There are excessive stocks of old drugs

malariadrugs_WHO_TDR_ Crump

Kenyan health workers are continuing to prescribe non-recommended antimalarial drugs that cause drug resistance because new prescribing policies have been poorly implemented, according to a study.

The study, led by Beatrice Wasunna — researcher at the Kenya Medical Research Institute-Wellcome Trust Research Programme — was published in Malaria Journal this month (5 February).

The Kenyan government introduced the WHO-recommended artemisinin based combination therapy (ACT) of artemether-lumefantrine (AL) for uncomplicated malaria treatment in 2006, after the malaria parasite was found to have developed resistance to the commonly used sulphur-based drugs.

They delivered supplies of AL to clinics and hospitals, trained health workers, and produced and disseminated national malaria guidelines.

But previous studies have shown that the new treatment guidelines are not being consistently adhered to. "[Several studies] have documented deficiencies related to diagnosis, treatment, counselling and drug dispensing," says Wasunna.

In 2007, Wasunna and colleagues carried out interviews with health workers in five rural areas of Kenya — Bondo, Gucha, Kisii, Kwale and Makueni — that have a high malaria risk, to find out why the new guidelines weren't always followed.  

They found that reasons for the continued use of the non-recommended drugs included concerns over the high cost and insufficient stocks of new therapies, excess stocks of older antimalarials, lack of follow-up supervision, and a weak and understaffed health system.

"We would like to suggest that improved drug supply, supportive supervision and a complete phase-out of non-recommended antimalarials is likely to improve health worker adherence to treatment policy," says Wasunna.

Willis Akhwale, head of the Division of Malaria Control Kenya's health ministry admits to the continued use of non-recommended antimalarials, but says the Kenyan health ministry is acting on a systematic replacement of the old drugs with more effective ACTs.

Robert Snow, a researcher at the KEMRI-Wellcome Trust Research Programme says, "It's not just about having the right drug policy, it's about having a health system that can effectively deliver it. This is the challenge for ACT policies across Africa."     

Last month, the Pharmacy and Poison Board in Kenya stopped licensing the importation of sulphur-based antimalarials and monotherapies in order to counter the flow of non-recommended malaria drugs.

Link to full article in Malaria Journal [196kB]