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Title: Poor quality vital anti-malarials in Africa - An urgent neglected public health priority
Authors: Paul N. Newton
Michael D. Green
Dallas C. Mildenhall
Aline Plançon
Henry Nettey
Leonard Nyadong
Dana M. Hostetler
Isabel Swamidoss
Glenn A. Harris
Kristen Powell
Ans E. Timmermans
Abdinasir A. Amin
Stephen K. Opuni
Serge Barbereau
Claude Faurant
Ray C.W. Soong
Kevin Faure
Jonarthan Thevanayagam
Peter Fernandes
Harparkash Kaur
Brian Angus
Kasia Stepniewska
Philippe J. Guerin
Facundo M. Fernández
Oxford University Tropical Medicine Research Collaboration
Nuffield Department of Clinical Medicine
London School of Hygiene & Tropical Medicine
University of Oxford
Centers for Disease Control and Prevention
GNS Science
International Criminal Police Organization (INTERPOL)
Georgia Institute of Technology
Armed Forces Research Institute of Medical Sciences, Thailand
Population Services International
Food and Drugs Board Ghana
East West Pharmaceuticals
Mahidol University
Keywords: Immunology and Microbiology;Medicine
Issue Date: 14-Dec-2011
Citation: Malaria Journal. Vol.10, (2011)
Abstract: Background: Plasmodium falciparum malaria remains a major public health problem. A vital component of malaria control rests on the availability of good quality artemisinin-derivative based combination therapy (ACT) at the correct dose. However, there are increasing reports of poor quality anti-malarials in Africa. Methods. Seven collections of artemisinin derivative monotherapies, ACT and halofantrine anti-malarials of suspicious quality were collected in 2002/10 in eleven African countries and in Asia en route to Africa. Packaging, chemical composition (high performance liquid chromatography, direct ionization mass spectrometry, X-ray diffractometry, stable isotope analysis) and botanical investigations were performed. Results: Counterfeit artesunate containing chloroquine, counterfeit dihydroartemisinin (DHA) containing paracetamol (acetaminophen), counterfeit DHA-piperaquine containing sildenafil, counterfeit artemether-lumefantrine containing pyrimethamine, counterfeit halofantrine containing artemisinin, and substandard/counterfeit or degraded artesunate and artesunate+amodiaquine in eight countries are described. Pollen analysis was consistent with manufacture of counterfeits in eastern Asia. These data do not allow estimation of the frequency of poor quality anti-malarials in Africa. Conclusions: Criminals are producing diverse harmful anti-malarial counterfeits with important public health consequences. The presence of artesunate monotherapy, substandard and/or degraded and counterfeit medicines containing sub-therapeutic amounts of unexpected anti-malarials will engender drug resistance. With the threatening spread of artemisinin resistance to Africa, much greater investment is required to ensure the quality of ACTs and removal of artemisinin monotherapies. The International Health Regulations may need to be invoked to counter these serious public health problems. © 2011 Newton et al; licensee BioMed Central Ltd.
ISSN: 14752875
Appears in Collections:Scopus 2011-2015

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