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BACKGROUND: Oral artemisinin monotherapy (AMT), an important contributor to multi-drug resistant malaria, has been banned in Nigeria. While oral AMT has scarcely been found for several years now in other malaria-endemic countries, availability has persisted in Nigeria's private sector. In 2015, the ACTwatch project conducted a nationally representative outlet survey. Results from the outlet survey show the extent to which oral AMT prevails in Nigeria's anti-malarial market, and provide key product information to guide strategies for removal.
RESULTS: Between August 10th and October 3rd, 2015 a total of 13,480 outlets were screened for availability of anti-malarials and/or malaria blood testing services. Among the 3624 anti-malarial outlets, 33,539 anti-malarial products were audited, of which 1740 were oral AMT products, primarily artesunate (n = 1731). Oral AMT was imported from three different countries (Vietnam, China and India), representing six different manufacturers and 11 different brands. Availability of oral AMT was highest among pharmacies (84.0%) and Patent Propriety Medicine Vendors (drug stores, PPMVs) (38.7%), and rarely found in the public sector (2.0%). Oral AMT consisted of 2.5% of the national anti-malarial market share. Of all oral AMT sold or distributed, 52.3% of the market share comprised of a Vietnamese product, Artesunat
CONCLUSION: Oral AMT is commonly available in Nigeria's private sector. Cessation of oral AMT registration and enforcement of the oral AMT ban for removal from the private sector are needed in Nigeria. Strategies to effectively halt production and export are needed in Vietnam, China and India.
O'Connell, Kathryn A.; Vasireddy, Vamsi; Littrell, Megan; Rusk, Andria; ACTwatch Group; Ujuju, Chinazo; Anyanti, Jennifer; Newton, Paul N; and Ntadom, Godwin, "When it just won't go away: oral artemisinin monotherapy in Nigeria, threatening lives, threatening progress." (2017). Collected Faculty and Staff Scholarship. 344.
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Photos of oral AMT products found in Nigeria’s 2015 ACTwatch outlet survey with NAFDAC registration numbers
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Product information and photos of oral AMT products found in Nigeria’s 2015 ACTwatch outlet survey
12936_2017_2102_MOESM3_ESM.docx (863 kB)
Photos of oral AMT packaging and product inserts noting use for resistant malaria found in Nigeria’s 2015 ACTwatch outlet survey