Vol 39 # 2 June 2007 - Kma.org.kw

208WHO-Facts Sheet June 2007medicines for malaria. The guidelines willcontribute to improving the quality of Artemisiaannua L to further develop artemisinin-basedmedicines, and help ensure a sustainable supply tomeet market demand.Artemisia annua L, used in Chinese traditionalmedicine for centuries, is today considered part ofthe solution where malaria has become resistant toother medicines. Artemisinin-based combinationtherapies (ACTs) have been recommended byWHO since 2001 in all countries where falciparummalaria - the most resistant form of the disease - isendemic.Since then, the world market for pro d u c t scontaining artemisinin derivatives has gro w nrapidly. However, not all artemisinin meets therequired standards to produce quality medicines,making it all the more urgent to promote bestpractices in the cultivation and collection of the rawmaterial used to make the combination therapy.About 40% of the world’s population is at risk ofcontracting malaria which is resistant to othermedicines. Of the 76 countries needing artemisininbasedtreatment today, 69 have adopted the WHOrecommendation to use this therapy.The availability of these treatments still fallsshort of what is needed. Of an estimated 600million people needing A C Ts worldwide, onlyabout 82 million are receiving the tre a t m e n tthrough public sector distribution systems (whichconstitute 90% of antimalarial distribution indeveloping countries).The “WHO monograph on good agriculturaland collection practices for Artemisia annua L.”provides a detailed description of the cultivationand collection techniques and measures requiredfor a harvest to meet quality requirements. Theinformation is based on research data and thepractical experience of several countries wheresuccessful cultivation practices have led to a highyield of good quality Artemisia annua L.As with most medicinal herbs, artemisinin’scontents and efficacy are subject to climatic,geographical and environmental conditions.Not allArtemisia annua plants necessarily containartemisinin and in some places, depending on thequality of the soil and rainfall, the content may bevery low and without industrial value. T h e s efactors make it necessary to run pilot tests ofcultivation on small areas of land to ensure that theland selected is suitable for growing high-yieldplants before large-scale cultivation begins.Cultivation of Artemisia annua re q u i res aminimum of 6 months and extraction, processingand manufacturing of the final product require atleast 2-5 months depending on the pro d u c tf o r m u l a t i o n . High temperatures during postharvesthandling can damage the quality of theplant. After harvesting or collection, the artemisinincontent of the leaves will gradually decrease. Thevalue of the raw material for extraction can be lostafter six to twelve months’ storage.The authors of the guidelines caution governmentson two fronts. First, they must ensure that farmerswork with manufacturers to determine the actualmarket demand for the plant. Recent experience insome countries has shown that overproduction notonly wastes money and time, it can also have anegative effect on the plant’s future yield. Second,they must ensure the availability of the technicalskills and know-how needed to extract artemisininfrom dried leaves.The WHO monograph also aims to provide amodel for countries and researchers to developfurther monographs on good agricultural andcollection practices for other medicinal plants, andpromote the sustainable use of the plant as part ofthe larger aim of protecting the wild resources ofmedicinal plants.Recent estimates of the global malaria burdenhave shown increasing levels of illness and deathcaused by malaria, reflecting the deterioration ofthe malaria situation in Africa during the 1990s.About 90% of all deaths from malaria occur inAfrica, in the areas south of the Sahara, and thegreat majority of these are in children under the ageof five.Key among the factors contributing toincreasing malaria mortality and morbidity is thewidespread resistance of Plasmodium falciparumto conventional antimalarial drugs, such asc h l o roquine, sulfadoxine-pyrimethamine andamodiaquine. The rising tide of counterfeit andsubstandard malaria medicines in parts of Africaand Asia contributes to the problem of resistance.M u l t i d ru g - resistant Plasmodium falciparum malariais also widely prevalent in south-east Asia andSouth America.The Guidelines can be found at:http://www.who.int/entity/medicines/publications/traditional/ArtemisiaMonograph.pdf