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The big idea
Malaria remains a significant health challenge globally, particularly in sub-Saharan Africa with 95% of malaria cases and 96% of malaria deaths occurring in 2020 and about 80% of them being children under 5 years. A recent study in three East African Community (EAC) countries estimated mean parasite prevalence at 4.7% in Kenya, 10.6% in mainland Tanzania, and 9.5% in Uganda. Assuming similar trends in Rwanda, Burundi, DR Congo and South Sudan, the number of EAC citizens with malaria at any point could be as high as 39 million. The current first-line treatments for malaria in eastern Africa are based on artemisinin combination therapies (ACTs) for both uncomplicated and complicated malaria. However, due to declining efficacy of ACTs, there is a resurgence of malaria all over the globe. The loss of ACT efficacy is thought to arise from widespread mutation-induced resistance by plasmodium species, the causative agent for malaria. This project will develop supplements to ACTs for effective treatment of resistant malaria. In this case, standardised dosages of the supplements will be made available for clinical use as an adjunct therapy to enhance reverse resistance to artemisinins thereby providing a formidable solution to the malaria threat in the Eastern Africa.
Why it matters
Malaria parasite resistance to ACTs has been reported in several countries in the EAC, including Rwanda, Kenya, and Tanzania. This poses a looming disaster. As a result of the resistance, prolonged courses of ACTs of at least 6 days are needed to obtain levels of efficacy similar to those obtained with standard 3-day treatments in sensitive parasites. Quinine, which is used as a second-line treatment for malaria, is associated with serious adverse effects. There are also reports of varying levels of resistance to sulfadoxine and pyrimethamine (SP), the drugs used for seasonal malaria chemoprevention and intermittent preventative treatment in pregnancy.
A new solution
The project will formulate standardised deartemisinised components of Artemisia species into microcrystalline cellulose-based phytopharmaceuticals with enhanced product safety, efficacy, quality, and bioavailability for supplementation of ACTs. Jena Herbals Ltd’s extensive research on deartemisinised extracts of Artemisia species has demonstrated their efficacy in preventing resistant malaria. As such, two market-ready solid dosages in form of capsules and reconstitutable powder capable of augmenting ACTs in malaria treatment and overcoming plasmodial resistance to ACTs will be developed through this project. The supplements will be a key innovation against the looming threat of mass deaths due to the spread of ACT-resistant malaria parasites.
Expectation
If successful, it is expected that SUPPACT formulations will get regulatory approval for use as traditional medicines in Uganda, and the neighbouring countries participating in the project. Consequently, malaria patients would use SUPPACT as part of the ACT treatment regimen, culminating into reduced resistance to ACTs in the population in Eastern Africa.
Additionally, various players in the value chain would benefit including:
- Farmers as growers and suppliers of the plants (raw materials).
- Health facilities and healthcare providers will benefit from effective alternative and/or supplementary malaria treatment widening the range of services available.
Environmental sustainability
The project relies on cultivated plants in already existing farmlands for raw material extraction, which encourages agricultural intensification and biodiversity conservation. The solvents used in extraction processes and production are not petroleum derivatives but safe solvents such as water, ethanol, acetic acid, and sodium chloride, which are safe for the environment. This eliminates any greenhouse gases (GHG) or carbon emissions into the atmosphere thus contributing to climate change mitigation.
Project Partners
- Pharmaceutical Society of Uganda (PSU)
- Jena Herbals Limited (JHL)
- University of Bahr El Ghazal (UBG)
- Official University of Bukavu (Université Officielle de Bukavu) (UOB)
Project Leader
Dr Jonans Tusiimire – Pharmaceutical Society of Uganda (PSU)
