New malaria drugs ‘too expensive’ for most Ugandans
Effective malaria drugs are too expensive in Uganda and often unavailable, forcing families to fall back on drugs that are cheap, but no longer work well, a new report reveals.
Even within Africa, Uganda is particularly hard hit by malaria, which is responsible for 20 to 23% of all deaths. Small children and pregnant women are worst affected.
Treating malaria has become more difficult because the parasite causing the disease, which is carried in Africa by the anopheles mosquito, has become resistant to one drug after another. But new drug compounds derived from a Chinese plant, known as the artemisinins, offer renewed hope and have become the centrepiece of a major UN-led strategy to defeat, and even eradicate, the disease.
A child in Katine receiving treatment for malaria A new report from the Medicines for Malaria Venture, together with Uganda’s ministry of health, the World Health Organisation (WHO) and the health consumer organisation HEPS-Uganda, reveals, however, that artemisinin combination therapies (ACTs), now supposed to be first-line treatment throughout Africa, are not getting to the people who need them.
Nine districts of Uganda, including Soroti, the nearest town to the sub-county of Katine in north east Uganda, were studied to establish what malaria drugs people were able to obtain, either in public health centres and hospitals or in private pharmacies. The researchers found that the artemisinin compounds were often not available in public health centres. Only around 60% of public health facilities in Soroti had any pack-size of the first-line recommended treatment, called artemether-lumefantrine. NGO and mission facilities had slightly more. Stocks tended to be low or very low everywhere, suggesting that “stock-outs” - a common occurrence across Uganda, in which the dispensary runs out completely - were imminent.
And although private pharmacies and drug stores are far better supplied with all medicines than the public sector (where drugs are free), they had few artemisinin treatments. The private drug shops sell what the customer will buy. Families who have a sick child will buy the very cheap drugs they have used for many years - quinine, chloroquine and sulfadoxine-pyrimethamine (SP) - which drug stores will sell them one tablet at a time. The cheapest of these old and increasingly ineffectual drugs cost 12 US cents. Artemisinin combinations, on the other hand, cost between $5.40 and $12.
That puts the recommended ACT way beyond most budgets. “All anti-malarials, let alone the expensive ACTs, are unaffordable to the average household, which has little or no disposable income left after purchase of food and other essential equipment,” says the report.
“An average household is assumed to have two adults, three children (aged 15, seven and two years) and an annual income of 600,000 Ugandan shillings ($3,600). More than 40% of households live on less than this amount.”
It would cost a family the equivalent of 90 months of primary schooling to pay the bill for a year’s supply of artemether-lumefantrine from a private drug store (even if they could find it) - or 62 days worth of food for the household.
Yet it is important that Ugandan families get the ACTs that the WHO now recommends and the Ugandan government endorses. The authors of the report say that across Africa, ACTs must be made available in private pharmacies and drug stores and that the price has to come down.
“Governments and donors will not win the fight against malaria and poverty unless they continue to strengthen the public health system. However, the study leaves us in no doubt that ACTs must also be made available in the private sector at a price that people can afford,” said Prof Awa Marie Coll-Seck, executive director of the Roll Back Malaria Partnership. “It presents evidence on the urgent need for action to ensure ACTs reach more people, quickly. There is no time to waste.”
Uganda’s minister of health, Dr Stephen Mallinga, said it had been proud to participate in a piece of groundbreaking work. “Three hundred and fifty Ugandan children die every day due to malaria in my country,” he said. “This report provides clear evidence on how we can make life-saving ACTs available to this vulnerable population.”
View article at <a href=”http://www.guardian.co.uk/katine/2008/nov/11/uganda-malaria” target=”_blank”>guardian.co.uk</a>
