[voir le tableau avec les noms et origines des produits analysés...
produits que l'on retrouve dans beaucoup de pays... la situation est
grave. Que peut-on faire ? CB}
Poor quality vital anti-malarials in Africa - an urgent neglected public
health priority
http://www.malariajournal.com/content/pdf/1475-2875-10-352.pdf
Paul N Newton, Michael D Green, Dallas C Mildenhall, Aline Plancon, Henry
Nettey, Leonard Nyadong, Dana M Hostetler, Isabel Swamidoss, Glenn A Harris,
Kristen Powell, Ans E Timmermans, Abdinasir A Amin, Stephen K Opuni, Serge
Barbereau, Claude Faurant, Ray CW Soong, Kevin Faure, Jonarthan
Thevanayagam, Peter Fernandes, Harparkash Kaur, Brian Angus, Kasia
Stepniewska, Philippe J Guerin, Facundo M FernandezMalaria Journal 2011,
10:352 (13 December 2011)
Abstract (provisional)
Background
Plasmodium falciparum malaria remains a major public health problem. A
vital component of malaria control rests on the availability of good
quality artemisinin-derivative based combination therapy (ACT) at the
correct dose but there are increasing reports of poor quality
anti-malarials in Africa.
Methods
Seven collections of artemisinin derivative monotherapies, ACT and
halofantrine anti-malarials of suspicious quality were collected in
2002/10 in eleven African countries and in Asia en route to Africa.
Packaging, chemical composition (high performance liquid chromatography,
direct ionization mass spectrometry, X-ray diffractometry, stable isotope
analysis) and botanical investigation were performed.
Results
Counterfeit artesunate containing chloroquine, counterfeit
dihydroartemisinin (DHA) containing paracetamol (acetaminophen),
counterfeit DHA-piperaquine containing sildenafil, counterfeit
artemether-lumefantrine containing pyrimethamine, counterfeit halofantrine
containing artemisinin, and substandard/counterfeit or degraded artesunate
and artesunate+amodiaquine in eight countries are described. Pollen
analysis was consistent with manufacture of counterfeits in eastern Asia.
These data do not allow estimation of the frequency of poor quality
anti-malarials in Africa.
Conclusions
Criminals are producing diverse harmful anti-malarial counterfeits with
important public health consequences. The presence of artesunate
monotherapy, substandard and/or degraded and counterfeit medicines
containing sub-therapeutic amounts of unexpected anti-malarials will
engender drug resistance. With the threatening spread of artemisinin
resistance to Africa, much greater investment is required to ensure the
quality of ACT and removal of artemisinin monotherapies. The International
Health Regulations may need to be invoked to counter these serious public
health problems.