By David South, Development Challenges, South-South Solutions
SOUTH-SOUTH CASE STUDY
Malaria is one of Africa’s biggest killers. Each year globally 300 to 500 million people are infected, and around 1 million die from the disease (theglobalfund). Ninety percent of malaria deaths occur in sub-Saharan Africa – mostly to children under the age of five. The disease costs African countries US$12 billion a year in lost gross domestic product.
Malaria is a parasitic disease – the parasite plasmodium – transmitted by mosquito bites. Symptoms include fever, headache and vomiting. Internal bleeding, kidney and liver failure may follow and can result in coma and death.
The most common and effective treatment, recommended by the World Health Organization, is artemisinin-based combination therapies, known as ACTs. ACTs have low toxicity, few side effects and act rapidly against the parasite. Research shows that artemisinin remedies cure 90 percent of patients within three days.
But there are far fewer doses available than people who need them. WHO has claimed the quantity made available by pharmaceutical companies falls far short of the more than 130 million doses required to combat malaria throughout the world.
And ACTs are very expensive to deliver: in just one country, Tanzania, providing such therapy for three years would cost US $48.3 million. Every year, this would account for 9.5 percent of Tanzania’s health budget, and 28.7 percent of yearly spending on medical supplies: a six-fold increase in budget for malaria treatment (Malaria Journal 2008, 7:4).
But a cheap alternative to the expensive pill form of the treatment is being piloted across Africa. It involves the drinking of a tea made from the bushes of the artemisia plant. Artemisia annua is an annual shrub and the active ingredient in the pills (artemisinin). It is native to China and Vietnam and has been used for 2,000 years to treat fevers.
Bushes cultivated by farmers in Kenya, Malawi, Tanzania, Zambia, Zimbabwe and Mozambique under the supervision of the World Agroforestry Centre in Nairobi, Kenya, are helping to bring down malaria rates without the long wait for the pills to arrive.
The leaves are boiled and made into a tea. Drinking the tea gives a high enough dose of artemisinin in the blood to cure malaria. Helen Meyer, a nurse operating nine mobile health clinics in rural Mozambique, is using the bitter tea made from the dried leaves. Even in treating drug resistant malaria, she has found the artemisia tea effective: “If you drink the tea, you feel better after the first day. Other medicines take a few days.”
A special hybrid of artemisia, A-3, is used because it is adapted for warmer climates. The wild variety grows to only five centimetres in the tropics, but A-3 grows to three metres and packs 20 times more artemisinin. It is also highly economical: thousands of plants can come from a single stem.
The daily adult dose of anti-malaria tea just needs five grams of dried A-3 leaves in one litre of water. The tea is drunk every six hours for seven days. Each plant produces 200 grams of dried leaves, and a thousand shrubs can cure 5,700 people. Since it is a cheap cure, money can be spent instead on other things. Farmers are also able to supplement their income by growing the bushes. And the dried leaves have long-lasting power: even after three years the leaves retain close to a 100 percent of their artemisinin.
Access to authentic artemisinin is critical: it is estimated 16 percent of malaria medicines in Kenya are counterfeit. Elsewhere, the proliferation of counterfeit anti-malarials substantially raises the risk of the emergence of resistance to artemesinin combination therapy, the last truly effective treatment against malaria. Past misuse of other malaria drugs, such as chloroquine in the 1980s and sulphadoxine/pyrimethamine in the 1990s, resulted in the malaria parasite becoming resistant. Hundreds of thousands of people in malaria-prone areas may have died as a result.
The World Agroforestry Centre, recognizing potential problems with artemesinin monotherapies, is working to combine it with indigenous herbal remedies made from other anti-malarial trees, producing a herbal combination therapy (HCT).
“I used to grow fruits and beans here,” said Charles Kiruthi, a Kenyan farmer, to the IRIN news service. “but I will get a better return from this plant. No pests attack it, and until harvesting time it requires very little labour.”
“I expect to get a good return, and I am also very happy to be helping fight malaria,” continued Kiruthi. “I recently lost two friends to the disease, and my child gets sick with malaria sometimes.”
- World Health Organization Malaria fact sheet:
- Malaria Drug Resistance map documents the areas where conventional drugs do not work
- World Health Organization worldwide malaria profile map:
- A film documentary on malaria by the IRIN news service:
- WHO monograph on good agricultural and collection practices
- Malaria travel advice.
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