The Antimalarial Drug Policy in the Republic of Yemen

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The Antimalarial Drug Policy in the Republic of
Yemen

• Meeting For Discussions Towards The Development
  Of An Interregional Network For Monitoring
  Antimalarial Drug Efficacy In The Horn Of Africa
• 23-25 March 2004

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• The results of the previous studies, conducted
  mainly in the eighties,
• were reviewed

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• Sanaa Inter-Country Meeting in April 2002
• On Monitoring the Efficacy of AMDs

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• Following the inter-country workshop on
  monitoring the efficacy of AMDs in Sheraton
  Sanaa in 2002, a national team (core group) was
  formed from the NMCP, the faculties of medicine
  and pharmacy and the WHO consultants.

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• Establishing sentinel sites representing the
  different epidemiological strata
• in Yemen

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• The following sites were initiated starting from
  2002
• 1- Bajil in Hodeida governorate in 2002
• 2- W. Mesemeer in Lahj governorate in 2002
• 3- Al Odein in Ibb governorate in 2003

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• The following sites are planned to be established
  in 2004
• 1- Harad in Hajja governorate
• 2- Broom in Hadramawt governorate
• 3- Al Madarba in Lahj governorate

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• Chloroquine was studied in the following sites
• 1- Bajil in 2002
• 2- Wadi Al Mesemeer in 2002
• 3- Al Odein in 2003

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• Sulfadoxine/Pyrimethamine (Fansidar) is being
  studied currently in Harad starting from February
  2004

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Bajil 02/03 ACPR 58 Failures 42
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Bajil 02/03 ACPR 58 Failures 42
W.Al Mesemeer 02/03 ACPR 43, Failures 57
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Bajil 02/03 ACPR 58 Failures 42
Al Odein 03 ACPR 61 Failures 39
W.Al Mesemeer 02/03 ACPR 43, Failures 57
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Harad 04
Bajil 02/03 ACPR 58 Failures 42
Al Odein 03 ACPR 61 Failures 39
Brom 04
W.Al Mesemeer 02/03 ACPR 43, Failures 57
Al Madarba 04
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• An Assessment Of The Quality Of The Most Widely
  Used Anti-malarial Drugs (AMDs) In Yemen
• A study conducted by Dr Ahmed Abdo-Rabbo,
• Associate Professor in Pharmacotherapy,
• Faculty of Medicine Health Sciences in Sanaa
  University

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• CONCLUSIONS
• 1- There is a problem of substandard AMD products
  in different districts and at different levels of
  the distribution chain
• samples below the lower limit of specification
• few high failures of active ingredient contents
  of CQ syrup and CQ tablets
• low failures for CQ tablets and S/P tablets
  dissolution

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• failures were found amongst locally made as well
  as foreign products
• 2- Percentage failure of samples based on
  ingredient content and dissolution failures
  cannot be ignored.
• 3- Poor quality of AMDs will result in
  ineffective treatment, health risks such as
  discomfort to the patient, exacerbation or
  prolongation of illness, admission to hospital,
  development or resistance and needless
  expenditure.

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• RECOMMENDATIONS
• 1- Promoting good procurement practices in the
  public sector by prequalification of suppliers,
  I.e, purchasing from reliable and approved
  sources and good quality suppliers.

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• 2- The pharmaceutical companies from which drugs
  are imported should be registered and AMDs should
  be subjected to QC before registration.
• 3- Specification at the time of tendering should
  include an adequate shelf-life, and detailed
  packing requirements and special labeling as
  relevant.

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• 4- Although the cost of AMDs is important, good
  quality AMDs are more important than cheaper and
  poor drugs.
• 5- Testing for initial quality should be given
  high priority. Routine testing of new supplies is
  recommended, even if the manufacturer has a
  proven good record.

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• 6- Monitoring the manufacturers and suppliers
  good manufacturer compliance (GMC) is important.
• 7- AMDs should be stored and distributed at
  appropriate conditions in harbour, stores and
  health facilities as well as at the level of the
  end users.

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• 8- Measures should be taken to stop illegal
  importing or smuggling of AMDs.
• 9- Proper training of pharmacists and assistant
  pharmacists and all those involved in drug supply
  management and QC

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• STUDY BY DR REEM MUBAJER
• FACULTY OF MEDICINE
• ADEN UNIVERSITY
• Ph.D Student in LSTM, UK
• TDR Grant/WHO/EMRO

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• Objectives
• 1- To determine the prevalence of CQ resistance
  in Pf by in-vivo testing
• 2- To study the susceptibility of Pf to CQ, MQ,
  Amodiaquine, Qn, S/P, Artemisinine by in-vitro
  testing
• 3- To assess the performance of molecular markers
  for mutations in pfcrt, pfmdr1 and Pfcrg in
  identifying CQ resistance in Yemen

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• 4- To correlate the results of in-vivo and
  in-vitro tests with the PCR results for point
  mutation
• 5- To study the association of some easily
  identifiable risk factors with CQ treatment
  failure

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• IN-VITRO STUDY IN 2003
• (Bajil district, Hodeida governorate)
• By Mr Abdul Illah Al Harazi
• Head of Laboratory in the Yemeni German Hospital
  in Sanaa

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Results of the in-vitro study on MQ in Bajil -
2003
1st resistant SG 3
1st sensitive SG 97
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Future Plans In 2004

• 1- AMDs planned to be monitored in 2004
• S/P (Fansidar)
• AQ (Amodiaquine)
• ART S/P (Artesunate Fansidar)
• ART AQ (Artesunate Amodiaquine)
• AM / LUM (Artemether Lumefantrine)
• Q (Quinine)

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• 2- Involving the private sector in monitoring the
  efficacy of AMDs

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• 3- Evaluation of the results and review of the
  national AMD policy by the Core Group (NMCP,
  Faculties of medicine and pharmacy in Sanaa
  Aden universities, WHO) in the 2nd half of 2004

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THANK YOU