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Kenya ‘continues to use old malaria drugs’

3 Mar 2008

Kimani Chege

Source: Scidev.net (see original article)

There are excess stocks of old drugs

Kenyan health workers are continuing to prescribe non-recommended antimalarial drugs that cause drug resistance because new prescribing policies have been poorly implemented, according to a study.

The study, led by Beatrice Wasunna – researcher at the Kenya Medical Research Institute-Wellcome Trust Research Programme – was published in Malaria Journal in February.

The Kenyan government introduced the WHO-recommended artemisinin based combination therapy (ACT) of artemether-lumefantrine (AL) for uncomplicated malaria treatment in 2006, after the malaria parasite was found to have developed resistance to the commonly used sulphur-based drugs.

They delivered supplies of AL to clinics and hospitals, trained health workers, and produced and disseminated national malaria guidelines.

But previous studies have shown that the new treatment guidelines are not being consistently adhered to. ‘[Several studies] have documented deficiencies related to diagnosis, treatment, counselling and drug dispensing,’ says Wasunna.

In 2007, Wasunna and colleagues carried out interviews with health workers in five rural areas of Kenya – Bondo, Gucha, Kisii, Kwale and Makueni – that have a high malaria risk, to find out why the new guidelines weren’t always followed.

They found that reasons for the continued use of the non-recommended drugs included concerns over the high cost and insufficient stocks of new therapies, excess stocks of older antimalarials, lack of follow-up supervision, and a weak and understaffed health system.

‘We would like to suggest that improved drug supply, supportive supervision and a complete phase-out of non-recommended antimalarials is likely to improve health worker adherence to treatment policy,’ says Wasunna.

Willis Akhwale, head of the Division of Malaria Control Kenya’s health ministry admits to the continued use of non-recommended antimalarials, but says the Kenyan health ministry is acting on a systematic replacement of the old drugs with more effective ACTs.

Robert Snow, a researcher at the KEMRI-Wellcome Trust Research Programme says, ‘It’s not just about having the right drug policy, it’s about having a health system that can effectively deliver it. This is the challenge for ACT policies across Africa.’

Last month, the Pharmacy and Poison Board in Kenya stopped licensing the importation of sulphur-based antimalarials and monotherapies in order to counter the flow of non-recommended malaria drugs.

Link to full article in Malaria Journal [PDF 196kB]

Reference: Malaria Journal doi 10.1186/1475-2875-7-29 (2008)

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Related external links:
Kenya Medical Research Institute-Wellcome Trust Research Programme

Photo credit: malariadrugs_WHO_TDR_Crump

Comments

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5 Mar 2008 by Mark Nanyingi:

recently in the wake of antimalarials toxicity from clinical trials and patients data , there is overwhelmingly evidence that proper research methodologies and post marketing surveillance be instituted in the developing world.

The withdrawal of GSKs Ducart (Lapdap-artusunate) was a lead trio of model pharmacophores that has stabbed scientists in the antimalarial pharmacovigilance teams both in Africa and world over.

The upsurge of multinational research teams in development of new antimalarials has compromised research ethics and signals an urgent need for setting up scientific review committees before further tests are undertaken.

The ministry of Health , Kenya has fallen short of standards in pharmacovigilance causing tremendous rise in multidrug resistance (MDR) infectious diseases like TB. The challenge to ACT in Kenya is the systematic delivery mechanisms.

The challenge falls heavily on scientists ranging from epidemiologists , pharmacologists and sociologists to collaborate with a single non partisan ideology of producing evidence based findings that will be purposeful in implementation of mitigation strategies to combat the malaria pandemic.

Research should also focus on alternative forms of antimalarials by integrating herbal medicines, a hub for screening of potential antiplasmodial compounds from plants is set up at Center for Biotechnology Research and Development(CBRD) , KEMRI Nairobi.
this is a concerted effort of pharmacologists , phytochemists and molecular biologists to steadfastly isolate a lead compounds that will be key to fighting malaria in Africa.