Government must put in more effort to promote artemisinin-based combination therapies (ACTs) says a leading malaria expert Professor Fred Binka, Dean of the School of Public Health, University of Ghana.

According to him, as Africa ventures into the arena of post-market surveillance of antimalarials, attention must be directed at strengthening health systems and encourage behaviour change in favour of ACTs.

He was speaking on "INDEPTH Effectiveness and Safety Studies of Antimalarials in Africa (INESS)" at the 11th INDEPTH Scientific Conference in Maputo, Mozambique.

Professor Binka said strengthening health systems is the only way to achieve the full potential benefits of drugs in malaria control. He said the effectiveness of highly efficacious drugs is largely determined by individual patient behaviour and health systems factors.

Professor Binka urged drugs regulatory authorities in Africa to institute mechanisms to measure the safety of medicines they register to be deployed in the population in order to guarantee their effectiveness. He said it would be very unfortunate for drug regulatory authorities to permit medicines to be deployed into the health system and fail to take safety concerns seriously.

Professor Binka who is a Principal Investigator on the INESS project said countries that fail to monitor the effectiveness of drugs would find themselves "running fast only to find themselves remaining at the same place."

"The regulatory authorities should be able for instance to find out who is collecting data on vaccine safety and i n s t i t u t e p o s t - r e g u l a t o r y mechanisms to find out why people do not take their drugs" he said.

He disclosed that results of health safet y effectiveness studi es conducted in Ghana between 2009 and 2010 into 1,000 uncomplicated malaria fevers treated with artesunate amodiaquine showed that 84 were successful and 916 failed to treat effectively.

In a similar study conducted into 1,000 cases treated with artemether lumefantrine in Tanzania, 242 were successful and 758 did not treat effectively.

Professor Binka said even though the drugs were highly efficacious in some instances they were not prescribed properly and the patients also did not take their drugs as directed.

He said there were instances where patients did not report adverse effects of the drugs to the health authorities to help in the evaluation of their quality. INESS is a platform established in 2009 by INDEPTH Network, an international grouping of health research institutions to provide safety and effectiveness information on antimalarials and vaccines to enable African countries to make rational and timely policies of those medicines.

The initiative evaluates anti-malarials to ensure their safety and effectiveness in and outside the health systems in Africa. Such post-market surveillance has been non-existent in Africa previously.

If successful, the INESS initiative is likely to be extended beyond malaria to other drugs and vaccines.

B e s i d e s p r o v i d i n g c r i t i c a l information on the safety and real life effectiveness of malaria drugs, INESS will provide important r e f e r e n c e i n f o r m a t i o n f o r subsequent evaluation of new anti-malarial drugs.

The INESS project has demonstrated that African scientists are capable of u n d e r t a k i n g c l i n i c a l t r i a l s sometimes better than some foreign commercial clinical research organizations.

Some scholars have expressed the view that if African public health research scientists are able to convince stakeholders with evidence from their research, they would be able to attract more funding for their projects.

They also contend that if African scientists were able to strengthen their collaboration with policy makers, it would be possible for all their clinical research sites to have national programmes running.

The INESS platform works in seven s i t e s i n G h a n a , Ta n z a n i a , Mozambique and Burkina Faso and is being partnered by their various ministries of health.

James Addy wrties from Mozambique