DAKAR, 26 February 2009 (IRIN) - Spoonfuls of sugar could save the lives of children with severe malaria, according to a recently published study on patients in Mali.

In severe cases of malaria, a child who is vomiting and not eating properly may have low blood sugar, which can lead to coma and death, according to Peter Olumese with the World Health Organization's (WHO) Global Malaria Programme. "It [hypoglycaemia] requires rapid treatment and if not treated quickly is more liable to kill the patient than the malaria itself."

In remote malaria-endemic areas with no trained medical staff or intravenous equipment to drip glucose, spoonfuls of sugar held under the tongue for quick life-saving absorption is a "child-friendly" emergency remedy, according to the Swiss-funded study of 23 children with severe malaria.

In the study, 14 children with severe malaria received water-moistened sugar every 20 minutes held under the tongue while nine others received glucose intravenously. Researchers found that the teaspoon of sugar worked as well as the drip to increase blood sugar; among children who kept the sugar under their tongues, the sugar levels of all but one increased to normal levels within 10 minutes.

But WHO's Olumese said while sugar is a potential life-saver, it can also be deadly without proper follow-up. "There are patients who may be cured of malaria, but who may be killed from improperly administered glucose. The good thing is that glucose can be absorbed into any surface, but it [sugar under the tongue] is not an ideal treatment."

He said in the absence of qualified medical staff, as often is the case when the sugar remedy is used, it is hard to know how much glucose has been given and to ensure proper follow-up after the first "high dose" is given to jolt the patient to recovery.

Olumese told IRIN another risk of the treatment is that comatose patients in the severe stages of malaria lose their "gag-reflex" to prevent sugar from entering the lungs and causing infection.

Thomas Bisika, University of Pretoria public health professor and former head of the African Union's health division, told IRIN the practice is promising because of its practicality. "In many settings, this may be the only care people have."

But he said more research is needed before sugar can be recommended as a standard treatment for hypoglycaemia. "We do not know the factors that could have affected the [study's] outcome. What were the children eating, for example? It could have been something else [other than sugar] doing most of the work. What worked in this community may not work in other communities."

He added: "Unfortunately, there will be no shortage of people to test."

There are some 400 million people infected with malaria every year, mostly in sub-Saharan Africa, according to the World Health Organization.

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