Artemisia annua has been used as a herbal medicine for intermittent fevers since at least 340AD. Artemisinin was isolated from A. annua in 1971 and is today the most powerful anti-malarial drug ever developed. Artemisinin combination therapy (ACT) is now recommended by WHO as the first-line treatment for uncomplicated malaria. However, ACT remains relatively expensive and is not consistently available in many malarious areas, leading some NGOs to promote the use of herbal preparations of A. annua. Preliminary clinical trials suggest these can be effective even though the artemisinin content is low.
There has been much debate about the appropriateness, effectiveness and safety of such programmes. Some critics believe it is too complicated to teach villagers how to grow, harvest and prepare a plant for their own use as a herbal medicine. Others fear that such practices may be ineffective and promote the spread of resistance to artemisinin, as the dose of artemisinin in the tea is lower than in tablets. Conversely, some NGOs argue that these programmes are often the only means of providing a sustainable supply of anti-malarial medicine in remote areas, which have little or no healthcare infrastructure. Furthermore, they argue that the herbal medicine contains several anti-malarial compounds as well as artemisinin, which act synergistically and may prevent the development of resistance.
Since 1998 the NGO Action for Natural Medicine has distributed 1,200 A. annua “starter-kits” (containing seeds and instructions for their use) to partners in 75 countries. In addition, Anamed key workers have run over 100 week-long training seminars on natural medicine in 20 different countries, mostly in Africa. Local people trained by Anamed continue to run week-long training seminars themselves. These seminars devote a lot of attention to the cultivation and use of A. annua and the full details are available in Anamed publications. The preparation recommended is an infusion of 5 g of dried A. annua leaf powder in 1 litre of water, to be taken as 250 ml four times a day (for adults).
The aim of this study was to evaluate some Anamed projects promoting the cultivation and local use of A. annua for the treatment of malaria in East Africa. In particular, the focus was to examine the feasibility of setting up a pharmacovigilance system for potential adverse effects, including in pregnant women.