IT is a matter of time before the most common malaria drugs are thrown out of Government hospitals and dispensaries.
Four years ago, when the failure rate of chloroquine reached alarming proportions, the Ministry of Health decided that the drug should be reinforced with sulfadoxine-pyrimethamine (SP), commonly known as fansidar.
But now health workers are realising that even the combination is increasingly failing to cure malaria. In the worst hit places, nearly half the malaria patients who take the chloroquine-SP combination remain ill until they take other medicines.
â€œStudies have shown that there is resistance to that combination, ranging from about 5% to 40% depending on the district,â€ said Dr. Sam Okware, commissioner for community health. â€œIf resistance to a drug is above 15%, ethically it is wrong to give it,â€ he said.
According to data published by the United States Centres for Disease Control (CDC) on their Internet website, the failure rate of the chloroquine-SP combination nearly doubled in just three years, from an average of 5.5% in 1999-2001, to 11.7% in 2002-2003. Their latest figures show that the failure rates of the chloroquine-SP combination in Uganda varies from 5.5% to 45%. The agency suggests, â€œ...it is evident that the current first-line anti-malarial treatment with chloroquine and SP is reaching the end of its useful life ...â€
Given the dwindling usefulness of the long-established drugs, the Minister of Health, Brig. Jim Muhwezi, last week announced that they would change to more effective drugs. Already, the ministry has ordered for Coartem, a drug that contains two effective anti-malaria substances, artemether and lumefantrine.
Artemether, is derived from the Chinese herb artemisia and has been available in Ugandan pharmacies since the 1990s.
More recently, drugs derived from the same herb have become available in Kampala under various trade names, costing between sh10,000 and sh15,000 per adult dose. Drugs of this group, broadly known as artemisinin derivaties, are renowned for faster action and fewer side effects.
Lumefantrine is another drug that was developed in China. When combined with artemether, they perform better. Artemether acts rapidly but gets cleared from the blood quickly, while lumefantrine stays longer to clear any parasites that could have survived the rapid action of artemether.
Okware said the plan is to have Coartem as the first line drug for malaria in all health facilities.
At the community level, village volunteers will continue distributing Homapak, a combination of chloroquine and SP, under the home-based management of fever programme.
The Secretary General of the Uganda Medical Association, Dr. Myers Lugemwa, said the ministryâ€™s change of policy was long overdue.
â€œWe who are working on the ground had noted that there was poor response to these drugs yet the ministry was holding on to that policy.
It is good they have come up to pick on something that is going to be effective,â€ he said. â€œWe criticised the combination of chloroquine and fansidar.â€ He, however, said the new drug would also run into problems in future unless the population is cleaned up through mass treatment at the same time.
The reason malaria prevails, he argues, is that many people harbour it and mosquitoes keep transferring the parasite from person to person. â€œIt is human beings who harbour the parasite and mosquitoes just get it accidentally when they go to feed,â€ he said.
Chloroquine, fansidar to be abandoned soon