A suppository form of a malaria-fighting drug could provide a lifeline to children in rural areas, drastically cutting the number of deaths caused by the disease.

A study in rural Zambia found that suppository drugs administered by community health workers provided a crucial window for children with severe malaria, allowing them to reach a health facility.

Each year, 445,000 people die from malaria, with more than 90% of deaths occurring in sub-Saharan Africa. Children under five are among those most vulnerable to the disease.

“If they don’t have immediate access to a facility, these are extremely vulnerable children,” said Pierre Hugo, director for Medicines for Malaria Venture (MMV), one of the research partners in the pilot project. “Their parasite count is through the roof, their red blood cells are almost totally destroyed. They’re literally on the brink of life or death.”

The research is published in advance of the World Health Organization’s annual malaria report, which is expected to call for greater investment in fighting the disease. Last year, the WHO warned that, for the first time in a decade, malaria cases were no longer falling.

The 12-month Zambia study was carried out in Serenje district, an area with high rates of malaria among young children. Communities in the district have limited access to medical care, and the nearest health facility can be 20km away.

During the pilot, child deaths related to severe malaria were cut dramatically, from 8% to 0.25%. There were three recorded deaths during the study period – 94 fewer than would previously have been expected in the timeframe, according to MMV.

All children suspected of having severe malaria were given rectal artesunate suppositories, a pre-referral antimalarial medicine. The suppository drug is effective because, unlike oral medication, it can be administered even if a child is unconscious or vomiting.

Children who received the suppository were then transferred to a health facility through the project’s emergency transport system, which was equipped with additional bicycle ambulances through the NGO Transaid. More than 1,000 cases of suspected severe malaria were referred by community health workers.

Once at the health facility, children were given injectable artesunate malaria medication, followed by a three-day oral antimalarial treatment course.

The WHO has recommended the use of artesunate suppositories in suspected cases of severe malaria for over 10 years, but until recently there was no quality-approved drug on the market.

“It’s not a product that’s widely used, its not a high commodity product, so for manufacturers it’s not an attractive treatment,” said Hugo. MMV has worked with two pharmaceuticals, Strides Shasun and Cipla, to secure WHO pre-qualification for suppository malaria products.

It is hoped the same model could be adopted in other rural settings where there is a high prevalence of malaria and limited access to healthcare workers.