The emergence of fake, counterfeit, unwholesome and sub-standard anti-malarial drugs is dashing the hopes of winning the war against malaria in Nigeria as well as increasing mortality from the disease. Not only are these drugs potentially harmful, they are currently promoting the emergence of drug resistance malaria parasites.
It is commonplace to buy drugs everywhere and anywhere in Nigeria. Drugs are hawked like any other article. Every Tom, Dick and Harry sells drugs in Nigeria. Hospital reports show that scores of patients are being inadequately treated, but the presence of these undesirable and illegal medications significantly raises the risk of drug resistance.
Antimalaria drug situation in Nigeria
In the face of these challenges, the declaration of the African Summit on Roll Back Malaria in 2000 comes to mind. It states: “Concerted efforts would be made to ensure that by the end of 2005 at least 60 percent of the vulnerable populations in Nigeria would have access to good quality, affordable and efficacious anitmalarial medicines.”
The same target was raised to 80 percent by 2010, according the Minister of Health, Professor Onyebuchi Chukwu, in order to achieve the goal of reducing the malaria burden by 50 percent. Alas, 14 years after, Nigeria is still faced with non availability of quality drugs for malaria.
Despite the many technologies deployed by the National Agency for Food and Drug Administration and Control, NAFDAC, antimalarial drug remain one of the most faked drugs after antibiotics.
The World Health Organization, WHO, recommended insecticidal spraying and distribution of bed nets to protect people in the developing world, where malaria is endemic but antimalarial drugs like artemisinin has been used to keep malaria under control.
Before now, chloroquine and sulphadoxine pyrimethamine (SP), are recommended to treat malaria no thanks to resistance as the once highly successful malaria treatments were replaced with artemisinin combination therapies, ACTs.
Although, the combination therapy has remained one of the strongest drugs available to fight malaria, there are fears now that flood of substandard antimalarial medicines may cut short the success already achieved.
Today, millions of lives are already at risk due to the activities of these counterfeiters.
According to a research carried out by the Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Lagos, UNILAG, on 13 brands of Artesunate-amodiaquine combinations, also known as Artemisin Combination Therapy (ACT), bought from pharmacies in Lagos state, 84.6 per cent of anti-malarial drugs sold in the state are sub-standard,
The study en titled: “Quality survey of some brands of artesunate-amodiaquine in Lagos drug market” and published n African Journal of Pharmacy and Pharmacology, concluded that the result raises the risk of treatment failures and resistant strains of the malaria parasite.
According to researchers, “Even though there is no case of outright counterfeiting from the results obtained in the study, the potency of the drugs vary considerably. Only 15.4 per cent of the samples studied had required amount of active ingredients for the two drugs.
“It is clear that the quality of most brands of artesunate amodiaquine combined therapy in circulation in Lagos metropolis is less than adequate. This poses a great threat to the global effort to combat the scourge of malaria.”
Also a study which examined fake and substandard anti-malarial drugs that were found on sale in 11 African countries between 2002 and 2010 discovered that some counterfeits contained a mixture of the wrong pharmaceutical ingredients which would initially alleviate the symptoms of malaria but would not cure it. Their analyses showed that some counterfeits contained a mixture of the wrong pharmaceutical ingredients, some of which may initially alleviate malaria symptoms but would not cure malaria. Worse still, these unexpected ingredients could cause potentially serious side effects, particularly if they were to interact with other drugs the patient was taking, such as antiretroviral therapies for HIV.
Health watchers are worried that the enormous investment in the development, evaluation and deployment of anti-malarials is wasted if the medicines that patients actually take are, due to criminality or carelessness, of poor quality do not cure.
For these concerned observers, the failure of artemisinin treatments has profound consequences for public health in the country.
Consequences of fake drugs
Director General, NAFDAC, Dr Paul Orhii noted in a report, during a sensitization workshop for medicine sellers and distributors within the Bridge-Head Drug Market, Onitsha in Anambra “Fake and counterfeit medicines pose great threat to the attainment of these goals as well as the overall public health. They cause several health problems including treatment failure, organs and system failure, economic loss, sickness, death etc.”
Former President, Pharmaceutical Society of Nigeria, PSN, Azubuike Okwor, to be able to guarantee and sustain the quality of medicines especially anti-malaria drugs “certain imperatives are necessary and unfortunately these imperatives are the exceptions rather than the rule in Nigeria.
Dr. Austin Nweke, a General Practitioner, in a report described the situation as worrisome. “Imagine you have malaria and you are taking Artesunate, only to find out later that the medication had no effect. The fake anti-malaria drugs have taken over everywhere, therefore, people can hardly differentiate between fake and original,” he said.
A Paediatrician, Professor Olugbenga Mokuolu, said counterfeit malaria drugs had become a major threat to effective malaria treatment in Nigeria. Mokuolu, a member of WHO Anti-malaria Therapy Group in a report, stressed the need to tackle the trend urgently, adding that, “Over 70 per cent of anti-malaria drugs are faked and this poses a threat to malaria treatment. Many people have been under-treated, thereby causing a re-occurrence.”
To check the usage of these fake drugs, public health organisations must take urgent, coordinated action to prevent the circulation of counterfeit and substandard medicines and improve the quality of the medicines that patients receive.
Multiple parallel strategies are needed to tackle the problem. There is need to increase investment in national medicine regulatory authorities in Nigeria and improve access to good quality, affordable