Use of monotherapies increasing malaria burden in Nigeria

– As Nigeria lacks local capacity to produce ACTs

The gaps in the knowledge of the right and recommended anti-malaria drugs, even among the educated ones, show that Nigeria still has a long way to go in defeating malaria and the need to intensify awareness about the ailment.

Worldwide, malaria has been described as a killer disease.

Experts say malaria is caused by female anopheles mosquitoes and it remains a serious disease affecting both adults and children with more severe impact on pregnant women and children.

However, the World Health Organisation has, for many years, stopped recommending the use of chloroquine, camoquine and other anti-malaria related medicines under monotherapies for the treatment of malaria. Instead, the use of Artemisinin Combination Therapies (ACTs) is approved and recommended by the world health body.

Investigation by our health desk discovered that though cross sections of the public are aware of WHO’s recommendation of ACT products for the treatment of malaria, the cost of this brand of drugs has forced most people to revert to chloroquine, camoquine and other anti-malaria related medicines under monotherapies, or simply look elsewhere for alternative treatment. But experts however, warn against this practice as patients who opt for drug classified under monotherapies are only getting symptomatic relief while the parasite keeps multiplying, thereby exposing themselves to complications which may eventually lead to death.

According to recent reports, the wrong use of anti-malaria medicines such as chloroquine and other monotherapies is increasing the malaria burden in Nigeria.

AMFm Initiative to the rescue

Even with the official launch of the Affordable Medicines Facility for malaria (AMFm) initiative in the country seven years ago – an initiative aimed at reducing the cost of ACTs and make the drugs available to the rural people, many Nigerians are still unable to afford them, let alone now that the country is in recession.

Hence, many Nigerians are still using monotherapies while others resort to traditional medicine (Agbo) in treating malaria.

Only recently, the Senate raised the alarm that as many as about 42 anti-malaria drugs banned by the European Union (EU) were still in circulation in the country.

Though the Acting Director-General,  National Agency for Food and Drug Administration and Control (NAFDAC), Mrs. Yetunde Oni, had refuted the Senate’s claim,  a patent medicine dealer who preferred anonymity, told The Daily Times that the drugs were still in the market and that they are the ones most Nigerians can afford than the ACTs.

He revealed that since March that the news of the ban was circulated in the social media, the prices of ACTs drugs have doubled.

“Lonart DS that sold between N600-N700 before, is now selling for between N1,100-N1,200. Lumartem was selling for between N250-N300 before, but now is N500-N600,” he said.

Nigeria in malaria endemic environment

Speaking in an interview with our correspondent, Chairman, Association of Community Pharmacists of Nigeria (ACPN), Lagos State Branch, Mrs. Bola Paul-Ozieh, said because Nigeria is in a malaria endemic environment, the Federal Government had put a treatment policy in place that is backed by WHO which must be followed in treating  the ailment.

The Federal Government policy, according to the pharmacist, stipulates that a combination therapy and not a monotherapy be used in treating malaria.

According to the statistics from the Nigerian National Malaria Strategic Plan 2014-2020, malaria is responsible for 60 percent of outpatient visits to health facilities, 30 percent of childhood deaths, 25 percent of deaths in children under one year, and 11 percent of maternal deaths.

The statistics showed that nine in 10 persons are at risk of malaria in Nigeria which accounts for 25 percent of malaria cases in Africa.

She revealed that monotherapies were banned to prevent resistant strains and stressed that the use of combination therapy produces better recovery outcomes.

She explained: “The Federal Government and the WHO recommended Artemether+Lumefantrin (AL) and Artesunate+Amodiaquine (AA) as the very first line drugs. Sulphadoxine Pyrimethamine (SP) is also a combination of anti-malaria medicine recommended by both WHO and the Nigeria National Anti-Malarial Treatment Policy for Intermittent Preventive Treatment (IPT) of malaria.”

Paul-Ozieh further noted that “This means that we are using more than one drug to treat malaria. So, every Nigerian with malaria episode must treat it with the approved first line ACT drugs.”

She noted also that those who use monotherapies to treat malaria were ignorant of the recommended therapies.

“People will not buy the wrong anti-malaria medicine if they go to genuine pharmacy with the right registered premises and ask their pharmacists the type of drug they need to take in treating malaria”, she said.

To avoid confusion and mistake, Paul-Ozieh advised Nigerians not to buy them separately, but to buy the ones that has been totally combined by the manufacturers.

Managing Director, Lefas Pharmaceuticals  and President, Nigerian  Representatives of Overseas Pharmaceutical Manufacturers (NIROPHARM), Pharm. Lekan Asuni, told our correspondent that monotherapies are no longer prescribed for malaria treatment, asserting that  any drug that does not conform with WHO’s recommendation, should not be consumed in Nigeria.

Nigeria needs local capacity to produce ACTs

As a manufacturer, Asuni said Nigeria needs to be self-sufficient in anti-malaria drugs through improved local capacity to produce them.

According him, the current local capacity to produce ACTs in the country is still very low.

His words: “If we have the right active ingredients locally, we would manufacture locally. Although we can produce ACTs, but we are not growing the plant here in Nigeria.

“The ingredient is a plant extract, therefore, there should be huge investment to grow the plant enough in the country that will meet our needs.  We, the manufacturers, still depend on few sources from Asia, and that is a big challenge.”

In line with the recommendations of the Nigeria National Anti-Malarial Treatment Policy and the WHO, NAFDAC said it had stopped registration of anti-malaria monotherapies.

Angela Onwuzoo