Tips on malaria prevention

I’ve recently become aware of two publications about malaria. The first is about preventing malaria in travelling children. The second, about malaria treatment. I’ve also become aware of a product on the market called “Nordman Artemisia Anti-Malaria“.

The article in the South African Family Practice Journal by Dr Sophie Mathijs has the title: “Malaria prevention in travelling children.” It highlights the potentially dire consequence (ie death) of an infection with plasmodium falciparum (the malaria-causing organism) in a child and gives excellent sensible advice on how to prevent this. The concerns are also applicable to adults.

The article from Malaria Journal focuses on malaria treatment in developing countries. The spectre of artemisinin resistance spreading globally is raised, with the possible loss of an effective first-line malaria treatment (as a combination therapy — ie artemisinin in combination with other anti-malarial medications). Although quinine is still used and is effective, it is not recommended for routine first-line treatment in uncomplicated malaria. Artemisinin-combination therapy is recommended. Artemisinin was originally obtained from a herb artemisia annua.

The announcement at UCT of a new single-dose antimalarial agent earlier in 2012, although an exciting discovery, was in some aspects premature. That agent has many years of research and testing ahead before it might become widely available as a treatment — if it indeed passes all the testing.

Artemisinin is not even mentioned in the first article about prevention. This is correct because it should not be used for prevention but reserved only for treatment. As the department of health’s South African guidelines for the prevention of malaria state “artemisinin derivatives are pivotal for the treatment of malaria and so should be strictly protected for this indication and never used (alone or in combination or as herbal or complementary medicines) for the prevention of malaria. This is strongly recommended by the World Health Organisation in order to delay the development of resistance” (emphases added). These guidelines also state “there is no scientific evidence to support use of complementary, alternative and homeopathic preparations for the prevention (or treatment) of malaria”.

“Nordman Artemisia Anti-Malaria” contains artemisia afra. It is stated in advertisements in the South African Journal of Natural Medicine that: i) the product can be used for both the prophylaxis (prevention) and treatment of malaria ii) its active ingredient is artemisinin and iii) because it is a herbal remedy and not a “man-made” drug, resistance is unlikely to develop.

Of these claims: i) is not scientifically proven ii) is false iii) is false.

The first statement is based only on “traditional” use. This is not (yet) a criterion accepted in the Medicines Act (The Medicines and Related Substances Act, 1965 (Act 101 of 1965) ) as evidence. In any case, the traditional use mainly involved making a decoction or tea using the herb — not packing “capsules” with a herbal powder!

The second statement was disproven in a 2008 South African Journal of Botany article which reported on testing for the presence of artemisinin in artemisia afra plants as well as in the “Nordman Anti-Malaria Artemisia” capsules — and found none in either. The same tests done at the same time by the same investigators on artemisia annua plants — the usual source of artemisinin — confirmed the presence of artemisinin. (It is perhaps fortunate that, despite the claims made for it, the product does not contain artemisinin so that it does not potentially contribute to both artemisinin-resistance globally and the possible loss of an effective anti-malarial treatment.)

Although journalist Siyammukela Mahlangu does not identify the product or company, she bluntly states ” … the company has been lying and has put people’s lives at stake“. She does refer to the journal, the university department and one of the co-authors by name — and the journal article refers to the company (“Nordman Natural Therapies”) by name — and their “capsules”.

The third statement seems to have emanated from the imagination of the copy writer. It comes perhaps from a failure to understand that the active ingredients of herbal or natural remedies are “chemicals” — as are the active ingredients of “man-made” drugs.

If you’re travelling to some of the malaria-endemic parts of South Africa or to a neighbouring country where malaria is prevalent — make sure you and your children are protected from malaria. Avoid being bitten by mosquitoes through using bed nets, insecticides and insect-repellents, get the most appropriate anti-malaria prevention from your pharmacist and take it correctly and, if you (or your children) get sick with a flu-like illness (especially: high temperature, sweating, chills and muscle aches) after returning — see your health practitioner as soon as possible, and tell them that you were recently in a malaria area.

It is advisable NOT to use Nordman Artemisia Anti-Malaria. The product has not had any independent testing of its quality, safety or efficacy (ie if it works or not) — verified by the Medicines Control Council (MCC) whose responsibility this is. Registered anti-malarials are classified as Schedule 4 substances and would only be available with a prescription and may not be advertised directly to the public. It is astounding that the MCC has allowed the continued availability of Nordman Artemisia Anti-Malaria (and its misrepresentation) to South Africans. People taking it may have a false sense of security that they are protected. The product clearly constitutes a serious public health risk.

Disclaimer: I am writing in my personal capacity. My views are not necessarily a reflection of the views of my employer, Rhodes University, or necessarily the views of the Allied Health Professions Council of South Africa, of which I am a council member.