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Uganda: ACT treatment is too expensive

May 12, 2011 - 21:22 -- Bart G.J. Knols
The article below was contributed by journalist Hope Mafaranga (Uganda) as part of the SjCOOP project in collaboration with MalariaWorld.


The government of Uganda wants people to use Artemisinin Combination Therapy (ACT) for treating malaria but the treatment is too expensive and there’s not enough available of this medicine. 
Malaria is the leading cause of death in Uganda killing 70,000 to 110,000 people per year, mostly pregnant women and children below five years.
 
The World Health Organization strongly recommends to use Artemisinin Combination therapy (ACT), as a second line treatment after oral chloroquine fails to heal malaria.
 
Dr. Richard Ndyomugyenyi, Director of the malaria control program in the Ministry of Health said the Government of Uganda switched to ACT in 2005 after the malaria parasite became resistant to chloroquine.
 
But the problem is that ACT is very expensive. One dose costs between seven and twelve US dollars. Most people in rural areas, where malaria is the most severe, cannot afford this treatment. Thirteen percent lives on less than a dollar per day. 
And if they can afford, the availability is a big problem. Twenty percent of the public health clinics doesn’t have ACT. Eighty percent has, but run out of supply quickly in the malarious months of October, November and December. 

The Ministry of Health has received funds since 2007 but not enough to handle the demand, Ndyomugyenyi says. Due to this problem people are forced to seek medical ACT-treatment from private organisations - which is even more expensive - or use alternative drugs like chloroquine. That’s a pity because chloroquine is not the best option for treating malaria says Ndyomugyenyi. “When not mixed in the right proportions, chloroquine can be deadly. Due to poor training of lower level health workers to administer it through injections, we are moving away from that medicine. We prefer ACT-injections’. 

The government lobbies now to get more funds for this medicine. ‘ACT is thirty times more effective than chloroquine and is currently the only way to beat severe malaria in our country.’

Comments

Submitted by Guest (not verified) on

I was in Tanzania earlier this month and was able to purchase (for my research study) the Indian-manufactured generic equivalent of coartem for TZS600 per treatment course, which is about US$0.40 from a wholesale distributor (30 treatment courses per case). Although I have no information about the quality of the drugs, I am told that at least some drugs of this type have been tested in WHO programmes. Also, I know from my colleagues that bioequivalence studies are this and other generics are underway in Tanzania for feedback to regulatory authorities.

I hope that this availability of Indian generics to treat malaria greatly increases the accessibility of suitable treatments for malaria.

Chloroquine resistance rates are very high in much of the world for P. falciparum and have been so in East Africa since the 1980's. Resistance to sulfadoxine/pyrymethamine (SP, the next drug used after chloroquine) was found in about 30% of malaria cases in the early 2000's in Kenya, which is why also this drug is no longer the first-line drug in most or all of Africa.

Jeffrey Dorfman
ICGEB Cape Town
jeffrey.dorfman@icgeb.org