29 October 2012

Zimbabwe: Govt Acquires Condemned Malaria Kits

GOVERNMENT has acquired nearly 60 000 Para-Check rapid malaria diagnostic test kits whose low sensitivity at picking malaria parasites has been condemned by the World Health Organisation. Last year, the Ministry of Health and Child Welfare banned the use of Para-Check owing to its low sensitivity of 50 percent to malaria detection compared to other tests kits whose sensitivity ranges between 95 and 98 percent.

The Government's decision to condemn Para-Check, was influenced by an avalanche of reports by medical practitioners countrywide, including provincial medical directors, that the kits were largely ineffective.

Ironically, the same ministry bought the test kits for US$100 000 and to date, about 20 000 units of the kits have been delivered to Natpharm.

A further 39 328 are expected in the second week of next month.

First Response test kits with a sensitivity of 98 percent, won the tender through the State Procurement Board while Para-Check came third.

Para-Check is manufactured by an Indian company, Tulip.

It could not be established how the condemned kits were procured.

However, Government officials in the national malaria programme yesterday maintained that Para-Check is not different from any of the available test kits.

Although malaria manager Dr Stanford Mashaire said there was nothing wrong with the test kits, Health and Child Welfare ministry laboratory services director Dr Douglas Mangwanya, said the kits were condemned and should be returned.

"It's a lie. Tell whoever gave you that story that the (malaria) programme said it's a lie. All test kits are the same. In fact, I do not even want to waste my time on that. I am afraid you are being used," said Dr Mashaire.

Dr Mashaire said, according to WHO recommendations, Para-Check could be bought with pre-shipment testing.

Said Dr Mangwanya: "We are not going to accept them. The Government of Zimbabwe agreed to use First Response (another product said to be more effective) and not Para-Check. When funding was released we heard that UNDP bought Para-Check which is inferior and not recommended by WHO."

UNDP bought the product with funding from the Global Fund to Fight Aids, Tuberculosis and Malaria on Government approval.

Provincial medical directors have also condemned the purchase of the test kit.

Mashonaland East provincial medical director Dr Simukai Zizhou said Para-Check was not reliable.

"People who are telling you that all test kits are the same are actually lying. Para-Check always gives us a negative result, but if you put the same sample on a slide you get a positive result, what does that tell you," said Dr Zizhou.

Dr Zizhou had compiled statistics of samples that were negative with Para-Check but turned out positive on slide test.

Although he could not provide figures, he said the numbers were so significant.

"I cannot remember the actual numbers unless I go back to Mutoko where we did the analysis and look at the records, but I know they were quite significant," Dr Zizhou said.

He said reports were sent to head office in Harare, but some officials from the ministry gave varying reasons to keep it in use.

"Para-Check is unreliable. We have always wanted to get rid of it," he said.

Dr Zizhou said continued use of Para-Check would compromise patients.

"If a result is negative, the patient might not get treatment unless the practitioner strongly suspects that its malaria and continue with prescribing treatment," he said.

Masvingo PMD Dr Robert Mudyarandima also expressed reservations on Para-Check.

"Para-Check is weak at picking parasites and we do not want to use it. There are better products on the market that our head office can consider," said Dr Mudyarandima.

Other provinces, which had bad experiences with Para-Check are Mashonaland Central, Matabeleland South and North.

According to WHO's notice of concern, countries should consider the risk of procuring products such as Para-Check.

It recommends alternative products for procurement, where a viable option exists.

"Principal Recipients should judiciously consider the risk related to procurement of any of these products and consider alternative products for procurement, where a viable option exists," reads part of WHO's recommendations.

WHO further recommends a systematic pre-shipment lot testing.

"At least two weeks should be foreseen from sampling at manufacturing site to reporting of test results."

It further recommends testing at central stores when pre-shipment lot testing is not done.

The Global Fund's country co-ordinating mechanism co-ordinator Mr Rangarirai Chiteure said a committee of malaria specialists had since been set to look into the issue and advise on the way forward.

"The CCM has taken note of the concern and a committee comprising of malaria specialists have been set to look into the issue," Mr Chiteure said.

Last year, a tender believed to have been corruptly floated by the National Pharmaceutical Company (NatPharm) for the supply and delivery of the controversial test kit, was withdrawn with the participating bidders being refunded their tender fees.

Zimbabwe recently lost its bid to become the Southern African Development Community (Sadc) reference laboratory after experts questioned its continued use of the inefficient Para-Check test kit.

This is not the first time the ministry's malaria test kits procurement has come under scrutiny because of alleged corruption.

In 2009 millions of the inefficient Para-Check test kits were corruptly procured ahead of the more effective test kits with reports of ministry officials having received kickbacks.

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