Self-medication to blame for resistance to malaria medicine

The government is raising the red flag that cases of drug resistance stand to water down its efforts towards ensure near-zero deaths from malaria by 2015 in line with its international commitment to fight the scourge.

It is concerned that unless Kenyans stop the practice of self-medication, the newest and more effective Artemisinin Combination Therapy (ACT) medication could become ineffective, quickly adding to the list of recently rendered ineffective drugs such as the salpaxine- pyremethamine (SP) based Metakelfin and Fansider drugs.

Quinine, though still effective, is only recommended for complicated malaria cases owing to its side effects.

According to the head of disease prevention and control, Dr Willis Akhwale, cases of resistance against the drug have already been recorded in some southern Asian countries.

Late last year, Prof Nicholas White of tropical medicine at Mahidol University in Bangkok urged the World Health Organisation to adopt a more aggressive approach to tackle the malaria strain resistant to the drug artemisinin that first emerged along the Thai-Myanmar border.

Given the close proximity of the Asian countries to Africa, the Prof expressed fear that unless quickly addressed, the drug resistant strain could easily find its way onto the continent.

Dr Akhwale said the new drug resistance cases were largely attributed to incorrect usage of the current ACT medication.

Dr Akhwale noted that the tendency by Kenyans to first self-medicate before seeking professional care may soon render the drugs ineffective, just like as was the case with such drugs as Chloroquine and SPs.

Local pharmacist

“It has become commonplace that when some people develop some fever they rush straight to their local pharmacist and demand malaria drugs. In some of those cases, the underlying disease is rarely malaria,” said the department head.

He further noted: “Actually close to 50 per cent of drug resistance cases are due to the overuse of drugs as people self-medicate.”

In a bid to safeguard against drug resistant cases, the Ministry of Medical Services recently issued a directive that all suspected malaria cases be diagnosed before medication is dispensed by health officers.

This is a clear departure from the previous WHO recommendation that any fever in children below the age of five should be treated as malaria.

The ministry has set aside Sh390 million for the procurement of eight million malaria diagnostic test kits to aid in quick and effective diagnosis, especially in the remote health centres that lack basic testing equipment like microscopes.

The new test kits which will take a minimum of 10 minutes to give a valid diagnosis will also be expected to help in bringing down the overall cost of treatment associated with overuse of drugs.

Dr Akhwale approximates that with the introduction of the kits, the overall treatment cost could come down to Sh200 million from the current Sh1 billion annual bill incurred in the treatment of malaria cases alone.

Health permanent secretary Mark Bor agrees: “The test kits will lead to rational use of medicines as well as improve treatment outcomes around the country.”

Added the PS: “Further, this approach will ensure that all malaria cases reported are treated and thus save on treatment costs.”

But even before benefits are realised from the use of the new tests kits, the ministry is urging Kenyans to exercise restraint in the use of the ACT drugs.

“We have planned a series of sensitisation programmes to educate Kenyans on the need for diagnostic testing before treating suspected malaria cases,” said Dr Akhwale.

Failure to exercise such restraint, the ministry is warning, the gains made against the killer disease that kills 57 children every day according to statistics from Unicef could be reversed.

It will also cost the taxpayer as the government will be forced to look for more effective, but expensive drugs.