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Exactly 1 year remains to the Abuja target of having 80% of patients with malaria treated early and effectively.1 Yet, in 2008, only 19% of febrile children in malarious areas received prompt antimalarial treat ment, and merely 3% got the recommended artemi sinin combinations. 2 WHO now advocates for home management of fever/malaria to increase early recog nition, physical access to and affordability of drugs, and use of preventive methods.3 The official endorse ment for such home manage ment was given initially for chloroquine, but with wide spread resistance to this drug, home manage ment is now being promoted for artemisinin combina tions. The debate on use of combination therapy for home management continues, with the pendulum swinging between safeguarding this expensive drug and the ethical issue of using "poor medicines for the poor".4,5
Uganda was among the first to take home management for malaria to scale through free dis tribution of prepacked sulphadoxine-pyrimethamine plus chloroquine through distributors in the com munity who classify, treat, and refer sick children. Many have looked at the implications of this strategy but no one has managed to answer whether such home management should be extended to the urban setting. Although home management of malaria in rural areas can reduce mortality and morbidity in children,6 strategies for rural areas might not be directly transferable to urban settings.7 This view is supported by Sarah Staedke and colleagues who, in The Lancet today, report on the merits of home delivery of artemether-lumefantrine for febrile illnesses in a low-transmission area in urban Uganda.8 In a randomised trial, the authors compared stocking households...