Nigeria calms fears over antimalarial drugs

[LAGOS/LONDON] Concerns that many antimalarial drugs in Nigeria are ineffective are largely unfounded, the country's National Malaria Control Programme has claimed.

Nigerians have been worried about malaria drugs not working because of concerns regarding the quality of drug production in the country.

In response, Nigeria began an efficacy trial last year of two different combination therapies for malaria (artemether and lumefantrine; artesunate and amodiaquine). It tested the drugs in seven sites across the country and the preliminary results are now being validated, said Babajide Coker, head of Nigeria's malaria control programme.

"The drugs from the government stores are efficacious, as discovered by the trials, but some failures were observed," said Philips Agomo, a malaria researcher at the Nigerian Institute of Medical Research. He said re-infection with the parasite midway into treatment may contribute to treatment failure in some people.

Enu Lawson, a mother of two told SciDev.Net "last time my son took ill to malaria, we used artemether–lumefantrine but the symptoms refused to go away".

But Samuel Oyeniyi of the World Bank's malaria programme in Nigeria said that most people who complain of failures buy drugs at open-air markets, where there are many fakes. "You cannot expect to buy any brand of malaria drug from the regular market and expect that you'll get the desired result", he told SciDev.Net. 

The study considered only malaria drugs registered by the Nigeria's National Agency for Food, Drug Administration and Control, excluding possible fakes.

Lembit Rägo, head of quality and safety of medicines at the WHO, said the Nigerian authorities recognise they have a problem with counterfeit medicines and have taken action. But there is still "room for improvement" for dealing with the substandard drugs that are legally produced but do not meet quality specifications, he said.

"In some of the poorest countries, some of them in Africa, the perception is that you can't trust any generic products, you only trust the brand names," he added."This tells you the public does not trust the health systems so they trust companies and, so, branded, more expensive drugs, instead."

In contrast to the Nigerian study, the WHO's Quality of Antimalarials in Sub-Saharan Africa study of ten countries found that in some countries almost 40 per cent of drugs, whose production and quality have not been checked by the WHO, underperformed.

These differences could come from different sampling methods, or from more emphasis being put on quality control amongst the Nigerian manufacturers since the WHO study, said Rägo, adding that any such improvements must be made sustainable in the long term.