MALARIA SITUATION AND THE USE OF HERBAL ANTIMALARIA DRUGS IN THE DEMOCRATIC REPUBLIC OF CONGO

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

2. DRCongo is located in the centre of Africa. POPULATION: 52,770,000 inhabitants SURFACE : 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 )

3. MALARIA AND PUBLIC HEALTH IN DRCONGO Malaria 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

4. 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

5. Kisangani CQ 48 % ; SP 19.2 % Vanga CQ 48.8 %; SP 4.8 % Bukavu CQ 80 % ; SP 9. 3 % Kinshasa CQ 35.2 % ; SP 5.5 % Kapolowe CQ 34 %; SP 3.9 % Kimpese CQ 50 % ; SP 10 % Mikalayi Mikalayi CQ 29,4 % ; SP 0 % 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 Q Failure rate: CQ: 29.4 to 80 % SP: 0 to 19.2 % Change of drugs policy ( intermediary period of two years ): SP / Q Therapeutic failure rate

6. Kisangani SP+AQ : 2 % SP+Art: 0 % Rutshuru SP+AQ :32 % SP+Art: 21 % Shabunda SP+Art : 1 % AQ+Art: 0 % Kimpese SP+AQ: 1.8 % SP+Art: 1.6 % Kapolowe SP+AQ: 2.8 % SP+Art: 0 % AQ+Art:1.4 % Mikalayi SP+AQ:1.4 % SP+Art: 0 % AQ+Art: 0 % Mikalayi ANTIMALARIAL DRUGS POLICY (2) 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 ) Therapeutic failure rate

7. 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.

8. 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.

9. HERBAL ANTIMALARIAL DRUGS DEVELOPMENT (2) 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. -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

10. 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.