BMJ News examines how drug resistance, access undermine malaria fight in Uganda, Cambodia

May 19 2010

BMJ News looks at how lack of access to drugs and resistance are undermining the fight against malaria.

In Uganda, investigators for a new health monitoring unit say that a lack of first line medicines in public health clinics is weakening efforts to fight malaria, BMJ News writes in an article examining the country's drug supply problems. "Uganda has been rocked by a number of drug supply scandals in recent years," which has contributed to the access problems, BMJ reports, adding "that around five billion shillings worth of government drugs had been recovered in the ongoing [government] crackdown" on corruption.

"Last month the Ugandan team of the charity Medecins Sans Frontieres [MSF] said it was 'extremely concerned that lifesaving antimalarial drugs are not reaching those who need them.' ... In northern Uganda MSF teams saw a 'sharp increase' in numbers of cases of malaria in 2009. In 2008 the charity treated more than 6,000 people with malaria in Kitgum district, northern Uganda. In 2009 this number rose more than fourfold to 27,000 people. The number of people with severe malaria admitted to hospital doubled in the same period. The charity notes that the rise in numbers of severe cases was mainly due to patients not having access to free artemisinin based combination treatment (ACT)."

Kodjo Edoh, MSF's head of mission in Uganda, said the irregular drug supply could promote drug resistance. "Limited stocks of ACT mean that in many clinics people are not receiving the correct treatment dosages," Edoh said. Clinics then dispense older drugs, which are not as effective because some strains of malaria are resistant to them (Moszynski, 5/17).

In a second article, BMJ News looks at the emergence of artemisinin resistance in Cambodia and the response to the situation.

To prevent further resistance, "local authorities have cracked down on unlicensed pharmacies in the country, closing down more than 60% in the past six months." According to the publication, "Last month the health ministry reported that the number of unlicensed pharmaceutical outlets had been reduced from 1,081 in November 2009 to 379 in March 2010, a 65% reduction."

Patrick Lukulay, director of the U.S. Pharmacopeial Convention's Promoting the Quality of Medicines programme, "said that although resistance had thus far only been detected in monotherapies of the artemisinin derivative artesunate - which was why the World Health Organization recommended that the compound should be used only in combination - resistance could eventually make artemisinin combination therapies ineffective too." He said, "[T]he fear is that ACT resistance could spread to Africa, where the burden of malaria is huge."

The piece also includes reaction from a physician from the London School of Hygiene and Tropical Medicine and looks at how Cambodia can prevent the resistance from spreading (Moszynski, 5/17).