By CHIOMA OBINNA
Little Nkem was the joy of her parents who were childless for over 15 years before her birth. From the date of her birth, Nkem was adored as the princess of the house. Her parents never ceased to thank God each day that breaks. But little did they know that their joy will be short lived.
It started like a fairy tale when Nkem all of sudden became ill. All efforts to bring down the high fever proved abortive. Sadly, there was no money to take her to a health centre. They, they resorted to self medication. Nkem was bombarded with different types of pain relievers in the absence of standard medical treatment in any hospital.
Still battling to save their only child, they decided to take her to a nearby diagnostic laboratory where a few tests were conducted. Lo and behold, malaria was confirmed. With the laboratory test, it was expected that Nkem’s illness would be tackled immediately, unfortunately, purchasing the recommended malaria drugs became a problem drugs due to the financial situation of the family.
Nkem’s parents are poor. Her mother sells packaged water, popularly known as pure water while the father is jobless. Things are tight.
Little Nkem’s health got worse. Worried that genuine Artemisinin combination Therapy, ACT, costs between N1, 000 and N1, 500 depending on the brand, Nkem’s mother started gathering proceeds from her daily sales, with the hope that within a week, she would buy the drug for her child.
However, luck ran out for her. Few days later, Nkem’s health deteriorated further, and she died.
She is part of the 90 per cent of the country’s population at risk of malaria, a statistic of the 30 per cent of childhood mortality and among the 30 Nigerian children who lose their lives every hour from malaria_ related illnesses.
Malaria remains a leading cause of morbidity and mortality in developing world including Nigeria. According to WHO, every 30 seconds a child dies from malaria.
In the views of Nigeria Minister of State for Health, Dr. Mohammad Ali-Pate, malaria scourge costs Africa’s economy about $12 billion and Nigeria alone loses about N132 billion to the plague apart from the loss of man hours by the nation’s labour force.
Before now, Chloroquine (CQ) has remained the treatment choice in Nigeria due to its remarkable safety and efficacy profile and affordability. Following the increase in Chloroquine resistant malaria parasites since their first detection in 1978 has resulted in CQ’s demise as the gold standard of uncomplicated falciparum malaria treatment.
Moreso, the evolution of malaria into a multi -drug resistant disease with concurrent increases in malaria-related morbidity and mortality has resulted in a global public health crisis.
In 2001, the WHO recommended the combination of an artemisinin derivative and a longer acting antimalarial such as lumefantrine, Sulfadoxine, SP, Mefloquine or amodiaquine as preferred first line treatment for uncomplicated malaria.
Thanks to the fact that there is overwhelming evidence that the addition of an arteminsinin derivative to another effective malaria treatment significantly reduces treatment failure, delays the emergence of resistance and reduces carriage of the gametocyte and thus potentially malaria transmission.
The global response has been to encourage the use of combination antimalarial alternatives preferably including an artemisinin derivative. Artemisinins are modern group of medicines which includes; artesunate, artemether, dihydroiartemsinin, artemotil. Today, current treatment guidelines for uncomplicated malarial is the use of Artemisinin – based Combination Therapies, ACTs. Although ACTs was introduced in 2000, but the WHO did not officially change treatment protocols recommending ACTs until January 2006. Since then, ACTs has remained the gold standard in malaria treatment.
Despite the clinical evidence which have shown that ACTs are effective against even severe forms of the diseases better than quinine, no thanks to the fact that many Nigerians cannot access these drugs due to the high cost of these ACTs. The use of the ACTs at the community level has been vigorously promoted over the years since the emergence of chloroquine_resistant strains of the parasite about a decade ago.
But in Nigeria today, many people resort to the use of herbs as they cannot afford to pay as high as N1, 000 and N1, 500 for a full dose of ACTs.
Again, there have been concerted malaria control efforts in the country to see how best it could reduce or totally eliminate the scourge unfortunately, only very little progress has been achieved as current statistics from the Federal Ministry of Health indicates that, “malaria is still a global emergency that affects mostly women and children.
