Natural Treatments for Malaria

Artemesia and Micronutrient Therapy in the Treatment of Malaria
Malaria affects more than 2400 million people which is the equivalent of more than 40% of the world's population. Each year, more than 2 million die from the disease, with one malarial death every 12 seconds somewhere in the world. Most of the malarial-related fatalities involve African children — somewhere in Africa, one child dies of malaria every 20 seconds.

Although this disease was nearly eradicated from most parts of the world by the early 60’s, we are now seeing a resurgence of the disease, with the World Health Organization forecasting a 16% growth in malaria cases annually. While the source of the disease remains the same — the bite of the parasite-infected female anopheles mosquito (some 60 species of this mosquito have been identified as vectors for malaria) — the emerging resistance to the best antimalarial drugs has also contributed to the resurgence. This has led to a greater interest in finding natural alternatives to conventional medicines to treat malaria.

Artemesia annua
One natural source for an antimalarial drug are the leaves of various species of Artemesia from which artemisinin can be extracted and used in its unprocessed state. Artemisinin has been used effectively to treat malaria for centuries in Chinese and other traditional settings and, given the enormous burden of disease in Africa and other poor locations, should be encouraged as a treatment option.

While clinical trials have demonstrated potential benefits of semi synthetic Artemesia derivatives in the treatment of malaria1-3, until recently there was only limited data on the clinical effects and safety of tea preparations from the dried leaves of Artemesia. Since 1997, ANAMED4 has been investigating whether leaves from a hybrid of the plant, (Artemisia annua anamed)5 cultivated in Central Africa can be used in the local treatment of malaria. ANAMED has compiled clinical data from three medical centers using the medicinal plant.

Following are summaries of the research reports provided by Dr Hans-Martin Hirt from ANAMED regarding the clinical data compiled from three of their medical centers: "Nebobongo," "Lwiro/Bukavu," and "Kinshasa." The preparation of this herbal medicine involves the use of one liter of boiling water poured onto 5 grams of dried leaves of Artemisia annua anamed. The preparation is then brewed for 10 to 15 minutes, and poured through a sieve. The medicinal tea is then drunk in four portions in the course of the day. The period of treatment is between 5 and 7 days.

Nebobongo
Nebobongo is in an area where malaria is completely endemic. The patients in this trial were all over 18 years old and had only ever lived in areas where malaria is endemic.

Forty-eight patients were admitted to the hospital with the classical symptoms of malaria, and found to have malaria parasites (all P. falciparum) in their blood. After five days of treatment, 44 (92%) of the patients had had blood free of parasites. Thirty-seven patients said they were totally without symptoms, while 11 patients complained of some discomfort (three of them had headaches, one had fever, four experienced pains in the joints and one, giddiness).

The patients showed no significant side-effects: although 11 (25%) reported feelings of sickness, no patient actually vomited. In this investigation, no measure of the density of parasites in the blood was made, although no patient had a relapse after treatment.

Lwiro/Bukavu
Lwiro is about 60 km north of Bukavu, in the north-east of the D.R. Congo. These patients had all almost exclusively lived in areas where malaria is endemic, so they had a significant immunity to malaria. Five of the patients were under 18 years old (17 months, 19 months, and 10, 11, and 17 years).

A total of 91 patients were treated with artemisia tea for five days between February 1998 and August 1999. Each patient had come to the health centre with symptoms typical of malaria, and all were shown to have plasmodium in their thick blood smears (59 patients had P. falciparum; 15, P. malariae; 15, both P. falciparum and P. malariae and two, both P. falciparum and P. vivax).

Following treatment, 86 of the 91 patients (95%) showed no evidence of parasites in the blood. Thirty-one of the 91 patients said that they had no new complaints. The thick blood smears were negative following treatment for each of the five children. Complaints during treatment ranged from giddiness (21 patients), feelings of sickness (11), noises in the ears (10), eye problems (8), itchiness (2) and stomachache (2).

For 24 patients, the parasite concentration in thick blood smears was determined before treatment and on every second day up to the eighth day following the first treatment. Before treatment, between 4 and 175 parasites were counted in the field of view. The number decreased markedly in the first two days, and a zero count was found between the fourth and sixth days. On the fourth day, parasites were still to be found in the blood of 14 patients, on the sixth day of four patients, and on the eighth day all patients were free of parasites in their blood (one patient showed no clinical improvement by the fifth day of treatment and was transferred to the hospital).

The progress of 31 patients was regularly checked following treatment. When discharged, tests showed that none of them had any parasites in their blood. Within the first month, four patients (13%) were once again positive; in the second month, two patients (6%); in the third month, six patients (19%) and in the fourth month after treatment, seven patients (23%). In this area where malaria is endemic, 50% of the patients had a measurable parasitaemia after 4 months.

