Single-drug malaria treatment more harm than good

If you are going to treat malaria, you are better off using a combination therapy that includes artemisinin. Fail that, and you could be doing more harm than shaking off malaria. Artemisinin has been adopted the drug of choice for treating malaria. Nigeria has adopted it for case management. The National Malaria Elimination Programme guidelines […]

If you are going to treat malaria, you are better off using a combination therapy that includes artemisinin. Fail that, and you could be doing more harm than shaking off malaria.

Artemisinin has been adopted the drug of choice for treating malaria. Nigeria has adopted it for case management.

The National Malaria Elimination Programme guidelines specify “early diagnosis” and “prompt treatment within 24 hours of onset of symptoms” and two combinations that include artemisinin derivatives—Artemeter+Lumefantrine and Artesunate+Amodiaquine. It has been on since 2005.

Taking just one of the component is considered monotherapy, period. And it increases the chances of malaria parasite developing resistance.

The logic of combination therapy is that the “that the probability of resistance developing simultaneously to two chemotherapeutic agents with independent mechanisms of action is extremely low,” according to the WHO.

In fact, the chances of that happening is one in 10 trillion. But surveys from parts of the world show it is happening—not just because malaria parasites are getting smarter, but also because the use of monotherapy is giving them the chance.

That threatens to make hash of Nigeria’s long-running campaign to eliminate malaria.

Incidents of malaria have been reducing, but the decline rate is in stall.

World over, malaria cases dropped from 262 million in 2000 to 216 million in 2016 a year. In the same period, deaths from the disease reduced from 985,000 to 445,000.

Nigeria’s malaria prevalence is now 27 in 100, down from 42 in 100 in 2010, the latest malaria indicator survey shows.

In spite of the progress, at least 27 in 100 malaria cases around the world are in Nigeria.

“We have used strategies to fight malaria, and they include sustained public service announcements, focusing on what individuals and groups can do to eliminate malaria,” says Audu Mohammed, national coordinator for NMEP.

“The strategies also include sleeping inside long lasting insecticidal treated nets, indoor residual spraying, larval sources management and [artemisinin-combination therapy], among other methods.”

With the ban on monotherapy, the National Agency for Food and Drug Administration and Control stopped registering and renewing registration for antimalaria monotherapy drugs in 2012.

It has also deployed a mobile authentication service (MAS) on ACT antimalaria drugs to distinguish them from other monotherapies. The service includes a scratch-and-send PIN to verify drug authenticity over mobile service.

The drug regulator has also trained customs and port officials to shore up vigilance on antimalarials shipped or imported into Nigeria, says Ali Ibrahim, director of phamacovigilance and post-market survey at NAFDAC.

But stopping monotherapies isn’t coming easy. Ibrahim says the campaign still faces illegal importation of oral antimalaria monotherapies and is inadequately funded to sustain operations to mop-up monotherapies in supply across the country.

Add to that, the supply of ACTs is inadequate in rural areas, and sensitising communities about ACTs is yet to hit critical mass.