However, when the Minister of Health, Prof Onyebuchi Chukwu in November 2010 officially launched the Affordable Medicines Facility for malaria (AMFm) initiative in the country, Nigerians, particularly, the down trodden who could not afford to treat successfully, a boot of malaria heaved a sigh of relieve that at last a solution has come to drastically tackle the scourge of malaria.
Little did they know that one year down the lane, the alleged benefits of the initiative which is primarily to cut down the ACTs prices is yet to be felt by Nigerians. There is no gainsaying the fact, that malaria, caused by parasites spread by anopheles mosquitoes, remains a serious disease affecting children and adults with consequences that are graver among children and pregnant women.
Although significant progress has been made to increase awareness about its prevention and treatment, malaria remains as one of the greatest public health burdens in the country.
In adults, its common symptoms are headaches, weakness, fever, aches and pains, high body temperature (chills and rigors) and bitterness in
the mouth (and loss of appetite) while in children, in addition, it may also manifest in more than normal sleeping, nausea and vomiting.
Statistics available have shown that estimated 50 percent of the adult population in Nigeria experience at least one episode of malaria yearly while infants have up to two to four attacks annually. Almost everyone on the street has had at least one malaria attack at some point. Many persons actually suffer multiple attacks in the same year.
With this heavy load, Nigeria shoulders one third of the world’s malaria burden.
Unfortunately, reports have shown that one of the reasons the malaria parasite continues to debilitate Nigerians is increasing resistance to older, inexpensive treatments, such as chloroquine.
In Nigeria, ACTs account for only one in five anti-malarial treatments taken. The primary reason for this is cost. On the average, ACTs cost about N1, 500, which is 10-40 times more than the older, ineffective drugs.
AMFm is a financing mechanism by Global Fund established to expand access to ACTs, thereby saving lives and reducing the use of inappropriate treatments.
The initiative has four objectives. First is increasing the availability of ACTs in public and private outlets; second, is reducing the cost of ACTs to a level that is comparable with other antimalarials (such as chloroquine, sulphamethamine, and artemisinin monotherapy). The third objective is increasing the market share of ACTs among antimalarials; four, increasing the use of ACTs, including among vulnerable groups such as poor people, rural communities, and children.
The Global Fund provides subsidy for ACTs both in public and Private Sectors. They have negotiated with manufacturers with a reduced price for ACTs. First line buyers purchase the ACTS directly from manufacturers thus lowering the cost to first line buyers.
Retailers are permitted a small mark up, but the idea of the AMFm is to pass the majority of the subsidy onto consumers, who would then be able to afford the ACTs. The aim of the AMFm is to reduce the cost of ACTs to compete with CQ and SP in order to increase the availability and use of ACTs, and poor quality antimalarial drugs from the market.
The AMFm also requires participating countries like Nigeria to implement supporting interventions, such as public awareness campaigns and policy / regulation measures specific to the situation in each country.
In the words of the minister while directing medical doctors and other health officials in the country to use ACTs henceforth for treatment of uncomplicated malaria, “The launch of AMFm will further accelerate
our drive to ensure we have 50 per cent reduction in malaria by 2013″.
One year after, the costs of ACTs continued to escalate. Health watchers are wondering if the celebrated initiative in the media is really having impact on the prices of ACTs in the country.
They are also asking if at all the country are abiding by the aims and objectives of the initiative which includes; increase in the provision of affordable ACTs through the public, private not-for-profit (such as NGO) and private for-profit sectors. Reducing the price of ACTs to be comparable with other antimalarials and increase in the use of ACTs?
Is government really providinga subsidy of up to 95 percent in manufacturing cost of ACTs by facilitating increased use of ACTs through drastic reduction of the cost of these drugs (potentially to N75.00 for end users for an adult dose)?
Nigerians would also want to know if the 43 importers that signed up to participate in the AMFm towards making ACTs affordable and available across the country are really committed. These and more are questions begging for answers.
Though, the AMFm remains an interesting model that could still be useful as one of several strategies to improve malaria treatment,there is need to make effective antimalrial drugs accessible and affordable to the vast majority of patients both in the urban and rural areas to check the endemic nature of the disease.
