of the Home Management of Malaria strategy is to improve 
the quality of treatment provided by caregivers at home by en-
suring access to pre-packaged quality antimalarial drugs close 
to the home, and by improving the community knowledge of malaria 
and its treatment through IEC and training.
In recent years, research projects, mainly TDR funded, have 
shown that Home Management of Malaria is feasible, can increase 
adherence with the correct treatment dosage and schedule, reduce 
the risk of developing severe disease and improve child sur-
vival. Consequently, many countries in high endemicity areas are 
now moving to large-scale implementation of HMM. However, the 
antimalarial drug used in these projects was chloroquine, a drug 
to which malaria parasites have been shown to become increas-
ingly resist ant and which is failing in most SSA. As a response 
to the antimalarial drug resistance situation, the WHO currently 
recommends that treatment policies for falciparum malaria in all 
countries experiencing resistance to monotherapies should be 
combination therapies, preferably those containing an artemisi-
nin derivative (ACT - artemisinin-based combination therapy). 
Over the last three years 7 countries in SSA have updated their 
treatment policies to include ACTs as 1st-line or 2nd-line 
treatment of malaria, and several have been granted funds by the 
Global Fund to fight AIDS, Tuberculosis and Malaria to purchase 
these drugs. TDR has supported the clinical studies that have 
provided evidence on the efficacy and safety of artesunate-based 
combinations in Africa, and research associated with phased in-
troduction of combination therapy.
Home management of malaria is thus currently facing two funda-
mental challenges: expanding its implementation into large-
scale, nation-wide programmes, and the need to incorporate in 
its strategy the use of efficacious drugs, such as ACTs. There-
fore, the need arises to produce new evidence on the feasibil-
ity, acceptability and safety of the use of ACTs in the context 
of HMM, within the shortest delay. The evidence will be devel-
oped in collaboration with and made available to the national 
malaria control pro grammes of countries having adopted ACTs as 
antimalarial treatment policy in order to support them to put in 
place large-scale HMM programmes.
The overall objective is to produce evidence on the feasibility, 
acceptability and safety of the use of ACTs in the context of 
The specific objectives are:
i. To identify best strategies to improve rational use of ACTs 
near to the home.
ii. To measure the degree of adherence by the communities 
achieved by the HMM strategy when using ACTs.
iii. To identify appropriate methods to monitor safety of ACTs 
when used in the context of HMM.
* The principal investigator should preferably be a social sci-
  entist. The team should include a scientist or implementer with 
  solid experience in community development work.
* The study should involve collaboration between researchers, 
  malaria control programme managers, and facilitators with ex-
  perience of implementing interventions in similar settings.
* The study design should include a formative and an interven-
  tion phase.
* The research should take place in a SSA country having adopted 
  ACTs as national antimalarial treatment policy
* The research should take place in a SSA country with grant ap-
  proval from Global Fund to fight AIDS, Tuberculosis and Malaria 
  to purchase ACTs.
Letters of intent should be 3-5-page long, in English or French, 
and be sent by email only to providing 
the following information.
* Outline of proposed research project: title, objectives, ra-
  tionale, and overall design
* Relationship with any ongoing programme, research project, ex-
  ternal funding
* Research team/institutions involved and collaborators
* Proposed budget breakdown
* Additional sources of support for the proposal, either match-
  ing funds or in kind support
* Brief description of the researcher's current activities and 
  research experience
* A one-page summary CV of the Principal Investigator and a sup-
  porting letter from the Institution Director should be included.
Deadline for submission of letters of intent: 10 February 2004
Letter of intent should be sent by e-mail only to:
For further details, please contact:
Dr. Franco Pagnoni
Manager, Home Management of Malaria
Intervention Development and Implementation Research Unit
UNDP/WORLD BANK/WHO Special Programme for
Research and Training in Tropical Diseases (TDR)
World Health Organization
1211 Geneva 27, Switzerland
Fax: +41-22-791-1811,  +41-22-791-4774

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