Are there enough antimalarial drugs?

An article in Nigeria’s Daily Trust on Sunday casts doubts about the availability of adequate treatment for malaria in the country with a headline that asks, “What Happened to Funds Sunk Into Anti-Malaria Projects?”  It is true that with Nigeria having the highest burden of malaria on the continent there may not yet be enough money, medicines, nets and other resources – the Minister for Health estimates that the country needs $1.3 billion – but that does not mean that current funds are being squandered as the headline implies.

In fact an irony may be that there are too many different types of drugs. Nigeria’s National Agency for Food Drug Administration and Control (NAFDAC) has registered the following Artemether-Lumafantrine ACTs:

  • Actimax
  • Actpro
  • Arcofan
  • Artemef
  • Artrin
  • Atmal
  • Coartem
  • Fanterm
  • Lonart
  • Lumether
  • Malagard
  • Ogamal

Nearly 100 Artesunate-Amodiaquine ACTs have been registered. Few of these ACTs are prequalified by WHO. Some monotherapy artesunate drugs, which WHO disapproves and whose NAFDAC registration won’t expire until 2012, are still for sale and available in shops.  There are at least 5 Artesunate-Mefloquine brands.  Artesunate-SP is registered in up to 10 brands.

malmeds-sm.jpgAside from the above, chloroquine is still common as is sulphadoxine-pyrimethamine, both of which exhibit resistance and are no longer recommended for first line treatment in Nigeria. There is of course quinine needed for treatment of malaria in pregnancy. Overall over 325 different brands of antimalarial drugs are registered.

While there may not be enough free or reduced price pre-qualified antimalarial drugs at the front line primary health care facilities, there is a plethora of questionable drugs on the market. One wonders how anyone could test, let along maintain pharmaco-vigilance, on all these medicines.

We hope Nigeria is successful in getting its Global Fund Round 8 malaria grant signed and has a positive experience in applying for the Affordable Medicines Facility for malaria to strengthen quality and supply of inexpensive drugs in the public and private sectors.  In the meantime, partners at national, state and local levels need to consider how the consumer – which includes local and state government medical stores – can make sense of all the antimalarial drugs out there.  Maybe one day NAFDAC and the National Malaria Control Program can truly work in partnership to ensure rational pharmaceutical practices.

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