The Nigerian National Malaria Control Programme recently published the result of an efficacy trial of two different combination therapies for malaria (artemether and lumefantrine; artesunate and amodiaquine) in which it claimed that concerns that many antimalarial drugs in Nigeria are ineffective are largely unfounded. The trials which were conducted in seven sites across the country used antimalarials from the official government stocks.
The finding by the Malaria Control Programme failed to touch on an important issue, that of fake or counterfeit drugs. The concerns of lack of efficacy of antimalarials in Nigeria are based on the believe that most medicines in Nigeria including antimalarials are fake or contain a lower amount of the active ingredient than labeled. A better approach would have been to use samples of the antimalarials in the open market where most Nigerians get their medications. A World Health Organization study on quality of antimalarials in ten Sub-Saharan African countries which used the open market sampling approach found that in some countries almost 40 per cent of drugs, whose production and quality have not been checked by the WHO, underperformed.
The bigger issue here is the distrust of medications available to treat the most endemic disease in Nigeria for which the Nigerian government has not provided any real solutions. Most Nigerians don’t get their antimalarials from government stores, it is therefore ingenious to conclude that fears of Nigerians on the efficacy of antimalarials which obviously come from the open market are unfounded.
The Malaria Control Programme needs to work with the National Agency for Food and Drug Administration and Control (NAFDAC) and relevant agencies to assure that medications on the Nigerian market are efficacious and safe. As a matter of urgency, the government needs to put in place mechanisms for inspecting companies that manufacture medicines in Nigeria and enforce the regulations on inspection of medicines imported into the country. While many will say this is easier said than done, we have no other option.