WHO Collaborating Centre for International Drug Monitoring

1. WHO Collaborating Centre for International Drug Monitoring Dr. Mohamed Farah the Uppsala Monitoring Centre 1

2. WHO Drug Monitoring ProgrammeFounding Members 1968 Australia Canada Denmark Germany Ireland Netherlands New Zealand United Kingdom Sweden United States of America 2

3. WHO Programme for International Drug Monitoring 3

4. WHO Collaborating Centrethe Uppsala Monitoring Centre • established as a foundation 1978 • based on agreement Sweden – WHO • international administrative board • WHO Headquarters responsible for policy 4

5. Signalling ProcedureWhat should be achieved? • Signals should not be missed • Signals should be found early • ‘False’ signals should be kept to a minimum 5

6. 1 2 5 3 4 Process for joining WHO Programme Ministry of Health • Ministry of Health (or equivalent) designates National Centre National Centre • Ministry of Health sends formal application to WHO-HQ, Geneva • National Centre sends sample reports to the UMC the UMC WHO-HQ Geneva • UMC notifies WHO-HQ that reports are compatible • WHO-HQ advises Ministry of Health of admittance to the Programme 6

7. Africa -WHO Official member Associate member Algeria Democratic Republic of Congo South Africa (1992) Madagascar Morocco (1992) Sierra leone Tunisia (1993) Botswana Tanzania (1993) Eritrea Zimbabwe (1998) Ethiopia Egypt (2001) Uganda Ghana (2001) Zambia Nigeria (2004) Mozambique (2005) 7

8. Nomina si nescis, perit et cognitio rerum.(Carl von Linné, Critica botanica) If you do not know the names, the knowledge about the things vanishes as well. 8

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11. Warburgia salutaris (Bertol. f.) Chiov. Isibhaha Syn: Warburgia breyeri Pott.; Warburgia ugandensis Sprague; Chibaca salutaris Bertl. f. Common names:Pepper bark tree, Pepperbasboom (Afr.), Shibaha (Tsonga), Amazwecehlabayo (Zulu), Isibaha (Z, V), Manaka (Venda), Sebaha (Sotho)Muthiga (Kikuyu), Sogdom (Amharic), Msokonoi (Swahili) Uses: Expectorant, Chest infections, Sinusitis, Malaria, Venereal diseases, Stomach ulcers, Toothache and Dermatological disorders Chemistry warburganal muzigadial polygodial mukaadial 11

12. Artemisia annua L. leaf 12

13. Artemisia annuua L. The plant can grown in many places but it may not contain artemisinin. For example: Visitors of the ancient palaces in the forbidden city in beijing can find nice artemisia annua plants pushing left and right as weeds, but these plants do not contain artemisinin 13

14. Artemisia annua L. The average artemisinin concentration in plants of European origin range from 0.03 to 0.22 % (dry leaves weight basis) artemisinin, but a clone from China could contain up to 1.1 %artemisinin 14

15. Artemisia annua L. 1,8-Cineole:leafpesticide, insectifuge, herbicide Alpha-Pinene:leafherbicide, insecticide, pesticide, insectifuge, insectiphile Artemisic-acid:plant: pesticide Artemisinin:flowerleafantimalarial, pesticide, schizonticide, herbicide Beta-Pinene:plant: herbicide, insectifuge, pesticide Beta-Sitosterol:plant: pesticide, antifeedant Borneol:plant: herbicide, insectifuge, pesticide, insect-repellent Camphene:plant: insectifuge, pesticide Camphor:leaf antifeedant herbicide, insect-repellent, insectifuge, pesticide Caryophyllene-oxide:plant: antifeedant, insecticide, pesticide Cuminaldehyde:leaf: larvicide, pesticide Delta-Cadinene:plant: pesticide Deoxyartemisinin:plant: pesticide Menthol:plant: pesticide, termiticide Ocimene:plant: insecticide P-Cymene:plant: herbicide, insectifuge, pesticide Scopoletin:plant: herbicide, pesticide 15 Terpinen-4-ol:plant: herbicide, insectifuge, pesticide

16. Artemisia annua L., flower, leaf ARTEMISININ Antimalarial Antitumor Antiviral Calcium-Antagonist Cytotoxic Herbicide Immunomodulator Neurotoxic Pesticide Plasmodicide Schizonticide 16 Teratogenic

17. Artemisia annua L. leaf Artemisinin青蒿素 Dihydroartemisinin Artesunate Arteether Artemether 17

18. Artemisinin Synthesis 18

19. Artemisinin can be synthesized, but synthetic compound is unlikely to be economically competitive with the naturally produced compound 19

20. WHO Record number: Country: Ghana Type of report: Spontaneous report/Hospital Age: 54 Years Sex: Female Adverse Reaction(s): Face oedema; Oedema periorbital Outcome: Not recovered Suspected Drug:Artesunate Drug administration data: 200 Milligram Oral Total Indication: MALARIA Concomitant Drug(s): Nifedipine 20 Milligram Oral per Day Rechallenge action: Rechallenge Rechallenge outcome: Reaction recurred Case report Nifedipine: 17 Face oedema 29 Oedema periorbital 20

21. ArtemetherTotal number of reports 44 21

22. Artesunate Reports 22260 22

23. Artemisinin and derivatives There is a fear that improper use of artemisinin and its derivatives will spur the malaria parasite to evolve to resist treatment with the compounds, something that has happened to all previous malaria therapies Spread of chloroquine resistance of Plasmodium falciparum 23

24. Natural Mosquito Repellents Agastache cana (Hook.) Woot. & Standl. Azadirachta indica Juss f. Cymbopogon nardus (L.) Rendle Melissa officinalis L. Pelargonium citrosum Vanleenii Pelargonium graveolens L'Her. ex Ait. Nepeta cataria L.* 24 *It is ten times more effective than DEET at repelling mosquitoes

25. Mosquito’s natural enemy Mosquitofish Bat 600/h 25

26. If you think you're too small tobe effective, you have never been in bed with a mosquito! 26

27. Thank you for your attention! 27

28. Is it acceptable that an African child dies of malaria every 30 seconds when safe and effective treatment is available. 28

29. ”Pull out, Bettyl Pull out...You’ve hit on artery” 29

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31. Mystic Herbal balm ? 31 Mystic Herbal balm ?

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