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Open Access Highly Accessed Research

Estimating antimalarial drugs consumption in Africa before the switch to artemisinin-based combination therapies (ACTs)

Jean-Marie Kindermans12*, Daniel Vandenbergh1, Ed Vreeke1, Piero Olliaro3 and Jean-Pierre D'Altilia1

Author Affiliations

1 AEDES Foundation, 34, rue Joseph II, 1000, Brussels, Belgium

2 Médecins Sans Frontières, 94, rue Dupré, 1090, Brussels, Belgium

3 UNICEF/UNDP/WB/WHO Special Programme for Research & Training in Tropical Diseases (TDR), 2, avenue Appia, CH1211 Geneva 27, Switzerland

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Malaria Journal 2007, 6:91  doi:10.1186/1475-2875-6-91

Published: 10 July 2007

Abstract

Background

Having reliable forecasts is critical now for producers, malaria-endemic countries and agencies in order to adapt production and procurement of the artemisinin-based combination treatments (ACTs), the new first-line treatments of malaria. There is no ideal method to quantify drug requirements for malaria. Morbidity data give uncertain estimations. This study uses drug consumption to provide elements to help estimate quantities and financial requirements of ACTs.

Methods

The consumption of chloroquine, sulphadoxine/pyrimethamine and quinine both through the private and public sector was assessed in five sub-Saharan Africa countries with different epidemiological patterns (Senegal, Rwanda, Tanzania, Malawi, Zimbabwe). From these data the number of adult treatments per capita was calculated and the volumes and financial implications derived for the whole of Africa.

Results

Identifying and obtaining data from the private sector was difficult. The quality of information on drug supply and distribution in countries must be improved. The number of adult treatments per capita and per year in the five countries ranged from 0.18 to 0.50. Current adult treatment prices for ACTs range US$ 1–1.8. Taking the upper range for both volumes and costs, the highest number of adult treatments consumed for Africa was estimated at 314.5 million, corresponding to an overall maximum annual need for financing ACT procurement of US$ 566.1 million. In reality, both the number of cases treated and the cost of treatment are likely to be lower (projections for the lowest consumption estimate with the least expensive ACT would require US $ 113 million per annum).

There were substantial variations in the market share between public and private sources among these countries (the public sector share ranging from 98% in Rwanda to 33% in Tanzania).

Conclusion

Additional studies are required to build a more robust methodology, and to assess current consumptions more accurately in order to better quantify volumes and finances for production and procurement of ACTs.