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Disappearance of drugs undermines Uganda’s fight against malaria

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c2611 (Published 17 May 2010) Cite this as: BMJ 2010;340:c2611
  1. Peter Moszynski
  1. 1London

    Efforts to control malaria in Uganda have been undermined by a lack of first line treatments in public health centres, say investigators from a newly established health monitoring unit that has made dozens of arrests in a crackdown on illicit sales of government owned drugs.

    Three senior health officials are currently on trial for corruption: Richard Ndyomugenyi, a senior medical officer, Myers Lugemwa, a doctor, and Martin Shibeki, programmes assistant.

    Detective Ian Kakuru told a court in Kampala that the case involved the alleged mishandling of more than 625 000 doses of antimalarial drugs worth 1.1 billion Ugandan shillings (£0.35m; €0.41m; $0.51m)

    Uganda has been rocked by a number of drug supply scandals in recent years. A former health minister, Jim Muhwezi, and two junior ministers, Mike Mukula and Alex Kamugisha, were arrested in May 2007 after a report by the Inspectorate of Government found “gross mismanagement and abuse of immunisation funds [from the Global Alliance for Vaccines and Immunization] by officials at the Ministry of Health.” The three former ministers were arrested and detained for alleged misappropriation of 1.6 billion shillings of GAVI funds while they were at the health ministry. They have yet to stand trial.

    Diana Atwine, who heads the new health monitoring unit, told the New Vision newspaper last month how difficult it was to prosecute senior officials. “This culture of impunity has to stop,” she said. “People are complaining that we are arresting suspects but they are released by courts. We are let down by the judiciary.”

    The unit was established last year by Uganda’s president, Yoweri Musevini, who announced a war on corruption. It reported that around five billion shillings worth of government drugs had been recovered in the ongoing crackdown, which also revealed the existence of a number of “ghost clinics” that existed only on paper.

    Last month the Ugandan team of the charity Médecins Sans Frontierès said it was “extremely concerned that lifesaving antimalarial drugs are not reaching those who need them.”

    Despite a “clear commitment” from the Ugandan government to reduce mortality related to malaria, MSF says that the disease kills up to 300 Ugandans a day, mostly pregnant women and children aged under 5 years. “Unless urgent action is taken, many more lives will be lost to this preventable and treatable disease,” it said.

    In northern Uganda MSF teams saw a “sharp increase” in numbers of cases of malaria in 2009. In 2008 the charity treated more than 6000 people with malaria in Kitgum district, northern Uganda. In 2009 this number rose more than fourfold to 27 000 people. The number of people with severe malaria admitted to hospital doubled in the same period.

    The charity notes that the rise in numbers of severe cases was mainly due to patients not having access to free artemisinin based combination treatment (ACT). It said, “Stock-outs in government clinics have been frequent, while private clinics can get ACT stocks within a day.”

    Kodjo Edoh, MSF’s head of mission in Uganda, said, “MSF was shocked to see such high numbers of malaria cases in our clinics throughout 2009. It seems that the drugs are arriving in Kampala but are not getting to the more remote areas where they are so desperately needed.”

    The charity warns that erratic supply of the treatments also increases the risk of resistance. “Limited stocks of ACT mean that in many clinics people are not receiving the correct treatment dosages,” said Dr Edoh. Where ACT is not available “many clinics have no choice but to prescribe chloroquine or Fansidar [pyrimethamine with sulfadoxine],” old formulations to which many strains of malaria are resistant, he said.

    “We’re calling for a thorough audit of the supply chain for ACT as a matter of urgency,” Dr Edoh added. “We need to find out why these drugs aren’t reaching those who need them and rectify the situation immediately. With the start of the rainy season we expect to see increases in the number of people suffering from malaria. This is a matter of life and death.”

    Notes

    Cite this as: BMJ 2010;340:c2611

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