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| Information on the medicines used for the prevention and treatment of malaria |
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| Written by AEFJN | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Friday, 25 January 2008 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 1. History of the steps taken since 20061.1. The record concerning access to a quality medication. Elena Chiarella composed and wrote the record “access to medicines: a wider perspective” in June 2006. It was then that it was decided to do a study limited to Africa in order to prevent and treat the so-called “neglected diseases” and to send a questionnaire to all the Congregations which are members of Africa-Europe Faith and Justice Network-AEFJN for them to send it to their committed personnel en the Health Sector in Africa. 1. 2. The composition and sending (dispatching) of the questionnaire. The questionnaire was made ready and then sent off. Since then we have received 87 answers proceeding from 23 African countries. 1. 3 Examination of the questionnaire From a framework, the members of the Secretariat in Brussels worded the questionnaire, established some classifications and realised that it would be better to limit it, for the moment, to malaria although the questionnaire did also mention other neglected illnesses as well as vaccinations. 1.4. Data concerning the investigation beyond malaria 1.4. 1. Investigation of other illnesses The majority of the countries have a medical investigation programme as far as the following are concerned: diabetes, cholera, hepatitis, Leishmaniasis, malaria, onchocercosis, polio, tuberculosis, Guinea worm, tripanosomiasis, typhoid, verminosis and Yellow Fever. 1.4.2. Vaccines The majority of the institutions which responded to the questionnaire enter into the programme of public vaccination, 14 centres also vaccinate privately. The vaccinations are against cholera, hepatitis, measles, whooping cough, diphtheria, polio, tuberculosis, tetanus, typhoid and Yellow fevers, some of these combine together, for example, Bacillus of Calmette and Guérin (BCG), variety DPT/DTC. The vaccines utilized come, principally, from the Governments, from the World Health Organization-WHO, and/or UNICEF and they are produced in situ or in France, India, Belgium, Denmark, Germany, Korea, Kenya, Austria, Canada, Burkina Faso, the USA, Eastern Europe, and the Low Countries. 2. AEFJN – Questionnaire concerning the medicines The questionnaire was sent in September, 2006, and its intention was to commit the missionaries (30,000 members, of whom 20,000 are in Africa and Madagascar), who work in health institutions, hospitals, health centres, dispensaries….to be attentive to the problems relative to the right to medicine, to the neglected diseases and to the access to medication of quality at reasonable prices. 87 answers came from 23 African countries : 1. Angola 1 2. Burkina Faso 2 3. Cameroon 14 4. Chad 3 5. Congo Brazza 3 6. DR Congo 18 7. Etiopía 4 8. Ivory Coast 1 9. Ghana 2 10. Guinea Conakry 1 11. Kenya 4 12. Lesotho 1 13. Madagascar 5 14. Malawi 1 15. Mozambique 1 16. Nigeria 8 17. Rwanda 1 18. Senegal 2 19. Sudan 1 20. Tanzania 2 21. Togo 3 22. Uganda 3 23. Zambia 6 2. 1. Information proceeding from the answers to the questionnaire The answers received come from 167 health institutions which include hospitals, dispensaries, health centres, sanitary animation centres, pharmaceutical warehouses, one pharmacy, and one health school. All these institutions depend on the Churches, except two which depend on private societies (Gécamines and Formulae in DRC). From the information received, sometimes very incomplete, we notice that the institutions that have sent statistical information have 343 doctors, 91 pharmacies,1,679 nurses, 53 midwives, 146 laboratory workers,. These cover the needs of 5,289 beds; the number of patients in Medical Centres comes to 66,362 a day. Un total de 34 congrégations ou et instituts religieux ont répondu au questionnaire : 1. Carmelites of Charity : 2 2. Comboni Missionary Sisters: 8 3. Don Bosco Salesians : 1 4. Divine Providence of Crehen 1 5. Franciscan Missionnaries of the Mother of the Divine Pastor : 1 6. Daughters of St Mary of Presentation: 2 7. Daughters of the Holy Spirit: 2 8. Franciscan Missionnaries for Africa : 4 9. Missionnaries Catechists of the Sacred Heart: 2 10. Religious of the Holy Union of the Sacred Heart : 3 11. Sisters of the Holy Union : 1 12. Sisters Conception of St Méen the Great : 3 13. Medical Missionary Sisters : 3 14. Sisters of the Holy Rosary : 1 15. Missionnary Sisters of the Immaculate Heart of Mary: 3 16. Sisters of Our Lady of the Apôstles: 5 17. Missionnary Sisters of Our Lady of Africa : 6 18. Little Sisters of the Assomption : 2 19. Little Dominican Sisters: 1 20. Little sisters of the Holy Spirit: 1 21. Sisters of St Charles of Angers 1 22. Sisters of Mercy : 2 23. Society of the Holy Child Jesus: 5 24. Sisters of the Immaculate Conception of Niort: 2 25. Sisters of Charity of Nevers : 1 26. Sisters of Charity of Ste Anne : 1 27. Sœurs Hospitalières : 1 28. Sisters pf the Christian Instruction (St Gildas) : 1 29. Missionnary Sisters of the Holy Spirit : 2 30. Sisters of Charity of Jesus and Mary : 2 31. Sisters of the Sacred Hearts of Jesus and Mary : 3 32. Sisters of the Sacred Heart of Jesus of St. Juant-le-Pin: 1 33. Sisters of Ste Ursule : 1 34. Ursuline Sisters of Jesus : 2 2 .1. 1. Purpose of the document To help those who are responsible for sanitary formations to realise the importance of and the necessity to have….quality medicines to treat people, to urge them to assure themselves that the control in the medicine buying centres is carried out correctly. 