Kenya studies two antimalarial drugs to confirm efficacy

Thursday April 28 2022

A nurse checks the file of her patients in the ward. Scientists say antimalarial medicine is becoming less effective. PHOTO | ISAAC WALE | NMG

By The EastAfrican

Kenya’s Ministry of Health is studying two medicines used to treat malaria in hospitals to check whether they are still effective.

The antimalarial Therapeutic Efficacy Study began in March 2021 in Siaya and Bungoma counties in western Kenya. The study checked whether the first-line medicine for uncomplicated malaria (Artemether Lumefantrine, AL) and second-line (Dihydroartemisinin-Piperaquine, DHP) are still effective.

In the studies, clinicians evaluated how patients with uncomplicated malaria respond to treatment by observing and analysing their blood for the presence and quantity of parasites. The last study done in Kenya was in 2016.

George Githuka, the head of the Division of the National Malaria Programme (DNMP), said the country is following the World Health Organisation (WHO) recommendation to governments to run therapeutic studies once every two years.

No record of resistance

Dr Githuka said that Kenya has not recorded any resistance yet. However, scientists in other parts of the world have said that antimalarial medication is becoming less effective.


"Kenya has used Artemether-Lumefantrin and Dihydroartemisinin-piperaquine to treat malaria since 2006. We continue monitoring to ensure the drugs we are using are effective," he said.

Maureen Mabiria, a technical adviser and physician from PMI-Impact Malaria, said they chose the timing and the place for collecting the blood samples.

"We picked Siaya County because of the high drug pressure, in which a person can have as many as four to six bouts of malaria infections in a year and would be put on antimalarials," Dr Mabiria said.

Bungoma has low drug pressure, where people get less than two bouts of infections in a year.

Whenever a person gets malaria, a blood check would show the presence of parasites in the blood.

Dr Mabiria said an effective medication against malaria would clear the parasites in the blood; ineffective medication to which the parasite has developed resistance would not.

However, a patient exhibiting the presence of parasites after the treatment does not automatically mean that there is resistance.

"The Artemether Lumefantrine stays in the body for about 28 days, but patients leave the hospital and get bitten by mosquitoes and are re-infected," Dr Mabiria said.

She said it would be essential to know whether the parasites found in the blood a few weeks after treatment are due to a new infection, or if the antimalarial did not clear them due to resistance.

Other parts of the world, such as South East Asia, started reporting the first signs of resistance to artemisinin in the early 2000s.

In no time, some of the most effective medicine against malaria became useless in the region, endangering millions of people.

Kenya Malaria indicator survey (KMIS) 2020, launched in April 2021, showed that the country has made significant progress toward reducing prevalence.

The WHO has raised the alarm about drug resistance in Africa. Scientists reported the existence of gene mutations associated with resistance in malaria parasites between 2012 and 2015 in Rwanda.

A September 2021 study published in the New England Journal of Medicine showed that; such mutations are causing an observable drop in antimalarials' ability to quickly treat people with the disease in Uganda.

Majority cases

According to the World Malaria Report, Africa accounted for 94 percent of malaria cases and deaths in 2019.

Dickson Mwakangalu, a public health specialist at John Hopkins Affiliate Jhpiego and the lead scientist in Kenya at the PMI Impact Malaria, said: "The results from this study will guide Kenya to know whether the medication is still working, or the country needs to look for alternative medicine for malaria.”

Kenya’s Ministry of Health said it has concerns about activities that could render the medications useless.

Dr Githuka said that health workers and the public flaunt guidelines for taking antimalarial medications, using them for any fever, headache or chills. He said these are common symptoms of any infectious disease, not just malaria.

A microscopy test is required to confirm the presence of malaria parasites. However, many health facilities do not have functional microscopes.

In addition, health facilities with microscopes may lack qualified lab personnel to conduct the test.

Dr Githuka added that counterfeit and substandard antimalarial drugs contain no active ingredients, or less than the required amount needed, to treat malaria.