1. AFRICA HERBAL ANTIMALARIA MEETING ORGANISED BY THE WORLD AGROFORESTRY CENTRE (ICRAF) AND THE ASSOCIATION FOR THE PROMOTION OF TRADITIONAL MEDICINE (PROMETRA
MALARIA SITUATION AND THE USE OF HERBAL
ANTIMALARIA DRUGS IN THE DEMOCRATIC REPUBLIC OF CONGO
MESIA KAHUNU GAUTHIER
1UNIVERSITY OF KINSHASA, FACULTY OF PHARMACY, KINSHASA XI
DEMOCRATIC REPUBLIC OF CONGO
2UNIVERSITY OF ANTWERP (UA), UNIVERSITEITSPLEIN 1,
B-2610-ANTWERP, BELGIUM

2. DRCongo is located in the centre of Africa.
POPULATION: 52,770,000 inhabitants
SURFACE : 2,345,000 Km2
Crossed by the equator, two seasons ( dry and rainy ), abundant flora ( four vegetation zones ).
TROPICAL SUBSAHARAN COUNTRY ( 90 % MALARIA, the most affected region )

3. Malaria is: MALARIA AND PUBLIC HEALTH IN DRCONGO
-The major public health problem
-The first cause of morbidity and mortality ( particulary: children < 5 years old
and pregnant women )
Main indicators:
- Endemicity: 100%
-Transmission: - Stable: %
- Seasonal: 2% ( East mountainous region )
-Malaria cases have been estimated at: -4,4 mio ( MSP, 2004 )
-59 to 80% Children
-Death: - 17,200
- 1/5 ( 80 % of sick persons don’t frequent hospitals, not notified )
Principal vector: Anopheles gambiae
Majority of infections ( 95 %) : Plasmodium falciparum

4. NATIONAL POLICY FOR THE STRUGGLE AGAINST MALARIA
The government has set up a national policy to face this serious situation,
based on:
I. Prevention measures: Improvement ( in and around homes)
-Insecticide spraying
-Impregnated mosquito nets with insecticide
( deltamethrine )
II. Treatments: -Presumptive ( symptoms, fever )
-Precocious ( early ) ( prevent complicated malaria)
-Correct ( recommended drugs, correct dosage )
III. Epidemiological surveillance

5. ANTIMALARIAL DRUGS POLICY (1)
May 2000 to nov 2001 : first chemosensitivity studies ( 8 sites )
WHO protocol 1996 (clinical responses only ): CQ, SP
Nov 2001: CQ : uncomplicated
SP : failure or allergy Q
Failure rate: CQ: to 80 %
SP: 0 to 19.2 %
Change of drugs policy ( intermediary period of two years ): SP / Q
Mikalayi
CQ 29,4 % ; SP 0 %
Kimpese
CQ 50 % ; SP 10 %
Kinshasa
CQ 35.2 % ; SP 5.5 %
Vanga
CQ 48.8 %; SP 4.8 %
Kisangani
CQ 48 % ; SP 19.2 %
Bukavu
CQ 80 % ; SP 9. 3 %
Kapolowe
CQ 34 %; SP 3.9 %
Therapeutic failure rate

6. ANTIMALARIAL DRUGS POLICY (2)
June june 2004 : second studies of therapeutic efficiency
WHO protocol 2001 (clinical responses + residual parasitaemia)
Combinations ( SP + AQ, SP + ART, AQ + ART )
Presently ( 2005 ) : ART + AQ / Q
SP ( intermittent preventive treatment )
Mikalayi
SP+AQ:1.4 %
SP+Art: 0 %
AQ+Art: 0 %
Kimpese
SP+AQ: 1.8 %
SP+Art: 1.6 %
Kisangani
SP+AQ : 2 %
Rutshuru
SP+AQ :32 %
SP+Art: 21 %
Kapolowe
SP+AQ: 2.8 %
AQ+Art:1.4 %
Shabunda
SP+Art : 1 %
Therapeutic failure rate

7. PROBLEMS
 Lack of financial resources ( 2005: covering rate projected: 34,76 % )
 Inaccessibility to known antimalarial drugs mainly in villages and
sometimes in towns (social and economic )
 70 to 80 % of the population resort to traditional healers who
administer them some preparations based on medicinal claims to
treat the disease and find some relief.

8. HERBAL ANTIMALARIA DRUGS DEVELOPMENT (1)
- DRCongo is one of the richest countries in botanical resources in the world
with one third of endemic medicinal plants.
- Many of them are used by traditional healers in many communities for the
treatment of various diseases including malaria.
- A large number of Congolese medicinal plants are less or not scientifically yet
explored for the evaluation of their pharmacological and therapeutical properties.
- In DRCongo, on the basis of literature data on some medicinal plants currently used,
some rechearchers have prepared modern galenic forms such as tablets and syrups
which are widely commercialized.

9. HERBAL ANTIMALARIAL DRUGS DEVELOPMENT (2)
Problems with improved preparations based on medicinal plants in RDCongo:
- Some Congolese pharmacists have made some improved traditional medicines
from medicinal plants with authorization for their marketing.
I.E.:Manalaria ( Nauclea latifolia and Cassia occidentalis)
Sansiphos ( Garcinia cola )
-The safety, stability, standardization and dosage of these preparations are not
scientifically guaranteed.
-The use of these kind of preparations is only based on an insufficient number of clinical
observations, they refer to the literature data of the starting plant material(s) for the
chemical and biological studies

10. FUTURE PERSPECTIVES
- Prof Dr A.J. VLIETINCK of the Department of Pharmaceutical Sciences of the University
of Antwerp and Prof Dr G. TONA Lutete of the Faculty of Pharmaceutical Sciences of the
University of Kinshasa have initiated a project aiming at the development of an
antimalarial medicine active against Plasmodium falciparum chloroquino-resistant and
sensitive strains and affordable from Congolese traditional medicinal plants.
- In the framework of this project, an ethnobotanical inventory was conducted leading to
the collection of 124 antimalarial medicinal plants in three regions which were tested in
vitro and in vivo. Some extracts were found to exhibit a good antiplasmodial activity at
different levels in both tests with no significant cytotoxic effects in mice. Among these
active extracts, two will be selected for the production of standardized antimalarial
preparations, which will be investigated in a clinical study.
- This project will be useful for the health authorities in DRCongo to regulate the herbal
medicinal production and initiate a collaboration with producers for the standardization of
their preparations necessary for the reproductibility of the medicinal activity.