Findings of poor quality malaria drugs in Africa add to artemisinin-resistance worries

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Feb 10 2010

A study released on Monday found that between 26 percent and 44 percent of artemisinin-based malaria drugs sold in Madagascar, Senegal and Uganda "failed quality testing" because of impurities or insufficient amounts of active ingredient, the Associated Press reports. The study, which was conducted by the nongovernmental U.S. Pharmacopeia program and received funding from USAID, adds to concerns about growing resistance to artemisinin, which is currently the most effective treatment for malaria.

"The study is the first part of a 10-country examination of antimalarials in Africa by the U.S. and the World Health Organization. It follows evidence from the Thai-Cambodian border that artemisinin-based drugs there are taking longer to cure malaria patients, the first sign of drug resistance," the news service writes (Mason, 2/8).

"The experts subjected 200 samples of anti-malaria drugs to quality-control testing in a U.S. laboratory. They found 44% of the drugs from Senegal failed the testing, followed by 30% from Madagascar and 26% from Uganda. Patrick Lukulay, director of the U.S. government-funded Pharmacopeia programme, said it was a 'disturbing trend,'" the BBC writes.

He said, "It is worrisome that almost all of the poor-quality data that was obtained was a result of inadequate amounts of active [ingredients] or the presence of impurities in the product" (2/8).

According to the AP, the "three-country report also found bad drugs in both the public and private health sectors, meaning governments - some buying medicines with donor funds - are not doing enough to keep poor-quality pills out. All of the drugs tested from the public sector in Uganda, however, passed the quality tests. But 40 percent of the artemisinin-based drugs in Senegal failed." The study also notes that the same drug brands generally had similar results across all sectors, which could help governments that are trying to eliminate substandard drugs.

While the study is not the first to assess the quality of antimalarials in Africa, it is the most rigorous and complete, according to the AP, which notes that similar failure rates were found in previous work that did not focus specifically on artemisinin-based drugs. The WHO has examined malaria treatments in Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria and Tanzania, the AP reports, adding that while the results have not been made public, "Clive Ondari, who worked on the study for the WHO in Geneva, said failure rates in three of those countries were also significantly high. Ghana has already withdrawn more than 20 drugs from the market after receiving the initial results, Lukulay said" (2/8).

In related news, Paul Orhii, director-general of Nigeria's National Agency for Food, Drug Administration and Control said the agency "confiscated N10 million [about $67,000] worth of Lonart, an anti-malaria drug, illegally imported into the country," NEXT reports. "Mr. Orhii said the drugs were intercepted and confiscated by personnel of the agency on routine checks," the news service writes (2/9).

IRIN examines the emergence of resistance to artemisinin in Myanmar. "Preliminary studies in 2008-09 by the Mekong countries of Cambodia, China, Lao PDR, Myanmar, Thailand and Vietnam, show tolerance elsewhere, with the drug proving less effective and taking longer than previously to kill the parasite. The studies, presented late last year at a WHO regional workshop of health officials, show tolerance may have extended to areas along the Myanmar-Thailand, Myanmar-China and Cambodia-Vietnam borders. WHO describes the Mekong countries as the epicentre of plasmodium falciparum resistance to anti-malarial drugs in the world, and the findings have prompted further studies over 2010 and 2011 to confirm increasing resistance," IRIN writes.

The article also looks at the factors involved in spreading drug-resistance and the challenges to prevent it (2/4).

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.