Publication: Poor quality vital anti-malarials in Africa - an urgent neglected public health priority
Accepted Date
2011-12-13
Issued Date
2011-12-13
Copyright Date
2011
Resource Type
Language
eng
ISSN
1475-2875 (electronic)
1475-2875 (Linking)
1475-2875 (Linking)
Rights
Mahidol University
Rights Holder(s)
BioMed Central
Bibliographic Citation
Newton PN, Green MD, Mildenhall DC, Plançon A, Nettey H, Nyadong L, et al. Poor quality vital anti-malarials in Africa - an
urgent neglected public health priority. Malar Journal. 2011;10:352.
Suggested Citation
Newton, Paul N., Green, Michael D., Mildenhall, Dallas C., Plançon, Aline, Nettey, Henry, Nyadong, Leonard, Hostetler, Dana M., Swamidoss, Isabel, Harris, Glenn A., Powell, Kristen, Timmermans, Ans E., Amin, Abdinasir A., Opuni, Stephen K., Barbereau, Serge, Faurant, Claude, Soong, Ray C.W., Faure, Kevin, Jonarthan Thevanayagam, Fernandes, Peter, Kaur, Harparkash, Angus, Brian, Stepniewska, Kasia, Guerin, Philippe J., Fernández, Facundo M. Poor quality vital anti-malarials in Africa - an urgent neglected public health priority. Newton PN, Green MD, Mildenhall DC, Plançon A, Nettey H, Nyadong L, et al. Poor quality vital anti-malarials in Africa - an
urgent neglected public health priority. Malar Journal. 2011;10:352.. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/685
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Title
Poor quality vital anti-malarials in Africa - an urgent neglected public health priority
Author(s)
Newton, Paul N.
Green, Michael D.
Mildenhall, Dallas C.
Plançon, Aline
Nettey, Henry
Nyadong, Leonard
Hostetler, Dana M.
Swamidoss, Isabel
Harris, Glenn A.
Powell, Kristen
Timmermans, Ans E.
Amin, Abdinasir A.
Opuni, Stephen K.
Barbereau, Serge
Faurant, Claude
Soong, Ray C.W.
Faure, Kevin
Jonarthan Thevanayagam
Fernandes, Peter
Kaur, Harparkash
Angus, Brian
Stepniewska, Kasia
Guerin, Philippe J.
Fernández, Facundo M.
Green, Michael D.
Mildenhall, Dallas C.
Plançon, Aline
Nettey, Henry
Nyadong, Leonard
Hostetler, Dana M.
Swamidoss, Isabel
Harris, Glenn A.
Powell, Kristen
Timmermans, Ans E.
Amin, Abdinasir A.
Opuni, Stephen K.
Barbereau, Serge
Faurant, Claude
Soong, Ray C.W.
Faure, Kevin
Jonarthan Thevanayagam
Fernandes, Peter
Kaur, Harparkash
Angus, Brian
Stepniewska, Kasia
Guerin, Philippe J.
Fernández, Facundo M.
Corresponding Author(s)
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.