…as national monitoring key in preventing malaria drug resistance
For health experts across the globe, there has been increased worry over the incidence of some malaria medications which is believed not to have been efficacious in delivering the desired cure to people who take such antimalarial drugs.
With complaints on the inability of some drugs regimens to effectively cure malaria, the World Health Organization (WHO) has called on countries to be increasingly vigilant in monitoring antimalarial drug efficacy in order to allow for early detection of artemisinin resistance. This is one among several conclusions of the “Global report on antimalarial drug efficacy and drug resistance: 2000–2010”, which was released recently.
The report is based on 1100 studies conducted by national malaria control programs and research institutes over the ten-year period. The report estimates that only 34 percent of malaria-endemic countries are complying with WHO recommendations to routinely monitor the efficacy of first- and second-line antimalarial medicines.
In February 2009, the WHO confirmed that resistance to artemisinin had emerged on the Cambodia-Thailand border. Although patients infected were cured following treatment with an artemisinin-based combination therapy (ACT), the recovery took more time. In artemisinin-resistant areas, the high cure rates observed depends heavily on the efficacy of the non-artemisinin component of the combination.
Nonetheless, the report found that ACTs currently recommended by national malaria control programmes remain efficacious in treating malaria, with cure rates generally greater than 90 percent. In countries where the currently recommended ACT has a cure rate of less than 90 percent, policy change is ongoing to implement an efficacious replacement treatment for malaria.
In an interview with BusinessDay, Wellington Oyibo, consultant medical Parasitologist, college of medicine, University of Lagos, Idi-araba, Lagos, said that the emergence of artemisinin resistance on the Cambodia-Thailand border has been a wake-up call to the world to prevent its spread, increase monitoring, and preserve ACTs as the only effective treatment we have for falciparum malaria. Oyibo disclosed that it is imminent to state that prompt action will be critical to sustain progress in malaria control and achieve the health-related Millennium Development Goals.
According to him, “Recently, The Federal Ministry of Health (FMOH) carried out a Drug therapeutic efficacy testing (DTET) in seven centres to ascertain assertions of ACT resistance. The last testing was done in 2003 to ascertain chloroquine resistance. However, globally, a WMNET network is trying to track ACT resistance gene as is the case with prophylactic drugs like chloroquine and Fansidar.”
For Shilaj Chakravorty, Consultant Pathologist, BT Health & Diagnostic Complex, LASUTH, Ikeja, Lagos, antimalarial drug resistance is like a cancer which must be fought at every level. Chakravorty stated that affected countries need to be in the frontline in combating the emergence of drug resistance through proper surveillance by states which should ensure that all health institutions submit data of malaria cases with special reference on resistance to anti malaria drug.
According to him “Anytime issues of anti-malaria drug resistance is reported, such should be reported to the state health authorities. Also, there should be the discouragement of Nigerians engaging on across the counter purchase of anti malarial drugs as well as the need to educate the public on the importance of diagnosis before any administration of drugs to the ailing patient.
Importantly, there is need for tertiary malaria research centers have facilities to diagnose and confirm drug resistance as per the WHO guidelines. WHO should be empowered and supported to take a strong lead. It is crucial to protect ACTs as they are the best treatments for millions of people against malaria”
Even as scientists continue to investigate how and why artemisinin resistance specifically emerges, it is noteworthy to state that antimalarial drug resistance first emerges through a rare spontaneous change in the malaria parasite.
The subsequent ability of the drug resistant strain to survive and spread is influenced by many factors, including the use of substandard medicines and artemisinin-based monotherapies. However, it is clear that if the efficacy of artemisinin component continues to decline, there is an increased risk that resistance to non-artemisinin medicines used in the combination will emerge.
Currently, research efforts are ongoing to discover and develop new medicines for the treatment of malaria.
No doubt, efforts to contain the spread of artemisinin resistance on the Cambodia-Thailand border have been ongoing since November 2008. However, there is some early evidence that resistance to artemisinins may also be emerging on the Myanmar-Thailand border. There is also concern that resistance could spread from the Cambodia-Thailand border to Africa, as it did with anti malaria drugs such as chloroquine and sulfadoxine-pyrimethamine in the 1960s and 1970s.
With the Federal Government’s introduction of the use of Small Messaging Service (SMS) for collection of data for malaria control last week, health workers will be able to monitor implementation of health interventions more effectively. In the long run, routine data management as well as antimalarial resistance can be trapped and be effectively nipped in the bud.
By Alexander Chiejina
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