Kenya conducts therapeutic study of two antimalarial drugs to confirm their efficacy

By The East African

Kenya’s Ministry of Health is studying two drugs used to treat malaria in hospitals to see if they are still effective.

The antimalarial drug efficacy study started in March 2021 in Siaya and Bungoma counties in western Kenya. The study tested whether first-line drugs for uncomplicated malaria (Artemether Lumefantrine, AL) and second-line drugs (Dihydroartemisinin-Piperaquine, DHP) are still effective.

In the studies, clinicians assessed how patients with uncomplicated malaria respond to treatment by observing and testing their blood for the presence and amount of parasites. The last study carried out in Kenya dates back to 2016.

George Githuka, head of the National Malaria Control Program (DNMP) Division, said the country was following the World Health Organization’s (WHO) recommendation for governments to conduct therapeutic studies once every two years.

No resistance record

Dr Githuka said Kenya had yet to register resistance. However, scientists from other parts of the world have said antimalarial drugs are becoming less effective.

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“Kenya has been using artemether-lumefantrine and dihydroartemisinin-piperaquine to treat malaria since 2006. We continue to monitor to ensure that the drugs we use are effective,” he said.

Maureen Mabiria, PMI-Impact Malaria’s technical advisor and physician, said she chose when and where to collect the blood samples.

“We chose Siaya County because of high drug pressure, in which a person can have up to four to six episodes of malaria infection in a year and would be put on antimalarials,” Dr Mabiria said.

Bungoma has low drug pressure, where people get less than two episodes of infections per year.

Whenever a person catches malaria, a blood test would show the presence of parasites in the blood.

Dr Mabiria said an effective malaria drug would eliminate parasites in the blood; ineffective drugs to which the parasite has developed resistance would not.

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

“Artemether Lumefantrine stays in the body for about 28 days, but patients leave the hospital and get bitten by mosquitoes and become reinfected,” Dr Mabiria said.

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

Other parts of the world, such as Southeast Asia, began reporting early signs of artemisinin resistance in the early 2000s.

In no time, some of the most effective drugs against malaria were rendered useless in the region, putting millions of people at risk.

The Kenya Malaria Indicator Survey (KMIS) 2020, launched in April 2021, showed that the country has made significant progress towards reducing prevalence.

WHO has sounded the alarm over drug resistance in Africa. Scientists reported the existence of genetic 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; these mutations cause an observable decline in the ability of antimalarials to rapidly treat people with the disease in Uganda.

Majority cases

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

Dickson Mwakangalu, Public Health Specialist at John Hopkins Affiliate Jhpiego and Kenya Senior Scientist at PMI Impact Malaria, said: “The results of this study will guide Kenya to find out if the drug is still working or if the country needs to look for the alternative medicine against malaria.

Kenya’s health ministry said it was concerned about activities that could render the drugs useless.

Dr Githuka said health workers and the public are posting guidelines on taking antimalarial drugs, using them for fever, headaches or chills. He said these are common symptoms of any infectious disease, not just malaria.

A microscopy test is needed to confirm the presence of malaria parasites. However, many healthcare facilities do not have working microscopes.

Additionally, healthcare facilities equipped with microscopes may lack qualified laboratory personnel to perform the test.

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

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