Ugandan researchers dispute WHO stand on malaria deaths

Contrary to a recent World Health Organisation survey, Ugandan researchers say the problem of increased resistance to malarial drugs is more likely related to improper use of medications than the presence of fake and poor-quality medications.

This non-compliant behaviour among Ugandan patients stems primarily from cultural beliefs and ignorance, said Dr Myers Lugemwa, the officer in charge of malaria research at the ministry of health.

And this pattern could significantly increase resistance to treatment if not addressed, he warned. 

While acknowledging the presence of fake and poor-quality drugs, Dr Lugemwa invokes Uganda’s policy for ensuring the quality and safety of malaria medications.

“We cannot just have people die because the drugs are not good,” he told The EastAfrican. “We have tested them and found them effective.”

His observations follow the release of a report, on February 8, which concluded that the most effective type of malaria-fighting drugs sold in three African countries — including Uganda — are often of poor quality, raising fears of increased resistance.

The use of poor-quality medications lower’s the body’s ability to resist the malaria parasite.

Nearly 200 drug samples have gone full quality-control testing at a US laboratory to examine the amount of active ingredients present and drug purity.

Forty-four per cent of samples from Senegal failed the full quality test, followed by 30 per cent from Madagascar and 26 per cent from Uganda. 

Overall, between 16 per cent and 40 per cent of artemisinin-based drugs sold in Senegal, Madagascar and Uganda failed the quality testing for reasons including impurities and lack of active ingredients, the survey found.  

The study was the first part of a 10-country examination of antimalarials in Africa by the US and the WHO.  

Artemisinin-based drugs are the only affordable treatment for malaria left in the global medicine cabinet.

Other drugs have already lost effectiveness due to increased resistance.

Ugandan experts sought to clarify the research findings, based on their work with patients.

They acknowledged a high failure rate for drugs 10 years ago, but said the rate has improved significantly in recent years, hence the need to focus on other causes of resistance.

For example, Ugandan researchers say patients are likely to stop taking medication when they begin to feel better, or to share their drugs with neighbours and friends who have not been properly diagnosed.

“There are problems with consumers due to self-medication and incomplete doses. As a result, drugs become ineffective,” said Fredrick Ssekyana, the spokesperson for the Uganda National Drug Authority (NDA).  

NDA confirmed that drug counterfeits are in the market, a global problem they say they are working with Interpol to curb.  

“We have people who change expiry dates, drug labels and even make pills using cassava flour,” said Ssekyana.    

The three-country report also found bad drugs at both the public and the private health facilities, meaning governments — some buying medicines with donor funds — are not doing enough to keep poor-quality pills out.

All of the drugs tested from the Ugandan public sector, however, passed the tests.

“There are countries where donated medicines are not subjected to quality controls; they’re just accepted,” he said.

“There are countries in Africa where Chinese products have been donated and found to be unacceptable later in the public sector.”  

Donations come in during epidemics or seasonal disease outbreaks.