When it just won't go away: Oral artemisinin monotherapy in Nigeria, threatening lives, threatening progress

Louis Akulayi, Angela Alum, Andrew Andrada, Julie Archer, Ekundayo D. Arogundade, Erick Auko, Abdul R. Badru, Katie Bates, Paul Bouanchaud, Meghan Bruce, Katia Bruxvoort, Peter Buyungo, Angela Camilleri, Emily D. Carter, Steven Chapman, Nikki Charman, Desmond Chavasse, Robyn Cyr, Kevin Duff, Gylsain GuedegbeKeith Esch, Illah Evance, Anna Fulton, Hellen Gataaka, Tarryn Haslam, Emily Harris, Christine Hong, Catharine Hurley, Whitney Isenhower, Enid Kaabunga, Baraka D. Kaaya, Esther Kabui, Beth Kangwana, Lason Kapata, Henry Kaula, Gloria Kigo, Irene Kyomuhangi, Aliza Lailari, Sandra Lefevre, Megan Littrell, Greta Martin, Daniel Michael, Erik Monroe, Godefroid Mpanya, Felton Mpasela, Felix Mulama, Anne Musuva, Julius Ngigi, Edward Ngoma, Marjorie Norman, Bernard Nyauchi, Kathryn A. O'Connell, Carolyne Ochieng, Edna Ogada, Linda Ongwenyi, Ricki Orford, Saysana Phanalasy, Stephen Poyer, Justin Rahariniaina, Jacky Raharinjatovo, Lanto Razafindralambo, Solofo Razakamiadana, Christina Riley, John Rodgers, Andria Rusk, Tanya Shewchuk, Simon Sensalire, Julianna Smith, Phok Sochea, Tsione Solomon, Raymond Sudoi, Martine Esther Tassiba, Katherine Thanel, Rachel Thompson, Mitsuru Toda, Marie Alix Valensi, Vamsi Vasireddy, Cynthia B. Whitman, Cyprien Zinsou, Chinazo Ujuju, Jennifer Anyanti, Paul N. Newton, Godwin Ntadom

Research output: Contribution to journalArticlepeer-review


Background: Oral artemisinin monotherapy (AMT), an important contributor to multi-drug resistant malaria, has been banned in Nigeria. While oral AMT has scarcely been found for several years now in other malaria-endemic countries, availability has persisted in Nigeria's private sector. In 2015, the ACTwatch project conducted a nationally representative outlet survey. Results from the outlet survey show the extent to which oral AMT prevails in Nigeria's anti-malarial market, and provide key product information to guide strategies for removal. Results: Between August 10th and October 3rd, 2015 a total of 13,480 outlets were screened for availability of anti-malarials and/or malaria blood testing services. Among the 3624 anti-malarial outlets, 33,539 anti-malarial products were audited, of which 1740 were oral AMT products, primarily artesunate (n = 1731). Oral AMT was imported from three different countries (Vietnam, China and India), representing six different manufacturers and 11 different brands. Availability of oral AMT was highest among pharmacies (84.0%) and Patent Propriety Medicine Vendors (drug stores, PPMVs) (38.7%), and rarely found in the public sector (2.0%). Oral AMT consisted of 2.5% of the national anti-malarial market share. Of all oral AMT sold or distributed, 52.3% of the market share comprised of a Vietnamese product, Artesunat®, manufactured by Mekophar Chemical Pharmaceutical Joint Stock Company. A further 35.1% of the market share were products from China, produced by three different manufacturers and 12.5% were from India by one manufacturer, Medrel Pharmaceuticals. Most of the oral AMT was distributed by PPMVs accounting for 82.2% of the oral AMT market share. The median price for a package of artesunate ($1.78) was slightly more expensive than the price of quality-assured (QA) artemether lumefantrine (AL) for an adult ($1.52). The median price for a package of artesunate suspension ($2.54) was three times more expensive than the price of a package of QA AL for a child ($0.76). Conclusion: Oral AMT is commonly available in Nigeria's private sector. Cessation of oral AMT registration and enforcement of the oral AMT ban for removal from the private sector are needed in Nigeria. Strategies to effectively halt production and export are needed in Vietnam, China and India.

Original languageEnglish (US)
Article number489
JournalMalaria journal
Issue number1
StatePublished - Dec 15 2017
Externally publishedYes


  • Anti-malarial products
  • Availability
  • Drug-resistance
  • Manufacturing
  • Market share
  • Oral artemisinin monotherapy

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases


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