The Role of NAFDAC in Eradicating Fake Anti-malarials in Nigeria

Malaria is a life threatening disease caused by a parasite called Plasmodium protozoa, which is transmitted via the bites of infected female anopheles mosquitoes. In the human body, the parasites multiply in the liver and then infect the red blood cells.

Five species of plasmodium can infect and be spread by humans. Most deaths are caused by P. falciparum, because P. vivax, P. ovale and P. malaria generally cause a milder form of malaria.

EPIDEMOLOGY OF MALARIA

Malaria is endemic throughout most of the tropics.

Malaria is transmitted via the bite of a female Anopheles spp mosquito, which occurs mainly between dusk and dawn.

Of the approximately 3.4 billion people worldwide who are exposed annually, 1.2 billion are at high risk.

Over 80 percent of the deaths occur in sub-Saharan Africa.

THE LIFE CYCLE OF MALARIAL PARASITE

• The malarial parasite, Plasmodium, is a very small, single-cell blood organism, or ‘protozoan’. This small single-cell organism has three to four different forms. Each form is specialized in living in a certain place.
• A mosquito causes an infection by a bite. First, sporozoites enter the bloodstream, and migrate to the liver. They infect liver cells, where they multiply into merozoites, rupture the liver cells, and return to the bloodstream.
• The merozoites infect red blood cells, where they develop into ring forms, trophozoites and schizonts that in turn produce further merozoites.
• Sexual forms are also produced, which, if taken up by a mosquito, will infect the insect and continue the life cycle.

Diagram Illustration of the plasmodium Life cycle

SYMPTOMS OF MALARIA

• The signs and symptoms of malaria often begin 8-25 days following infection.
• Classic symptoms would be fever and shivering. The attack begins with fever, with the temperature rising as high as 40ºC and falling again over a period of several hours.
• A poor general condition, feeling unwell and having headaches like influenza,diarrhoea, nausea and vomiting often occur as well.

TREATMENT OF MALARIA

• Antimalarial drugs are used for the treatment and prevention of malaria infection.
• Most antimalarial drugs target the erythrocytic stage of malaria infection, which is the phase of infection that causes symptomatic illness
• For infection due to Plasmodium ovale or P. vivax, terminal prophylaxis is required with a drug active against hypnozoites.
• Uncomplicated malaria may be treated with oral medications. The most effective treatment for P. falciparum infection is the use of artemisinins in combination with other antimalarials (known as artemisinin-combination therapy, or ACT), which decreases resistance to any single drug component.These additional antimalarials include: amodiaquine, lumefantrine, mefloquine or sulfadoxine/pyrimethamine.Another recommended combination is dihydroartemisinin and piperaquine.

ANTIMALARIALS IN PREGNANCY

• The antimalarials that can be used in pregnancy include chloroquine,amodiaquine, quinine,azithromycin,sulfadoxine-pyrimethamine,mefloquine, dapsone-chlorproguanil,artemisinin derivatives, atovaquone-proguanil and lumefantrin
• Antimalarial drugs that should not be used in pregnancy including halofantrine,tetracycline/doxycycline, and primaquine.

MALARIAL DRUG RESISTANCE

The development of resistance to drugs poses one of the greatest threats to malaria control and results in increased malaria morbidity and mortality. Resistance to currently available antimalarial drugs has been confirmed in only two of the four known malaria parasite species, Plasmodium falciparum and P. vivax. P. falciparum has also developed resistance to nearly all of the other currently available antimalarial drugs, such as sulfadoxine/ pyrimethamine, mefloquine, halofantrine, and quinine. Artemisinin Combination Therapies, or ACTs, are currently the frontline treatments against P. falciparum malaria.

KEY DRIVERS OF RESISTANCE TO ANTI-MALARIAL DRUGS.

Counterfeit or substandard treatments.

Unregulated or poor administration of antimalarial drugs.

Artemisinin drug use without a complementary combination treatment, such as lumefantrine.

NAFDAC’S STRATEGY IN ERADICATING FAKE ANTIMALARIALS

• Through sensitization exercises informing masses on the dangers of purchasing drugs from unreliable sources and also on the dangers of self-medication.
• Carrying out raids on suspected marketers and manufacturers of counterfeit antimalarial drugs.
• The use of mobile authentication service (MAS).
• Destruction of seized counterfeits.
• • Pharmacovigilance activities nation wide.
  • Post marketing surveillance of regulated product (quality and safety)
  • Creating awareness of pharmacovigilance among health professionals,health care providers,marketing authorization holders and the general public.
  • Establishing and maintaining a functional
• • database on ADRs and other medicine related problem.
  • Providing science based advice and information on rational use of drugs.

WAYS FORWARD

• Further education on the effective use of anti malarial drugs.
• Improving personal and community protection ,-insecticide treated bed nets.
• Publicizing the presence and use of MAS (Mobile authentication service).
• Malaria Rapid Diagnostic tests (RDT).
• Increased surveillance at the borders to control the importation of fake anti malarials.

CONCLUSION

• The discovery of new treatments for malaria, along with their proper execution in the field, will contribute to an important achievement of controlling, and eventually eradicating counterfeit antimalarials and hopefully malaria.NAFDAC has a large and important role to play in ensuring that this becomes a reality in Nigeria.

 

 

Written by Pharm. Adebayo Madinat Abiola