title: Evaluation and pharmacovigilance of projects promoting cultivation and local use of Artemisia annua for malaria.
abstract: BACKGROUND
  Several non-governmental organisations (NGOs) are promoting the use of Artemisia annua teas as a home-based treatment for malaria in situations where conventional treatments are not available. There has been controversy about the effectiveness and safety of this approach, but no pharmacovigilance studies or evaluations have been published to date.
  
  
  METHODS
  A questionnaire about the cultivation of A. annua, treatment of patients, and side-effects observed, was sent to partners of the NGO Anamed in Kenya and Uganda. Some of the respondents were then selected purposively for more in-depth semi-structured interviews.
  
  
  RESULTS
  Eighteen partners in Kenya and 21 in Uganda responded. 49% reported difficulties in growing the plant, mainly due to drought. Overall about 3,000 cases of presumed malaria had been treated with A. annua teas in the previous year, of which about 250 were in children and 54 were in women in the first trimester of pregnancy. The commonest problem observed in children was poor compliance due to the bitter taste, which was improved by the addition of sugar or honey. Two miscarriages were reported in pregnant patients. Only four respondents reported side-effects in other patients, the commonest of which was vomiting. 51% of respondents had started using A. annua tea to treat illnesses other than malaria.
  
  
  CONCLUSIONS
  Local cultivation and preparation of A. annua are feasible where growing conditions are appropriate. Few adverse events were reported even in children and pregnant women. Where ACT is in short supply, it would make sense to save it for young children, while using A. annua infusions to treat older patients who are at lower risk. An ongoing pharmacovigilance system is needed to facilitate reporting of any adverse events.
authors.affiliation: Department of Primary Health Care, University of Oxford, UK. merlinwillcox@doctors.org.uk
authors.forename: Merlin L
authors.initials: ML
authors.lastname: Willcox
authors.forename: Shelly
authors.initials: S
authors.lastname: Burton
authors.forename: Rosalia
authors.initials: R
authors.lastname: Oyweka
authors.forename: Rehema
authors.initials: R
authors.lastname: Namyalo
authors.forename: Simon
authors.initials: S
authors.lastname: Challand
authors.forename: Keith
authors.initials: K
authors.lastname: Lindsey
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D031172:Artemisia annua; D037621:Artemisinins / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D007630:Kenya; D008288:Malaria / Q000188:drug therapy*; D008517:Phytotherapy / Q000379:methods*; D028321:Plant Preparations / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy; D011795:Surveys and Questionnaires; D014454:Uganda
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D028321:Plant Preparations