2.1.2. The means to achieve this objective 1. Make a list of the quality medicines and the names of the producing pharmaceutical companies valid in each country. 2. Send this list to the people responsible in the institutions that responded to the questionnaire and to those who are in contact with the Network. The use of the questionnaire has been limited, for the moment, to those medicines used to treat or prevent malaria. The rest of the information can be taken again later in order to study other problems (vaccinations, other neglected diseases) 2.2. Information received from the questionnaire 2.2.1. The origin of the production of the medicines An examination of the answers received showed that the list of the origin of production of the medicines given to the Health Institutions was long and varied. In fact, for Europe, the countries mentioned are: Germany, Belgium, France, Switzerland, Spain, Italy, United Kingdom, the Netherlands, Denmark, and Ireland. As far as Asia is concerned, China, India, the Arab Emirates, Malaysia, Vietnam are mentioned. For Africa, Nigeria, Senegal, Egypt, Morocco, and local production (like quinine in DR of Congo). For South America, Brazil, Canada and the USA are mentioned. 2.2.2. Pharmaceutical supply Some institutions are provided by governmental pharmaceutical centres (15 are mentioned) and all the centres (except 10) are supplied en pharmaceutical supply centres (department stores with control of the products) in their country It is also mentioned that some supplies are made locally in the market or in the local pharmacies Some ecclesiastical (national and diocesan) supply centres are mentioned in Senegal, Zambia, Uganda, Chad, Kenya, Ethiopia, Nigeria, Cameroon, Congo Brazzaville, Tanzania y Ghana. 2.2.3. Protocol for the treatment recommended by the local sanitary authorities The majority of countries have a protocol for treatment recommended or imposed by local sanitary authorities for medication based on artesunate and the great majority for the Artemisinine Combination Therapy, the DR of Congo for quinine and cloroquina, other countries for sulfonamides, (among others Fansidar), sometimes associated with artemisinine, amodiaquine and sulfadoxine-pyrimethamine. 3. The origin and quality of anti-malaria medicines The answers given gave rise to some related questions: • The quality of the medicines produced in some countries (India, China, Nigeria…) • The multiple answers and the distinct information concerning the treatment which (ACT) employs caused us to look for clarification and precise information about its composition. All these doubts were raised by Mr. Michel Caudron, a pharmacist who worked for “Doctors without Borders” and who now works for the European Agency for Development and Health (AEDES). 3.1. Precise details about the quality of the medicines Here are some details (requirements) about the quality of the most efficient medicines now being used against malaria. They will be mentioned again in the following. 3.1.1. The SULFADOXINE/PYRIMETHAMINE The commercial name is FANSIDAR The original medicine was developed by the Swiss company Roca It is difficult to produce a generic equivalent to this product. The problem generally created is the dissolution of the medicine in the stomach and its consequent absorption Thus Fansidor from the Roca laboratory continues to be the securest product Wherever the original medicine is not available the following manufacturers of generics CIPLA, IPCA, STRIDES, AJANTA ( all in India) and GUILIN (China) give greater guarantees of quality ( the World Health Organisation has approved their production centres) As far as Sulphadoxina/Pyrimethanime, (made in South Africa), is concerned, there is no information about its quality 3.1.2. AMODIAQUINE AMODIAQUINE is an old molecule which forms part of the same chemical group as cloroquina Because it was used relatively less than cloroquine, its resistance to amodiaquina extended more rapidly and less extensively than with cloroquine. For this reason its use in Africa is still recommended but PREFERENTIALLY IN ASSOCIATION with the by-products of artemisininanina Amodiaquina was originally developed by the French laboratory Sanofi/Aventis (commercial name = Flavoquine) Generic amodiaquina from the GUILIN Laboratory (China) is pre-qualified by the World Health Organization (WHO). This source is preferable Wherever the original product and the Guilin product are not available it is possible to consider the generics of CIPLA, IPCA, STRIDES, AJANTA as acceptable alternatives 3.1.3. The DERIVATIVES of ARTEMISININE ARTEMISIA is a plant cultivated originally in Asia (China, Vietnam) and the substance extracted from it is called artemisinina This substance is afterwards transformed in artesunate or artemether or arteether which are really the best current medicines against Plasmodium Falciparum These medicines exist in injectable or oral forms The WHO recommends the use at all times of the oral form in conjunction with other anti-malaria (medicines) (lumefantrine or amodiaquine). This is to prevent the quick development of resistance. Lumifantrine or amodiaquine are really “shields” which protect the derivatives of artemisinine. These associations are called ACT (Artemisinine Combination Therapy) 3.1.4. COFORMULATION OF ARTEMETHER + LUMEFANTRINE It’s a combined medication (two products in one tablet) which has been developed by the Swiss Company Novartis (commercial name = Co Artem) Numerous generic forms exist. Currently only the Novartis product is pre-qualified by the WHO. It seems that the generics manufactured by the Indian companies AJANTA, IPCA, STRIDES and CIPLA are about to be approved by the WHO. If the Novartis product is not available it is preferable to choose these generics 3.1.5. CO-BLISTERS ARTESUNATE + AMODIAQUINE In this case it is a question of two different tablets (one white and the other yellow) sold in a unique preparation (container, package). The object is that the patient takes both medications at the same time The WHO has pre-qualified the COBLISTER from the Chinese company GUILIN. It is, therefore, preferable to buy this. If the co-blister of GUILIN is not available, those of CIPLA an IPCA are acceptable alternatives. 