Little Nkem was the joy of her parents who were childless for over 15 years before her birth. From the date of her birth, Nkem was adored as the princess of the house. Her parents never ceased to thank God each day that breaks. But little did they know that their joy will be short lived.
It started like a fairy tale when Nkem all of sudden became ill. All efforts to bring down the high fever proved abortive. Sadly, there was no money to take her to a health centre. They, they resorted to self medication. Nkem was bombarded with different types of pain relievers in the absence of standard medical treatment in any hospital.
Still battling to save their only child, they decided to take her to a nearby diagnostic laboratory where a few tests were conducted. Lo and behold, malaria was confirmed. With the laboratory test, it was expected that Nkem’s illness would be tackled immediately, unfortunately, purchasing the recommended malaria drugs became a problem drugs due to the financial situation of the family.
Nkem’s parents are poor. Her mother sells packaged water, popularly known as pure water while the father is jobless. Things are tight.
Little Nkem’s health got worse. Worried that genuine Artemisinin combination Therapy, ACT, costs between N1, 000 and N1, 500 depending on the brand, Nkem’s mother started gathering proceeds from her daily sales, with the hope that within a week, she would buy the drug for her child.
However, luck ran out for her. Few days later, Nkem’s health deteriorated further, and she died.
She is part of the 90 per cent of the country’s population at risk of malaria, a statistic of the 30 per cent of childhood mortality and among the 30 Nigerian children who lose their lives every hour from malaria_ related illnesses.
Malaria remains a leading cause of morbidity and mortality in developing world including Nigeria. According to WHO, every 30 seconds a child dies from malaria.
In the views of Nigeria Minister of State for Health, Dr. Mohammad Ali-Pate, malaria scourge costs Africa’s economy about $12 billion and Nigeria alone loses about N132 billion to the plague apart from the loss of man hours by the nation’s labour force.
Before now, Chloroquine (CQ) has remained the treatment choice in Nigeria due to its remarkable safety and efficacy profile and affordability. Following the increase in Chloroquine resistant malaria parasites since their first detection in 1978 has resulted in CQ’s demise as the gold standard of uncomplicated falciparum malaria treatment.
Moreso, the evolution of malaria into a multi -drug resistant disease with concurrent increases in malaria-related morbidity and mortality has resulted in a global public health crisis.
In 2001, the WHO recommended the combination of an artemisinin derivative and a longer acting antimalarial such as lumefantrine, Sulfadoxine, SP, Mefloquine or amodiaquine as preferred first line treatment for uncomplicated malaria.
Thanks to the fact that there is overwhelming evidence that the addition of an arteminsinin derivative to another effective malaria treatment significantly reduces treatment failure, delays the emergence of resistance and reduces carriage of the gametocyte and thus potentially malaria transmission.
The global response has been to encourage the use of combination antimalarial alternatives preferably including an artemisinin derivative. Artemisinins are modern group of medicines which includes; artesunate, artemether, dihydroiartemsinin, artemotil. Today, current treatment guidelines for uncomplicated malarial is the use of Artemisinin – based Combination Therapies, ACTs. Although ACTs was introduced in 2000, but the WHO did not officially change treatment protocols recommending ACTs until January 2006. Since then, ACTs has remained the gold standard in malaria treatment.
Despite the clinical evidence which have shown that ACTs are effective against even severe forms of the diseases better than quinine, no thanks to the fact that many Nigerians cannot access these drugs due to the high cost of these ACTs. The use of the ACTs at the community level has been vigorously promoted over the years since the emergence of chloroquine_resistant strains of the parasite about a decade ago.
But in Nigeria today, many people resort to the use of herbs as they cannot afford to pay as high as N1, 000 and N1, 500 for a full dose of ACTs.
Again, there have been concerted malaria control efforts in the country to see how best it could reduce or totally eliminate the scourge unfortunately, only very little progress has been achieved as current statistics from the Federal Ministry of Health indicates that, “malaria is still a global emergency that affects mostly women and children.
However, when the Minister of Health, Prof Onyebuchi Chukwu in November 2010 officially launched the Affordable Medicines Facility for malaria (AMFm) initiative in the country, Nigerians, particularly, the down trodden who could not afford to treat successfully, a boot of malaria heaved a sigh of relieve that at last a solution has come to drastically tackle the scourge of malaria.
