Anti-malarial drugs are a critical part of public health efforts to control malaria. Despite the widespread availability of these medications in some areas, malaria still kills hundreds of thousands of people in Africa every year.

One significant factor contributing to this problem is the misuse of antimalarial drugs, which can lead to severe health consequences. The issue of drug resistance also poses a serious threat to those who rely on malaria medications to treat or prevent malaria.

This article will explore antimalarial drug misuse, its risks, consequences and ways to combat this issue. To begin, let’s understand what an antimalarial drug is.

What Are Anti-Malarial Drugs?

Anti-malarial drugs are used to treat and prevent malaria. They work by killing the parasites inside the affected red blood cells. To do this, they have to attack the structure of the parasite’s respiratory mechanism leading to its death

The WHO guidelines for malaria show they are effective in treating malaria, especially when used correctly and in the appropriate settings. They are also safe for babies and given according to body weight, usually in suspension form or, in severe cases, via intravenous injection.

Note: Antimalarials are not a substitute for antibiotics and deworming medications.

Examples of some common antimalarials include

  • Chloroquine phosphate: This is more effective in treating non-Plasmodium falciparum malaria, as this type of malaria parasite is yet to develop chloroquine resistance. 
  • Artemisinin-based combination therapies (ACT): Common examples are Coartem, Lonart, and Amartem soft gel.
  • Sulfadoxine Pyrimethamine combination (Fansidar): This is commonly used to prevent and treat malaria, especially in pregnant women during antenatal periods. They are safe and do not cause miscarriages.

Side effects of Antimalarials include headache, muscle pain, itching, weakness, jaundice, diarrhoea, chest pain, eating disorder, and fast breathing. However, most antimalarials are generally safe under a physician's prescription and supervision.

How Can One Misuse Antimalarial Drugs?

Antimalarial drugs are susceptible to intentional or unintentional misuse due to inadequate knowledge or other factors. Here are some ways in which misuse can occur:

  • Misdiagnosis of malaria: Not all fevers are caused by malaria, and some infections can present with symptoms similar to those of malaria. Proper diagnosis requires a trained physician’s evaluation, including medical history, clinical assessment, and laboratory tests.
  • Prescriptions by unqualified medical personnel: Non-medical personnel may provide inaccurate diagnoses and prescribe medications that may counteract each other, leading to potentially harmful consequences. Under or overdosing may also occur due to incorrect weight consideration and disease severity assessment.
  • Poor Compliance with medications: Many people skip doses or stop taking medications once they feel better. This leads to a relapse of the disease, resistance to drugs, or even complications of the disease.
  • Use of Fake Antimalarial Drugs: This can arise due to systemic corruption, dubious people in the pharmaceutical chain, poor health education, and lack of financial resources to get authentic medication options. Using fake drugs can increase morbidity and mortality rates.

Risk Factors For Misuse Of Antimalarial Drugs

Several factors can contribute to the misuse of antimalarial drugs beyond poverty and illiteracy. These underlying issues include:

  • Poor health-seeking behaviour: People may seek potentially harmful alternatives or poorly informed opinions for health solutions instead of seeking appropriate medical care.
  • Poor or inaccessible healthcare facilities: Long hospital waiting lines, inability to see doctors, and lack of proximity to healthcare facilities encourage self-medication and other alternatives.
  • Religious and cultural myths: People might depend on faith or traditional remedies such as roots and herbs instead of taking anti-malarials.
  • Distrust of medical personnel: Many fear being financially exploited in hospitals or being regarded condescendingly for making poor health decisions before seeking medical care.
  • Environmental acceptance: Often, people’s behaviours are influenced by what they know and are used to - nature and nurture. So, people who grow up in households where drugs are misused become adults who believe this practice is okay because they turned out fine.

Consequences Of Misuse Of Antimalarial Drugs

The misuse of antimalarial drugs can lead to short and long-term consequences, including:

  • Resistance: Drug resistance occurs when the parasites change over time and no longer respond to the usual drugs, making infections harder to treat.
  • Waste of financial resources: Lack of health improvement due to lack of finance necessitates more hospital visits and tests, which pushes people to self-medicate instead.
  • Prolonged illness: Resistance, poor dosing, or misdiagnosis means the patient suffers longer from the illness until the right treatment is administered.
  • Reduced economic productivity: Sickness reduces a worker’s ability to carry out everyday activities, affecting work productivity. It also costs companies revenue from sick leave and the inability of workers to turn up for work.
  • Loss of life: Severe malaria worsened by fake drugs, wrong drugs, or misdiagnosis can lead to death.

Prevention Of Misuse Of Antimalarial Drugs

While increasing knowledge and awareness can help reduce and prevent the incidence of anti-malarial drug misuse, government intervention is the most significant way to combat this challenge.

This plays out in the following ways:

  • Targeted and aggressive health education: Government agencies, corporate bodies, media, NGOs, and philanthropists should collaborate to educate the public on the appropriate use of antimalarial drugs.
  • Accessible Healthcare Infrastructure: Proper healthcare infrastructure, especially well-equipped primary healthcare centres, should be established in multiple locations to ensure easy accessibility.
  • Motivated healthcare workers: This can be achieved through fair employment practices, reasonable payment, and creating a conducive work environment.
  • Regulation of alternative healthcare providers: Providers of fake drugs should be prosecuted, and alternative healthcare providers should be regulated.
  • Subsidised treatment: Treatment should be subsidised for the most affected or vulnerable groups, such as children under five and pregnant women.
  • Implementation of malaria vaccine: This will help to prevent malaria and reduce the subsequent misuse of anti-malarials.

The Ongoing Conversation

For drugs that save millions of lives every year, it’s sad that the challenge of antimalarial drug misuse is an ongoing reality. However, with proper education and a well-motivated healthcare system, this challenge can be tackled.

With proper administration and dosage, these drugs are invaluable in stemming the spread of malaria. And you can play your part by speaking to a care specialist when you feel unwell. North is a great place to begin.