[e-drug] OTC sale of antimalaria drugs in Kenya

[Kirsten Myhr <myhr@online.no>]

E-drug: OTC sale of antimalaria drugs in Kenya
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Lancet 2001; 357 nr 9271 (9 June)
Over-the-counter sale of antimalaria drugs stalls Kenyan disease strategy
A study by the African Medical and Research Foundation (AMREF) has found 
that many prescription-only antimalaria drugs are being sold over the 
counter in kiosks and pharmacies across the country. Researchers focused on 
East Bungoma and Webuye, which are in western Kenya and found 56 
antimalaria drugs on sale that are not part of the government's national 
antimalaria programme.
Doctors fear these drugs may thwart efforts to fight malaria because the 
misuse of drugs could create new strains resistant to the 
government-approved antimalarial drugs. Most unnerving was the 
over-the-counter sale of amodiaquine-based drugs, which the Ministry of 
Health says should only be used as second-line treatment.
According to the government's policy, second-line drugs can only be given 
on doctors' advice and only after first-line drugs have failed. However the 
government's policy on the sale of over-the-counter antimalaria drugs is 
unclear and there is no legal framework to tackle the issue. Worse still, 
the national technical working group on antimalaria national policy, which 
is supposed to assess and make recommendations on antimalaria drugs to the 
government, has been dormant.
Richard Muga, the Director of Medical Services, says that drug 
manufacturers and suppliers are likely to be held responsible if they 
dispense drugs that are classified as prescription-only treatment as 
over-the-counter drugs.
The Government Chief Pharmacist, Kipkerich Koskey, says that 
amodiaquine-based drugs are preferred for areas where malaria was endemic 
because they are easier to administer. But he stressed that such drugs are 
only supposed to be used if they have been prescribed by a clinician.
Currently, the government's guidelines clearly state that "in areas where 
malaria is chloroquine-resistant and sulfadoxine pyrimethamine is the 
first-line treatment, the second-line treatment shall be amodiaquine or 
oral quinine". However in some parts of Kenya retailers note that 
amodiaquines are selling faster than the sulfadoxine pyrimethamines.
Last month David Alnwick, Manager of the Roll Back Malaria project said 
"the fact is that malaria is a bigger killer of young children in Africa 
than HIV/AIDS". Alnwick was speaking at the launch of a new antimalaria 
drug by Novartis, which the drug firm will supply to WHO and cost US$2�50 
per course. The drug is a combination of a Chinese herb derivative, 
artemether, and lumefantrine, and has demonstrated cure rates above 95%, 
even in areas of multi-drug resistance.
Samuel Siringi

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