MALARIA SITUATION AND THE USE OF HERBAL

ANTIMALARIA DRUGS IN THE DEMOCRATIC REPUBLIC OF CONGO

MESIA KAHUNU GAUTHIER

1UNIVERSITY OF KINSHASA, FACULTY OF PHARMACY, KINSHASA XI DEMOCRATIC REPUBLIC OF CONGO

2UNIVERSITY OF ANTWERP (UA), UNIVERSITEITSPLEIN 1, B-2610-ANTWERP, BELGIUM

AFRICA HERBAL ANTIMALARIA MEETING ORGANISED BY THE WORLD AGROFORESTRY CENTRE (ICRAF) AND THE ASSOCIATION FOR THE PROMOTION OF TRADITIONAL MEDICINE (PROMETRA

DRCongo is located in the centre of Africa.POPULATION: 52,770,000 inhabitantsSURFACE : 2,345,000 Km2 Crossed by the equator, two seasons ( dry and rainy ), abundant flora ( four vegetation zones ).TROPICAL SUBSAHARAN COUNTRY ( 90 % MALARIA, the most affected region )

MALARIA AND PUBLIC HEALTH IN DRCONGOMalaria is:

-The major public health problem

-The first cause of morbidity and mortality ( particulary: children < 5 years old

and pregnant women )

Main indicators: - Endemicity: 100% -Transmission: - Stable: 97% - Seasonal: 2% ( East mountainous region ) -Malaria cases have been estimated at: -4,4 mio ( MSP, 2004 ) -59 to 80% Children -Death: - 17,200 - 1/5 ( 80 % of sick persons don’t frequent hospitals, not notified )

Principal vector: Anopheles gambiae

Majority of infections ( 95 %) : Plasmodium falciparum

NATIONAL POLICY FOR THE STRUGGLE AGAINST MALARIA

The government has set up a national policy to face this serious situation,

based on:

I. Prevention measures: -Improvement ( in and around homes)

-Insecticide spraying

-Impregnated mosquito nets with insecticide

( deltamethrine )

II. Treatments: -Presumptive ( symptoms, fever )

-Precocious ( early ) ( prevent complicated malaria)

-Correct ( recommended drugs, correct dosage )

III. Epidemiological surveillance

ANTIMALARIAL DRUGS POLICY (1)May 2000 to nov 2001 : first chemosensitivity studies ( 8 sites ) WHO protocol 1996 (clinical responses only ): CQ, SP Nov 2001: CQ : uncomplicated SP : failure or allergy QFailure rate: CQ: 29.4 to 80 % SP: 0 to 19.2 %Change of drugs policy ( intermediary period of two years ): SP / Q

Mikalayi

MikalayiCQ 29,4 % ; SP 0 %

KimpeseCQ 50 % ; SP 10 %

KinshasaCQ 35.2 % ; SP 5.5 %

VangaCQ 48.8 %; SP 4.8 %

KisanganiCQ 48 % ; SP 19.2 %

BukavuCQ 80 % ; SP 9. 3 %

KapoloweCQ 34 %; SP 3.9 %

Therapeutic failure rate

June 2002- june 2004 : second studies of therapeutic efficiency WHO protocol 2001 (clinical responses + residual parasitaemia) Combinations ( SP + AQ, SP + ART, AQ + ART )

Presently ( 2005 ) : ART + AQ / Q SP ( intermittent preventive treatment )

ANTIMALARIAL DRUGS POLICY (2)

Mikalayi

MikalayiSP+AQ:1.4 %SP+Art: 0 %AQ+Art: 0 %

KimpeseSP+AQ: 1.8 %SP+Art: 1.6 %

KisanganiSP+AQ : 2 %SP+Art: 0 % Rutshuru

SP+AQ :32 %SP+Art: 21 %

KapoloweSP+AQ: 2.8 %SP+Art: 0 %

AQ+Art:1.4 %

ShabundaSP+Art : 1 %AQ+Art: 0 % Therapeutic failure rate

PROBLEMS

Lack of financial resources ( 2005: covering rate projected: 34,76 % )

Inaccessibility to known antimalarial drugs mainly in villages and sometimes in towns (social and economic )

70 to 80 % of the population resort to traditional healers who

administer them some preparations based on medicinal claims to

treat the disease and find some relief.

HERBAL ANTIMALARIA DRUGS DEVELOPMENT (1)

- DRCongo is one of the richest countries in botanical resources in the world

with one third of endemic medicinal plants.

- Many of them are used by traditional healers in many communities for the

treatment of various diseases including malaria.

- A large number of Congolese medicinal plants are less or not scientifically yet

explored for the evaluation of their pharmacological and therapeutical properties.

- In DRCongo, on the basis of literature data on some medicinal plants currently used,

some rechearchers have prepared modern galenic forms such as tablets and syrups

which are widely commercialized.

Problems with improved preparations based on medicinal plants in RDCongo:

- Some Congolese pharmacists have made some improved traditional medicines

from medicinal plants with authorization for their marketing. I.E.:Manalaria ( Nauclea latifolia and Cassia occidentalis) Sansiphos ( Garcinia cola )

-The safety, stability, standardization and dosage of these preparations are not

scientifically guaranteed.

HERBAL ANTIMALARIAL DRUGS DEVELOPMENT (2)

-The use of these kind of preparations is only based on an insufficient number of clinical

observations, they refer to the literature data of the starting plant material(s) for the

chemical and biological studies

FUTURE PERSPECTIVES

- Prof Dr A.J. VLIETINCK of the Department of Pharmaceutical Sciences of the University

of Antwerp and Prof Dr G. TONA Lutete of the Faculty of Pharmaceutical Sciences of the

University of Kinshasa have initiated a project aiming at the development of an

antimalarial medicine active against Plasmodium falciparum chloroquino-resistant and

sensitive strains and affordable from Congolese traditional medicinal plants.

- In the framework of this project, an ethnobotanical inventory was conducted leading to

the collection of 124 antimalarial medicinal plants in three regions which were tested in

vitro and in vivo. Some extracts were found to exhibit a good antiplasmodial activity at

different levels in both tests with no significant cytotoxic effects in mice. Among these

active extracts, two will be selected for the production of standardized antimalarial

preparations, which will be investigated in a clinical study.

- This project will be useful for the health authorities in DRCongo to regulate the herbal

medicinal production and initiate a collaboration with producers for the standardization of

their preparations necessary for the reproductibility of the medicinal activity.