Africa Herbal Antimalaria Meeting

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• Africa Herbal Antimalaria Meeting
• Nairobi, 20-22 March 2006
• Research on Traditional Medicines used for the
  Treatment of Malaria in WHO African Region

Traditional Medicine Programme, WHO Regional
Office for Africa, Brazzaville, Congo Presented
by Dr Mawuli W. Kofi-Tsekpo, PhD Kenya Medical
Research Institute (KEMRI) Member of WHO Regional
Expert Committee on Traditional Medicine
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Malaria Burden of Disease

• The prevalence of malaria has been escalating at
  an alarming rate and an estimated 300-500 million
  cases each year cause 1.5 to 2.7 million deaths.
• More than 90 of the deaths are in children under
  5 years of age in Africa.
• Malaria (which accounts for 9 of global disease
  burden)  ranks third among major infectious
  disease threats in Africa after pneumococcal
  acute respiratory infections (3.5) and 
  tuberculosis (TB) (2.8). 
• Malaria cases in Africa account for approximately
  90 of malaria cases in the world.
• Between 1994 and 1996, malaria epidemics in 14
  countries of Sub-Saharan Africa caused an
  unacceptably high number of deaths, many in areas
  previously free of the disease.  Adolescents and
  young adults are now dying of severe forms of the
  disease.

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Factors favouring the spread of malaria

• Resistance of parasite to drugs is confounded by
  regional conflicts forcing mass migration of
  people to or from infected areas, and migration
  of non-immune people to infected areas for
  agricultural reasons
• Changing rainfall patterns favouring mosquito
  breeding sites.
• Adverse socioeconomic conditions leading to
  inadequate health budget to fight malaria

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Policy orientations and Commitment of countries
and WHO
Alma Ata Declaration, 1978
Adoption of Regional Strategy by RC50
Ouagadougou, 2000
Malaria, HIV/AIDS, TB and Other Infectious
Diseases
The April 2001-Abuja Declaration on research of
traditional medicines
Adoption of Plan of Action in 2003 in Tripoli
The July 2001 - Lusaka Declaration on the decade
of African TM (2001-2010) Adoption of global TRM
Strategy 2002-2005
WHA56.13
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The Regional Strategy

• Promoting the Role of Traditional Medicine in
  Health Systems A Strategy for the African
  Region.
• AFR/RC50/R3
• - Resolution of the Regional Committee 31 August
  2000

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Research Methodology

• General Objective
• Specific Objectives
• Preclinical Evaluation/ Retrospective Study
  /Ethnomedical Evidence
• Methodology
• Criteria for patient selection (including
• Inclusion criteria and exclusion criteria)
• Sample size
• Screening Phase
• Serum chemistries
• Haematology
• Treatment Phase
• INFORMED CONSENT

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Research Methodology

• Drug Administration
• Traditional Herbal Remedy to be tested
• Control treatment
• Parasitaemia
• Serum chemistries
• Haematology
• Physical examination and vital signs
• Electrocardiogram (ECG) examinations
• Assessment of Efficacy
• a) Primary outcome measures
• b) Secondary outcome measures (optional)
• Assessment of Safety
• Discontinuation from the study

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Countries that are conducting research of
traditional medicines used for malaria

• Burkina Faso
• DRC
• Ghana
• Kenya
• Madagascar
• Mozambique
• Nigeria
• South Africa
• Tanzania
• Zambia
• Zimbabwe
• The ability to conduct research and the tools and
  guidelines do exist. However, there is need to
  build the culture for research in the Region.

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Nascent pilot farms of Artemisia annua in
Zimbabwe (Source WHO/AFRO, 2006)
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Nascent pilot farms of Artemisia annua in
Zimbabwe (Source WHO/AFRO, 2006)
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Countries locally producing in small-scale
traditional medicines for Malaria and HIV/AIDS in
WHO African Region (Source WHO/AFRO, 2006)
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• The Role of WHO in Research
• To provide technical (and financial) support to
  research institutions and WHO Collaborating
  centres for research to produce evidence of TMs
  used for malaria and other priority diseases
• To produce tools and guidelines on research
  methodology for adaptation by countries
• Clinical evaluation of traditional medicines in
  WHO African Region, Brazzaville, (AFR/EDM/
  TRM/04.04)
• WHO Guidelines on research methodologies and
  traditional medicine, Geneva, (WHO/EDM/TRM/2002.1)
  .
• Monograph on Artemisia Annua (of which I was
  chairperson during its review in China)
• Guidelines on Good Agricultural and Collection
  practices of medicinal plants, 2004

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Traditional Medicine is our own, if we Africans
do not develop it, nobody else will