Little did they know that one year down the lane, the alleged benefits of the initiative which is primarily to cut down the ACTs prices is yet to be felt by Nigerians. There is no gainsaying the fact, that malaria, caused by parasites spread by anopheles mosquitoes, remains a serious disease affecting children and adults with consequences that are graver among children and pregnant women.
Although significant progress has been made to increase awareness about its prevention and treatment, malaria remains as one of the greatest public health burdens in the country.
In adults, its common symptoms are headaches, weakness, fever, aches and pains, high body temperature (chills and rigors) and bitterness in
the mouth (and loss of appetite) while in children, in addition, it may also manifest in more than normal sleeping, nausea and vomiting.
Statistics available have shown that estimated 50 percent of the adult population in Nigeria experience at least one episode of malaria yearly while infants have up to two to four attacks annually. Almost everyone on the street has had at least one malaria attack at some point. Many persons actually suffer multiple attacks in the same year.
With this heavy load, Nigeria shoulders one third of the world’s malaria burden.
Unfortunately, reports have shown that one of the reasons the malaria parasite continues to debilitate Nigerians is increasing resistance to older, inexpensive treatments, such as chloroquine.
In Nigeria, ACTs account for only one in five anti-malarial treatments taken. The primary reason for this is cost. On the average, ACTs cost about N1, 500, which is 10-40 times more than the older, ineffective drugs.
AMFm is a financing mechanism by Global Fund established to expand access to ACTs, thereby saving lives and reducing the use of inappropriate treatments.
The initiative has four objectives. First is increasing the availability of ACTs in public and private outlets; second, is reducing the cost of ACTs to a level that is comparable with other antimalarials (such as chloroquine, sulphamethamine, and artemisinin monotherapy). The third objective is increasing the market share of ACTs among antimalarials; four, increasing the use of ACTs, including among vulnerable groups such as poor people, rural communities, and children.
The Global Fund provides subsidy for ACTs both in public and Private Sectors. They have negotiated with manufacturers with a reduced price for ACTs. First line buyers purchase the ACTS directly from manufacturers thus lowering the cost to first line buyers.
Retailers are permitted a small mark up, but the idea of the AMFm is to pass the majority of the subsidy onto consumers, who would then be able to afford the ACTs. The aim of the AMFm is to reduce the cost of ACTs to compete with CQ and SP in order to increase the availability and use of ACTs, and poor quality antimalarial drugs from the market.
The AMFm also requires participating countries like Nigeria to implement supporting interventions, such as public awareness campaigns and policy / regulation measures specific to the situation in each country.
In the words of the minister while directing medical doctors and other health officials in the country to use ACTs henceforth for treatment of uncomplicated malaria, “The launch of AMFm will further accelerate
our drive to ensure we have 50 per cent reduction in malaria by 2013″.
One year after, the costs of ACTs continued to escalate. Health watchers are wondering if the celebrated initiative in the media is really having impact on the prices of ACTs in the country.
They are also asking if at all the country are abiding by the aims and objectives of the initiative which includes; increase in the provision of affordable ACTs through the public, private not-for-profit (such as NGO) and private for-profit sectors. Reducing the price of ACTs to be comparable with other antimalarials and increase in the use of ACTs?
Is government really providinga subsidy of up to 95 percent in manufacturing cost of ACTs by facilitating increased use of ACTs through drastic reduction of the cost of these drugs (potentially to N75.00 for end users for an adult dose)?
Nigerians would also want to know if the 43 importers that signed up to participate in the AMFm towards making ACTs affordable and available across the country are really committed. These and more are questions begging for answers.
Though, the AMFm remains an interesting model that could still be useful as one of several strategies to improve malaria treatment,there is need to make effective antimalrial drugs accessible and affordable to the vast majority of patients both in the urban and rural areas to check the endemic nature of the disease.
http://www.vanguardngr.com/2012/01/affordable-malaria-medicines-when-will-nigerians-begin-to-benefit/
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