Putting a gift horse in the mouth

The old saying goes, ‘don’t look a gift horse in the mouth.’ Equine experts can tell a lot about the age, health and travails of a horse by examining the teeth and mouth.  The admonition not to examine an animal that is a gift might arise from not wanting to embarrass the giver, and why worry anyway if you did not pay for the horse.

It may me another matter when the intended gift is to be swallowed.

duo_cotecxin.jpgNews reports record that, “The Chinese government on Monday (18 January 2010) donated over 244,000 doses of anti-malarial drugs to the Uganda in a bid to fight the deadly disease that kills over 320 people daily in the East African country.” The donation includes 144,000 doses of Arco and 100,000 doses of Duo-Cotexin.

Supplies of the same two drugs were also donated by China in April 2009. The two medicines apparently are not yet included in the country’s essential medicine list or listed as firstline treatments in the national malaria strategy/policy. “The drugs are, however, still awaiting pre-qualification from the World Health Organisation (WHO).”

Duo-Cotexin is a dihydroartemisinin plus piperaquine product (of which other brands include Artekin, Artecom, CV8) and is “given in a four-dose regimen that has proved highly effective and well tolerated in South East Asian trials.” ARCO is a combination of two drugs – Artemisin and Naphthoquine Phosphate. At present the only two combinations that have WHO pre-qualified products are Artemether+Lumefantrine (AL) and Amodiaquine+Artesunate (AA).  AL is the firstline treatment used in Uganda.

The two donated drugs apparently do offer a more convenient regimen than AL, which is taken for 3 days. “For Arco, its dose is swallowed once while Duo-Cotexin the tablets are swallowed once a day as prescribed by a doctor.”

The main concern is that when there are many different types of drugs on the shelves with different regimens, as is the case here, health workers and patients can get confused. There may also be different formulations for different age groups.

Granted, Uganda has not often had the luxury of too many malaria drugs, and shortages have been common. Thus, there may be the tendency not to look this gift horse (or medicine) in the mouth. Uganda, like most endemic countries, is definitely under pressure to scale up for impact this year.

We can only encourage the malaria partners in Uganda to practice pharmaco-vigilance with these donations and ensure thorough in-service education for health staff and patient education to promote adherence among clients.

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