The first and second-line malaria drugs in Kenya are being evaluated afresh for their effectiveness against the killer parasite.
This is a high-stakes study involving not just health issues but who gets multi-billion dollar contracts to supply the huge public sector.
The study funded by the US President’s Malaria Initiative (PMI) is being conducted in Bungoma and Busia counties in Western Kenya.
Technical support is provided by USAID and US-CDC through the NGO Jhpiego which is affiliated to Johns Hopkins University, US.
Others in the study include Kenya’s Ministry of Health and the county governments’ of Siaya and Bungoma.
The seven-month study at Mahonge Health Center in rural Bungoma and Kaluo Health Centre in Siaya targeted 400 children aged between 6 and 59 months ends in September.
Study protocol registered at the US National Institutes of Health, says the objective is to inform on the possible revision of antimalarial guidelines and policy in Kenya.
This, the protocol says is in line with World Health Organisation’s (WHO) recommendations to keep track of possible emergence of drugs resistance.
“WHO recommends that Therapeutic Efficacy Studies for 1st and 2nd line antimalarial medicines should be routinely carried out and data made available for decision-making due to the threat of emergence and spread of artemisinin resistance in malaria-endemic countries, especially in Africa,” says the protocol.
Coartem or AL (Artemether-Lumefantrine) manufactured by Novartis of Switzerland is the first-line drug in Kenya while Duo Cotecxin or DHP (Dihydroartemisinin-Piperaquine) made by Holley Pharma of China is second in line.
Kenya adopted this class of antimalarial known as ACTs or Artemisinin Combination Therapy for the treatment of uncomplicated malaria in 2004.
This was after previous medicines had become ineffective as the malaria-causing parasite was confirmed to have developed resistance.
Kenya Medical Research Institute
The WHO recommends efficacy studies, such as the current one, be carried out after every three years with the last such done in Kenya in 2016.
However, in 2017, the Kenya Medical Research Institute (Kemri), the country’s national advisor on such matters said the Novartis drug had become ineffective and should be replaced.
Citing a four-year study in Kenya, Rwanda, Uganda, and Tanzania, Kemri said they had compared the two drugs finding the Chinese version more effective.
“The study, therefore, recommends that DHP, which is a second-line drug, should be adopted as the first-line drug,” advised Kemri in an official statement.
Since then several other Kemri studies have also claimed AL to have become less effective. But these have largely been trashed or ignored by the Ministry of Health.
“Ignore such findings or statements, they are the opinion of individual researchers and not government policy,” Dr Erjesa Waqo former head of malaria at the Ministry of Health had told this writer in an earlier interview.
No wonder then Kemri has been kept out of the current assessment which is likely to uphold the prevailing status quo. Malaria medicines and products are big business in Kenya and other donor-dependent African countries.