Africa Herbal Antimalaria Meeting Nairobi, 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

Malaria Burden of Disease 1.The prevalence of malaria has been escalating at an alarming rate and an estimated million cases each year cause 1.5 to 2.7 million deaths. 2.More than 90% of the deaths are in children under 5 years of age in Africa. 3.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%). 4.Malaria cases in Africa account for approximately 90% of malaria cases in the world. 5.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.

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

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

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

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

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

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.

Nascent pilot farms of Artemisia annua in Zimbabwe (Source: WHO/AFRO, 2006)

Countries locally producing in small-scale traditional medicines for Malaria and HIV/AIDS in WHO African Region (Source: WHO/AFRO, 2006) Malaria Countries producing medicines for Malaria EMRO Countries Regions Others countries

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

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