NEWS: Coartem- A dose in time saves life

By Irene Nabusoba (NEW VISION)

A laboratory technician takes a child’s blood for testing. A baby suffering from malaria could die within 24 hours if not treated immediately

LITTLE Maliza could have probably died had it not been for the drug shop in her neighbourhood. Her mother, Maria Kirya, recounts how Maliza, aged 18 months, developed high temperature and diarrhoea in the evening, only to worsen at night.

“I gave her herbs because the nearest health facility is 20km away.” However, the herbs did not work and Maliza’s condition deteriorated. At 3:00am in the morning, Kirya, a resident of Kakoro village in Pallisa district, ran to the nearest drug shop where she was given panadol and ‘coartem with a green leaf.’

“That is how my little girl survived,” Kirya says. “I did not have money, so I gave the nurse four eggs.”

‘Coartem with a green leaf’ as the medicine is fondly referred to by the locals in Pallisa, is a subsidised and repackaged version of coartem, only found in private medical outlets.

The drugs are an initiative of Medicine for Malaria Ventures (MMV), a Swiss-based organisation. The organisation aims to reduce the burden of malaria in disease-endemic countries by developing and facilitating delivery of affordable antimalarial drugs.

Dr. Ambrose Talisuna, the MMVs country representative in Uganda, says they conducted a study that saw coartem going for between sh200, 400, 600 (for children’s doses) to sh800 for adults.

On average, coartem costs between sh15,000 and sh25,000. “We distributed coartem to outlets within 5km of households in Budaka, Pallisa, Kaliro and Kamuli,” he says.

Talisuna says five out of every 100 children aged five and below, who had fever in the last two weeks of their survey (over 1,000 households were surveyed per district), received treatment in all the pilot districts.

He said more than a half of all health facilities in Kamuli and Budaka and less than a half in Pallisa had no artemisinin combination therapy (ACT). Half of all the facilities had quinine.

Penny Grewal, MMV’s director for Global Access says they bought one million doses of coartem at $2.5m (about sh5b).

Grewal says the number of people purchasing artemisinin combination drugs in the private clinics rose from almost zero to 55% (over 60 % of the 251 outlets sampled had coartem) from almost zero to 51% while chloroquine dropped from 40% to 11% and quinine from 50% to 35%.

“MMV is extending the project until June when the Affordable Medicines Facility for malaria (AMFm), an initiative of the Global Fund to Fight AIDS, tuberculosis and malaria takes over,” Grewal says.

The UK government and UNITAID allocarted money to AMFm to subsidise Artemisinin drugs and make them affordable for the patients.

The health ministry has hailed MMV’s initiative, saying it will save about 320 lives a day; 70,000 — 110,000 lives a year. This will help every household save between sh85,000 and 150,000 per year in artemisinin treatment.

Richard Ndyomugyenyi, the programme manager malaria control programme at the ministry, says because of lack of laboratory services, there is a lot of wastage.

Out of 100 people who visit health facilities with malaria symptoms, he says, about 70 do not have malaria but are still treated for the disease.

He says a child with fever due to malaria can die within 24 hours thus the need for effective treatment. However, ministry records show that the number of children under five years receiving treatment within 24 hours of developing fever dropped from 55% in 2005 to 10% in 2008 because of coartem shortages in the country.

In 2009, about 12 million cases of malaria were reported by the Health Management Information System.
Ndyomugyenyi says the Government allocates sh60b for the drugs and ARVs, and soon they will include TB.

“The money can only last us six months. With TB on board we shall only get 20% (only sh12b) which can only last three months,” he argues.

The World Health Organisation remmended artemisinin drugs as the first-line treatment for uncomplicated malaria after the disease became resistant to chloroquine and quinine.

MMV officials recommend that all countries that participate in the AMFm remove barriers to ACT availability.
“Researchers should look for ways to upgrade unlicensed shops and consider granting over-the-counter status to artemisinin drugs,” Grewal says.

Dr. Myers Lugemwa, a senior medical officer at the health ministry, says they will consider the recommendations during roll-out but while the price may not be the same as the ‘green leaf ACTs’, it will still be affordable. He says a dose could cost sh400.