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  • Volume 1

Malawi orders malaria drugs off shelves

 

By Caroline Somanje-Malawi

Fifty-one year old Edward Maseko was feverish when he decided to go to the nearest chemist  for anti-malarials to cure his symptoms. At the till, the teller informed him that the sulfadoxine-pyrimethamine (SP) he was looking to buy had been ordered off the shelves to control its intake because it was no longer an effective treatment for malaria.

"Liar!," thought Edward as he sped off to the next chemist to get his cure. The news there was equally disappointing but reality had not yet sunk in until he got to the third shop.

Government had ordered the drugs off the shelves, period!

Edward was far from amused. "How could government do such a thing when all along we have been accessing the drugs easily? Has it no consideration for people that cannot afford to go to hospital right away and opt for SP as a first line treatment? Isn’t it appalling that such a decision could be made without consultation," he mused

Malawi government had indeed ordered the removal and sale of malaria SP without prescription in shops because it is no longer an effective treatment of malaria. It is promoting the popular use of its recommended treatment, Lumefantrine Artemether (LA).

While claiming to be unaware of the development the Executive Director of the Malawi Health Equity Network ( MHEN) Martha Kwataine, said the new policy will have a negative impact on people who need the anti malaria drug especially in rural areas that are very far from the nearest health facility, compounded by the frequent drug shortages in most health centres.

She said the availability of SP in groceries eased accessibility for many especially the poor, vulnerable and that in terms of cost, LA is expensive compared to SP. Kwataine said difficulties in accessing anti-malaria drugs would pose a big challenge to the fights against HIV and AIDS bearing in mind that malaria is one of the greatest opportunistic infections for people living with the disease.

Said Kwataine: "We are not aware of the withdrawal of SP from the shelf. However, it is not coming as a surprise to us because there has been a lot of talk surrounding the issue of SP alongside LA. The argument is that SP has been a failure in malaria treatment because many people were not being cured quickly.

"Scientifically, many developed resistance to SP. On the other hand, LA has proven potency. The withdrawal of SP from the shelves means that one can only get SP if a clinician has recommended its use. Currently, SP is recommended as malaria prevention drug for pregnant mothers because it is less powerful than LA".

She noted that there has not been adherence to the use of LA as malaria treatment as people still preferred to take SP drugs because they are taken once unlike the alternative which must be taken in a couple of days.

Kwataine also observed that many private clinics still prescribed SP because it is cheap. She said, as a policy, LA is supposed to be provided free charge in both private and public hospitals. She however said that there was need to enforce compliance by private clinic owners to ensure that the recommended first line treatment is being adhered to.

She said the benefits of removing the drugs from the shelves do not outweigh the costs considering access problems and that in the absence of LA in grocery stores, the chances of having SP sold by vendors would be high, thereby risking people’s lives because of the conditions under which the drugs are stored

"If indeed it is true that government has decided to remove the SP from the shelves, it is untimely because the first step should have been to make LA easily accessible including in grocery shops. We need supporting policies to curb drug pilferage and drug vending. We have been to many rural grocery shops where daraquine is sold as treatment for malaria and yet government does not recognize that drug as first line anti malaria treatment.

"The other challenge is a marketing issue. There are more than 10 brands of malaria treatment available on the market and who monitors that? It becomes very tricky in a liberalized market to enforce compliance. The challenge however is that this is about people’s lives and in a country with high illiteracy levels, understanding is another mountain to climb," she said.

Principal Secretary at the Ministry of Health Dr. Charles Mwansambo said the decision was based on a study that showed SP can no longer be a first line treatment for malaria.

Said Mwansambo: "Government policy is to have Lumefantrine Artemether (LA) as the first line treatment for malaria. There are other conditions where you need SP like in pregnant mothers for prevention and in some case infants.

"We don’t want a drug that has been removed as a first line for malaria to be out there for anybody to use. Some general practitioners in private hospitals are still using the drug which is dangerous because we know there is high resistance. Even if we leave it in the villages, what are we doing to the villagers by giving them false hopes that they are being cured?

He challenged MHEN to base their arguments on science and not opinion. Mwansambo said that government would be doing injustice to the masses by exposing it to SP. He said government is simply replacing it with LA. He said the policy also includes availing LA easily to the populace and that this will be achieved in phases.

 

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