3.1.6. CO-FORMULATION ARTESUNATE+AMODIAQUINE In this case, the two medications are joined together in one tablet. Initially developed by SANOFI AVENTIS under the name of Co-Arsucam or ASAQ, the WHO has not yet recommended this association. Generic copies exist but the WHO has not validated any. 3.1.7. CO-CORMULATION DIHYDROARTEMISININE+PIPERAQUINE This is an interesting association but not yet approved by the WHO. Numerous firms commercialise this association. It is better not to buy it for the moment and to prefer the associations mentioned above. If there is no other choice, the product commercialised by the Chinese company HOLLEY COTEC (DUO COTEXIN) is recommended. 3.2. Quality of anti-malaria medicines and production factories
4. Recommendations 4.1. Relative to medication Be careful with the condition of Fansidar given the complexity of the product. Cloroquine is a stable product, easy to handle. Its efficacy is becoming limited given that this product now does not act against some forms of malaria. Pay attention to the date of production by ACT; remember that it is not guaranteed beyond two years. Bear in mind that the Cotecxine produced in China and accessible in many countries is presented in different colours in different countries. Be very careful that the different colours of the product correspond well to the age of the patient. Do not buy medication sold in the street nor in the stalls in local markets. 4.2. In relation to people Here are some more precise observations and recommendations arising from the questionnaire a. Health Personnel They should be trained in the knowledge of the medications they have to prescribe: know their names, generics and commercials, the name of the valid pharmaceutical companies that produce them, their quality, the risks involved in their use and the expiry dates Dissuade the use of products not mentioned above In Nigeria avoid buying medicines locally for their use implies great risk Bear in mind that Soakim, which comes from Vietnam, is of doubtful quality while the products of Guilin and Holley-Cotec are recognised as of good quality. Be very attentive to the dosage which varies according to the age of the patients. Some products should be administered according to colours, dosage, different frequency in the case of a small child, an adolescent, an adult. If the medication is administered badly (quantity or frequency) it will not have the desired effect or it will have a negative effect. It is also necessary to assure the correct conservation of medication and also the expiry date. Some medicines have a short duration of efficacy and are fragile as far as their conservation is concerned. Great vigilance is, therefore, required. b. The patients They should be trained in the need to cure themselves with quality medication. Persuade them not to buy medication in local markets or on the roads and to follow the instructions given by the health personnel. It is also necessary to help the people to understand that their health is a great asset that requires care and attention. For this reason it is essential (a must) to spend money on it when necessary and not to take medication about whose origin, whose conservation and whose efficacy they are not sure or little sure. 5. Conclusions The answers received have informed us that in the prevention and the treatment of malaria, an enormous variety of treatments are employed and that they come from a great diversity of pharmaceutical companies and medication producing countries. We are thankful to Sister Jacqueline Lamotte, member of the French Antenna a doctor who worked in Cameroon, and to Mr. Michel Caudron, pharmacist of the European Agency for Development and Health (AEDES) who collaborated with the personnel of the AEFJN Secretariat in the writing of this document. Brussels, 7th. January, 2008. APPENDIX The importance of the presence of the Christian health institutions in the debates with the European Union. In a meeting with a member of the Health Commission (of the General Directorate for Development) of the European Union, we saw that it is very important that the Health Institutions of the Churches should be present in the meetings of the European Union and the health services in Africa. The Churches represent a major part of the health establishments, of the health personnel as well as of the patients... However, they are almost always absent when health strategies are being selected and when decisions in this matter are being taken. So that they are represented, it would be necessary to produce data (statistics) about the importance of the Christian medical network in Africa, its geographic coverage and the number of people affected by these services. Unfortunately, the answers received from the questionnaire are not sufficient to allow us to supply this information. We would like, in the future, to be able to supply calculated information concerning the importance of the Christian health network in Africa so that the European Union would allow the participation of the Churches’ health establishments in the negotiations in the different countries of the continent. We are seeking ways to specify (pin down) this search for information in order to let the E.C. know the impact of the action of the Christian health formations in the different countries of Africa. |
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