Nigeria adopted artemisinin-based combination therapy as its first line of malaria treatment in 2005. While it did not ban chloroquine, it has actively discouraged its use since efficacy studies across the country showed high levels of parasite resistance. Likewise Nigeria has tried to confine sulphadoxine-pyrimethamine (SP) for use at intermittent preventive treatment during pregnancy (IPTp), and discourage its use for case management.
Specifically the National Malaria Control Program (NMCP) recommends artemether-lumefantrine and artesunate-amodiaquine, for which there are only few WHO ‘prequalified’ producers, for first line treatment of uncomplicated malaria. Based on WHO recommendations the NMCP also recommends against artesunate monotherapies (i.e. medicines not containing a combination of drugs).
One is not surprised to find inappropriate malaria drugs in patent medicine shops around the country (see picture). Unfortunately the National Agency for Food and Drug Administration and Control approves drugs based more on safety than on appropriateness to control efforts.Â Thus, the chloroquine found in shops will not kill you, but it will not cure your malaria either.
With this in mind it came as a shock to see local government clinics stocking chloroquine and artesunate monotherapies, among others.Â These were in clinics that were being supplied by the National Health Insurance Scheme using Millennium Development Goals special funds to provide free treatment for pregnant women and children less than five years of age. This laudable goal of reaching the poor can be undermined when drugs with questionable therapeutic value are provided.
The NHIS drug list for malaria includes the following in various forms (tablets, syrups, suspensions, injections):
While the SP in the list should ideally be used for antenatal clinic services, one is not sure this happens since several of the clinics visited had no stock of SP, but plenty of chloroquine syrup bottles – a formulation that is not very stable in these climates.
We encourage the NMCP to take stock of malaria drug stocks – basically, there are many national and international agencies supplying malaria medicines at national, state and local government level.Â They should be brought together so that one coordinated national malaria drug policy is enacted. Only then will the public receive effective malaria treatment.