Kinshasa
Twenty-one patients were treated with artemisia tea for seven days in a Red Cross Health Centre in Kinshasa. All patients presented with symptoms typical of malaria, and each produced a positive think blood smear. Records of parasite concentrations were available for 13 patients; for whom the number of trophozoites in the field of view was between two and 10. All the patients were over 18 years old.

During treatment, two patients complained of stomachache, one of colic and one of giddiness. One patient had a fever until the third day of treatment and another until the last day. One patient had already been treated intravenously with quinine, and one patient, who showed advanced symptoms of AIDS, died two days after treatment. With regard to the immunity of the patients, researchers note that in the inner-city area of Kinshasa, malaria does not appear to be endemic. Hence only some of the patients in this group may have been semi-immune.

After seven days of treatment with artemisia tea, the blood smears of 19 (91%) of the 21 closely monitored patients were negative. The smears of two patients still contained a few trophozoites. Of the 21 patients, 20 showed a good clinical recovery.

Table 1 offers a summary of the results of the ANAMED clinical study.

Table 1. Summary of the use of Artemisia tea in treating malaria

	Nebobongo	Bukavu/Lwiro	Kinshasa	Total
n =	48	91	21	160
Th.Bl. neg. post-tr.	44 (92%)	86 (95%)	19 (91%)	149 (93%)
Complaints	11 (25%)	58 (64%)	6 (29%)	75 (47%)
Nau + Vom	11	11	-	22
Giddiness	-	21	1	22
Abd.	-	2	3	5
Eye + Ear	-	18	-	18
n = number of patients. Th.Bl. neg. post-tr = the number of patients for whom, after treatment, no parasites were found in the blood. Complaints = the total number of patients who appeared to suffer side-effects from the treatment. Nau+Vom = nausea and vomiting. Abd. = stomachache. Eye + Ear = problems with seeing or hearing.

This data provided by ANAMED points to a 90% recovery rate with minimal clinical side effects noted. However, there are questions to be answered. For example, there is widespread use of chloroquine or quinine (an antimalarial) in Africa, as it can be purchased in some regions without a prescription and elsewhere it can be extracted at home from the cinchona tree. This study did not control for its concurrent use with the Artemesia preparation. Also, as noted by Dr. Hirt, there is a recrudescence rate of up to 50% with all the semi-synthetic artemisinin derivatives (Artemether, Arteether and Artesunate).6 What this means is that there is a small amount of plasmodium that can survive treatment but are undetectable via the microscope. They can then multiply again to the point of causing reinfection.

Because of the short half-life of artemisinin, a recrudescence within the first four weeks after treatment can be expected. However, in an area in which malaria is highly endemic it becomes difficult to differentiate between a recrudescence and a new infection.

Altogether, the results from each of the three centers demonstrate a very pronounced effectiveness of artemesia tea. In areas in which there is absolutely no possibility of obtaining plentiful supplies of antimalarial drugs, this treatment would have great potential if artemesia could be cultivated locally.

Micronutrient Treatment
Micronutrient deficiencies that hamper protective immunity are common among individuals at risk of morbidity due to Plasmodium Falciparum malaria. Vitamin A, a nutrient that is essential for normal immune function, has been studied for its effects on malaria morbidity.

Researchers at Johns Hopkins School of Hygiene and Public Health conducted a randomized double-blind placebo-controlled trial7 in an endemic area of Papua New Guinea involving 520 children aged 6-60 months. Every three months for 13 months, the children were randomly assigned to high dose vitamin A or placebo, with weekly assessments taking place to monitor progress.

The children aged 12-36 months who took the vitamin A supplement demonstrated 35% fewer febrile episodes (p=0.0023), 26% fewer enlarged spleens (p=0.0045) and a 68% lower parasite density (p=0.0054) as compared to the placebo group.

Research is also pointing to the benefits of combining vitamin A therapy with Artemesia extracts in an effort to eradicate multidrug-resistant strains of P. falciparum.8 Vitamin A appears to be a promising partner for the antimalarial therapy with artemisinins.

Research completed at Johns Hopkins University School of Medicine also suggests that other micronutrients such as vitamin E and zinc, together with vitamin A, may improve the morbidity of malaria through immune modulation and alteration of oxidative stress.9

Discussion
It is clear that more clinical research must be done on cost-effective and safe natural options for the treatment and prevention of malaria. The research done thus far on the use of artemesia is promising, particularly in light of the fact that this herbal medicine can be cultivated locally in African villages where malaria is widespread.

It is very important to keep in mind, however, that widespread use of the herb may also invite careless use which can lead to the development of resistances. Drug resistance, as great a problem with this disease as with any other infection, requires scrupulous attention to resistance patterns, drug regimens and treatment compliance. Incomplete eradication of parasites allows the more resistant organisms to survive and propagate. On the other hand, the herbal tea is quite bitter, and cultivation is not easy, making resistance due to improper use of this herb unlikely.

The addition of micronutrients such as vitamin A and possibly vitamins E and zinc, offer promising partners for Artemisia with their synergistic actions, providing further benefit and hope for the eradication of this killer.