Rwanda News Agency/Agence Rwandaise d'Information (Kigali)
14 May 2008
Kigali — The East African Community block is one of the regions most affected by the surge in fake malaria medicines that still remain on the prescription list of private pharmacies, a news study suggests.
The block includes Rwanda, Uganda, Kenya, Burundi and Tanzania but the study released last week by US-based The Public Library of Science (PLoS) was done in four capitals except for Burundian Bujumbura.
However, the samples for the entire study were bought in six cities: Accra - Ghana; Dar-es-Salaam - Tanzania; Kampala - Uganda; Kigali - Rwanda; Lagos - Nigeria; and Nairobi - Kenya.
Tests on 195 packs of malaria drugs bought at private pharmacies found that 35 percent either did not contain enough active ingredients or did not dissolve quickly enough to work.
The study looked at doses of medicines including sulfadoxine-pyrimethamine, amodiaquine, mefloquine, artesunate, artemether, dihydroartemisinin and artemether-lumefantrine fixed-dose combinations.
This study is the first to sample the quality of medicines throughout the geographic band of hyper- and holoendemic P. falciparum malaria which stretches unbroken from West, to Central, to East Africa-the world's worst, the researchers said.
"The results are not happy reading for people taking these drugs," Richard Tren, director of Africa Fighting Malaria, a health advocacy group that sponsored the tests, was quoted as saying.
Moreover, a third of the packets tested contained just artemisinin, the newest anti-malarial from China. Last year, to prevent artemisinin-resistant strains of malaria from developing, the World Health Organization asked all the world's drug companies to stop selling it except in multidrug cocktails.
Nearly half the drugs that were made in Africa - assuming that their packaging was legitimate - failed the tests, the study found. So did a third of those made in Asia.
The good news for the authorities in Rwanda and their people is that none of the three samples of CoArtem, a multidrug cocktail made in Switzerland for global health agencies, failed.
In 2007, government in Rwanda ordered all medical practionners to drop prescribing medicines like chloroquine and quinine in favour of CoArtem.
The drug is heavily subsidized. Prices moved down from $10 (about Rwf. 5,000) to Rwf. 250 and Rwf. 150 for patients in urban and rural areas, respectively.
The World Health Organization found - in a study in February this year that following a combination of extensive preventive measures employed in Rwanda, malaria prevalence had dropped by up to 66% in just two years.
Until recently, according to the PLoS study, fake malaria drugs have been a problem largely confined to Southeast Asia, where a sampling two years ago found 53 percent of the drugs substandard, and drug experts said Asia was facing "an epidemic of counterfeits."
The study suggests that the epidemic is spreading to Africa, where the malaria burden is even greater, and the regulatory agencies are even weaker.
Especially in Africa, PLoS researchers say governments lack the ability through customs and policing to stop these medicines entering the private market, where many persons buy their treatment.
In Rwanda however, people do not have the freedom to buy malaria medicine from a pharmacy. They can only be given doses after they have presented medical a prescription note from a doctor.
Last year, hundreds of private pharmacies were closed down across the country as part of the plan to ensure that whoever deals with medicines industry has the required qualifications. Officials said then that the measure was aimed at easing the regulatory system on the pharmacies.
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