BRAZZAVILLE, 14 January 2009 (IRIN) - As poor people in Congo shun costly malaria remedies, deaths are being caused by erroneous self-medication and poor diagnosis by unauthorised medical practitioners.

"As in many other professions there are people working in the health system who aren't properly qualified; this is hindering the anti-malaria campaign because of incorrect diagnosis," said Serge Bouka, director of the Makélékélé hospital in Brazzaville.

"It's playing with people's lives," he explained. "Under-qualified workers may be tolerable in other fields but not in the health service.

"People are brought here dying after being wrongly diagnosed, sometimes having undergone lengthy treatment in their neighbourhoods, and often it's too late to save them," he added.

Even when the diagnosis is correct, malaria sufferers run the risk of being prescribed outdated remedies by non-licensed practitioners.

Cheap and widely available chloroquine-based treatments have previously saved countless lives in Africa and elsewhere, but strains of malaria have now become resistant.

"It is now dangerous to prescribe medicine containing chloroquine, but it can still be easily bought," said Bouka.

Incorrect use of malaria drugs can also diminish symptoms in the short term but damage long-term resistance to malaria.

The national anti-malaria programme is trying to make people aware of the dangers they run by turning to non-qualified practitioners or by simply buying unsuitable medicines on the open market.

"Some patients realise [the medicine is ineffective] in time and come to the hospital for proper treatment," said François Libama, director of the national anti-malaria campaign.

While the sale of products without prescription is illegal, they are widely available from street hawkers or even sometimes approved chemists, and are often less effective, after being stored at incorrect temperatures, for example.

However, it is still the first choice for many ordinary people in Brazzaville. "I myself have taken this type of medicine and when one of my children or grandchildren gets malaria I go and get some for them straight away," said Juste Mouali.

He is far from being alone. Official figures indicate 60 percent of people in Brazzaville turn to so-called street drugs rather than the recommended remedy, which since February 2006 has been Artemisinin combination therapy (ACT).

But ACT is expensive, especially in a city where 50 percent of the population lives on less than a dollar a day.

Many street drugs are in fact counterfeit, manufactured illegally in China or India and brought to the Congo via the neighbouring Democratic Republic of Congo.

The government decided in 2007 to provide ACT to pregnant women and children under-five free of charge. But while many medical centres have indeed begun to administer these free remedies, the effects of this on public health have yet to be seen. The aim is to reduce deaths of under-fives and pregnant women by 60 percent.

Up to 21,000 under-fives die of malaria each year. Life expectancy is 54 for men and 57 for women in a population of 3.8 million.

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