Kenya’s Ministry of Health is researching two antimalaria treatments used in hospitals to see if they are still effective.
In March 2021, the antimalarial Therapeutic Efficacy Study in Siaya and Bungoma counties in western Kenya began.
The study checked whether the first-line medicine for uncomplicated malaria (Artemether Lumefantrine, AL) and second-line (Dihydroartemisinin-Piperaquine, DHP) are still effective.
Clinicians observed and analysed patients’ blood for the presence and number of parasites in the studies to see how they responded to treatment for uncomplicated malaria. Kenyan researchers last conducted research in 2016.
The country is following the World Health Organization’s (WHO) advice for countries to conduct therapeutic research every two years, according to George Githuka, the head of the Division of the National Malaria Programme (DNMP).
Kenya, according to Dr. Githuka, has yet to encounter any resistance. Antimalarial treatment, on the other hand, is becoming less effective, according to scientists in other regions of the world.
“Kenya has used Artemether-Lumefantrin and Dihydroartemisinin-piperaquine to treat malaria since 2006. We continue monitoring to ensure the drugs we are using are effective,” he said.
Maureen Mabiria, a technical adviser and physician from PMI-Impact Malaria, said they chose the timing and the place for collecting the blood samples.
“We picked Siaya County because of the high drug pressure, in which a person can have as many as four to six bouts of malaria infections in a year and would be put on antimalarials,” Dr Mabiria said.
Bungoma has a minimal drug pressure, with residents experiencing little more than two infections each year.
A blood test would reveal the presence of parasites in the blood if a person contracted malaria.
According to Dr. Mabiria, an efficient malaria drug would eliminate the parasites in the blood, while an ineffective medication to which the parasite had evolved resistance would not.
However, the existence of parasites following therapy does not necessarily indicate resistance.
“The Artemether Lumefantrine stays in the body for about 28 days, but patients leave the hospital and get bitten by mosquitoes and are re-infected,” Dr Mabiria said.
She believes it’s critical to determine if the parasites discovered in the blood a few weeks after treatment are the result of a new infection or if the antimalarial failed to eliminate them owing to resistance.
In the early 2000s, other parts of the world, such as South East Asia, began to report the first signs of artemisinin resistance.
In short time, some of the most efficient malaria medicines in the region were rendered worthless, putting millions of people at risk.
The Kenya Malaria Indicator Survey (KMIS) 2020, which was launched in April 2021, revealed that Kenya has achieved substantial progress in reducing malaria prevalence.
The World Health Organisation has issued a warning concerning medication resistance in Africa. Between 2012 and 2015, researchers in Rwanda discovered gene changes linked to resistance in malaria parasites.
Such changes are causing an evident decline in antimalarials’ capacity to quickly cure persons with the disease in Uganda, according to a report published in the New England Journal of Medicine in September 2021.
Africa accounted for 94 percent of malaria infections and deaths in 2019, according to the World Malaria Report.
“The results of this study will guide Kenya to know whether the medication is still working, or the country needs to look for alternative medicine for malaria,” said Dickson Mwakangalu, a public health specialist at John Hopkins Affiliate Jhpiego and the lead scientist in Kenya at the PMI Impact Malaria.
The Kenyan Ministry of Health expressed concern about activities that could render the drugs ineffective.
Dr. Githuka claims that health personnel and the general public disregard antimalarial treatment recommendations, prescribing them for any fever, headache, or chills. These are signs that can be seen in any infectious condition, not just malaria, according to him.
To establish the presence of malaria parasites, a microscope test is required. However, many health-care facilities lack working microscopes.
Furthermore, health facilities with microscopes may be unable to execute the test due to a lack of skilled lab employees.
Dr. Githuka went on to say that counterfeit and substandard antimalarial medications either don’t have any active components or only have a fraction of the amount needed to treat malaria.
