Evaluation and pharmacovigilance of projects promoting cultivation and local use of Artemisia annua for malaria

Abstract

BackgroundSeveral non-governmental organisations (NGOs) are promoting the use of Artemisia annua teas as a home-based treatment for malaria in situations where conventional treatments are not available. There has been controversy about the effectiveness and safety of this approach, but no pharmacovigilance studies or evaluations have been published to date.MethodA questionnaire about the cultivation of A. annua, treatment of patients, and side-effects observed, was sent to partners of the NGO Anamed in Kenya and Uganda. Some of the respondents were then selected purposively for more in-depth semi-structured interviews.ResultsEighteen partners in Kenya and 21 in Uganda responded. 49% reported difficulties in growing the plant, mainly due to drought. Overall about 3,000 cases of presumed malaria had been treated with A. annua teas in the previous year, of which about 250 were in children and 54 were in women in the first trimester of pregnancy. The commonest problem observed in children was poor compliance due to the bitter taste, which was improved by the addition of sugar or honey. Two miscarriages were reported in pregnant patients. Only four respondents reported side-effects in other patients, the commonest of which was vomiting. 51% of respondents had started using A. annua tea to treat illnesses other than malaria.ConclusionsLocal cultivation and preparation of A. annua are feasible where growing conditions are appropriate. Few adverse events were reported even in children and pregnant women. Where ACT is in short supply, it would make sense to save it for young children, while using A. annua infusions to treat older patients who are at lower risk. An ongoing pharmacovigilance system is needed to facilitate reporting of any adverse events.

Ethnopharmacology in overdrive: The remarkable anti-HIV activity of Artemisia annua

“…In both studies a tea was prepared from the plant, either alone or with other plant species. Informal feedback from partners of the NGO Anamed, which promotes the use of Artemisia annua as an antimalarial, also claims that the herb is often used by HIV patients (Willcox et al, 2011). If true, this will be an important case of how people in areas heavily affected by HIV infections explore plants available to them for possible medicines (Verpoorte et al, 2005).…”

“…A survey about such use of the plant in Kenya and Uganda conducted from 2009 to 2011 revealed some interesting additional observations: more than half of the respondents had started using Artemisia annua for ailments other than malaria. Of these, about half had started to use Artemisia annua to treat HIV/AIDS (Willcox et al, 2011). In another survey of treatments prescribed by herbalists for people living with HIV/AIDS in Cameroon, Artemisia annua was one of the most frequently mentioned plants (Noumi, 2011).…”

Adverse drug reaction reporting among health care workers at Mulago National Referral and Teaching hospital in Uganda

“…However, there is limited literature on the magnitude, and factors associated with ADR reporting among healthcare workers in Uganda. Existing pharmacovigilance studies conducted in Uganda [8][9] , and neighbouring countries 10 , focus on ADRs related to antimalarial therapy, in spite of diversities in disease burden and medicines used in Uganda. Nevertheless, one of the studies 9 superficially hinted that some of Uganda's healthcare workers were unfamiliar with formal pathways for reporting ADRS.…”

Identification and purification of novel chlorogenic acids in Artemisia annua L.

“…Furthermore, remarkable anti-HIV activity of A. annua plant was also reported by various researchers (Mueller et al, 2000;Clifford et al, 2003). In addition, A. annua leaves contain variety of chlorogenic acids (Willcox et al, 2011), known as potential and nontoxic HIV-1 Integrase Inhibitors (Ferreira et al, 2010;Lubbe et al, 2011). Therefore, chlorogenic acids may be potential candidates in anti-HIV treatment.…”