The impact of anti-malarial markets on artemisinin resistance: perspectives from Burkina Faso

• Published in: Malaria journal Vol. 22; no. 1; pp. 269 - 14
• Main Authors: Guissou, Rosemonde M, Amaratunga, Chanaki, de Haan, Freek, Tou, Fatoumata, Cheah, Phaik Yeong, Yerbanga, R Serge, Moors, Ellen H M, Dhorda, Mehul, Tindana, Paulina, Boon, Wouter P C, Dondorp, Arjen M, Ouédraogo, Jean Bosco
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.09.2023; BioMed Central; BMC
• Subjects: ACT; Administrative Personnel; Antimalarial market; Antimalarials; Antimalarials - pharmacology; Artemisinin; Artemisinin resistance; Artemisinins - pharmacology; Burkina Faso; Chloroquine; Data analysis; Diagnostic tests; Dosage and administration; Drug resistance; Drug stores; Drugs; Emergence; Generic drugs; Humans; Illustrations; Logistics; Malaria; Mortality; Pharmaceuticals; Pharmacy; Policies; Prevention; Private sector; Profits; Public health; Public policy; Public sector; Quality control; Risk factors; Supply chains; Tuberculosis; Wholesale industry; Burkina Faso; Sub-Saharan Africa; Southeast Asia; Artemisinin resistance; ACT; Burkina Faso; Malaria; Antimalarial market
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-023-04705-0

Widespread artemisinin resistance in Africa could be catastrophic when drawing parallels with the failure of chloroquine in the 1970s and 1980s. This article explores the role of anti-malarial market characteristics in the emergence and spread of arteminisin resistance in African countries, drawing on perspectives from Burkina Faso. Data were collected through in-depth interviews and focus group discussions. A representative sample of national policy makers, regulators, public and private sector wholesalers, retailers, clinicians, nurses, and community members were purposively sampled. Additional information was also sought via review of policy publications and grey literature on anti-malarial policies and deployment practices in Burkina Faso. Thirty seven in-depth interviews and 6 focus group discussions were conducted. The study reveals that the current operational mode of anti-malarial drug markets in Burkina Faso promotes arteminisin resistance emergence and spread. The factors are mainly related to the artemisinin-based combination therapy (ACT) supply chain, to ACT quality, ACT prescription monitoring and to ACT access and misuse by patients. Study findings highlight the urgent requirement to reform current characteristics of the anti-malarial drug market in order to delay the emergence and spread of artemisinin resistance in Burkina Faso. Four recommendations for public policy emerged during data analysis: (1) Address the suboptimal prescription of anti-malarial drugs, (2) Apply laws that prohibit the sale of anti-malarials without prescription, (3) Restrict the availability of street drugs, (4) Sensitize the population on the value of compliance regarding correct acquisition and intake of anti-malarials. Funding systems for anti-malarial drugs in terms of availability and accessibility must also be stabilized.