Artemisia Annua to fight malaria in Africa by Iday-International

IDAY

Newsletter Spring 2016

Artemisia annua

Health and education in Africa

Raising voices for education in Africa

Features

- News from the IDAY network - Health and education in Africa - Interview with Prof. Pamela Weathers - School gardens for Nyarugusu Refugee Camp

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Index 2 - The Chairman’s view 3 - News from IDAY network 4-5 - Artemisia annua 6 -7 - Interview with Prof. Pamela Weathers 8 - Project: School gardens for Nyarugusu Refugee Camp

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About IDAY IDAY-International is an advocacy network of African civil associations working in the field of education. IDAY-International fights for the right of every young African to get full access to quality education by encouraging a positive and sustainable dialogue between African civil society and their governments.

IDAY-International 19, rue des Jambes - 1420 Braine-l’Alleud - Belgium Responsible Publisher : J-J. Schul Editor in chief / Graphic designer : L. Fourmentin Phone : +32 (0)2 385 44 12 - lfourmentin@iday.org Bank account: IBAN - BE 93 5230 8026 6767 BIC - TRIOBEBB (TRIODOS)

IDAY p. 2 / Spring 2016

IDAY Chairman’s view Dear friends and partners,

One is entitled to wonder when Europe is mourning its victims of new horrid deadly terrorist attacks it is appropriate to discuss malaria in Africa. IDAY, however, which is expressing its deepest sympathy for the victims of these attacks reminds the readers of this Newsletter that today, Africa is still mourning several hundred thousands deaths each year including1 000 children each day due to malaria.

As the articles in this Newsletter show, malaria could be stopped in Africa. If IDAY has become aware of the close relationship between stopping malaria in schools and education quality in Africa it is due to the support given by a number of prominent scientists. First and foremost, Dr. Pierre Lutgen from the Luxemburger NGO Iwerliewen, who helped IDAY become aware of the potential of Artemisia annua and remains the central pillar between scientists and practitioners, Dr Tobias Arudo who succeeded the large scale breakthrough with the first Kenyan School Garden Project, Dr Lucile Cornet-Vernet of More for Less in France who helped organise a training session on Artemisia annua in Ouagadougou, Professor Guy Mergeai of the Agricultural Faculty of the University of Liège, who tests African cultivars of Artemisia annua, Dr Patrick Ogwang, Researcher at the University of Makerere in Uganda, Dr Ahmed Hassanali, who fights to launch clinical test meeting the World Health Organisation’s norto verify the field evidence regarding the effectiveness of Artemisia annua, and Bernabe Ollo Kambou who seeks to organise an African colloquium on the subject. But most specially, I thank here the prominent researchers Professor Pamela Weathers of Worchester Polytechnical Institute in Massachussets (USA) and Rosine Désirée Nkuitchou Chougouo Kengne of the University “ des Montagnes ” in Cameroon for their support to IDAY and for their contributions to this Newsletter. Sooner or later, rational and logic will prevail in the fight to liberate Africa from this plague and IDAY is proud to be part of this combat.

I dedicate this Newsletter to all the IDAY members who in Burundi, Uganda, Kenya, Tanzania, DRC, Cameroun, Gabon, Togo, Benin, Burkina-Faso and Senegal are participating in this challenge.

Jean-Jacques Schul Chairman of IDAY-International www.iday.org

News / IDAY-International

Coordination visit in Kenya and Tanzania As part of the regional campaign on domestic workers, the IDAY Coordinator met with IDAY-Kenya members and partner organisations PALM and CEFA. The mission ended with the visit of KHAI, an IDAY-Kenya member association working on education and social integration for intellectually handicapped young adults. In Tanzania, the Coordinator met the coalition’s National Coordination team and the coordinators of 7 provinces. During a one day meeting in Dar Es Salaam, the coordinators of Zanzibar, Dar Es Salaam, Kigoma, Mwanza, Dodoma, Morogoro and Bagamoyo regions were able to exchange information about their structure and the challenges they face. They examined a joint project for promoting Tanzanian students’ right to education at a national level. At a similar meeting in Zanzibar, the Pemba Island and Zanzibar coordination teams reviewed the conclusions from the Dar Es Salaam session and drew up the outline of a strategic programme that will be implemented in IDAY-Tanzania’s nine areas of intervention.

Awareness action in Kivu IDAY-Kivu/DRC is participating in the regional project to fight against violence towards children and young domestic workers. On 10 March 2016, the project team organised a festive event in Uvira , South Kivu, DRC, to raise awareness among the population and advocate to the local authorities. The event brought together people from various backgrounds, in particular the Mayor of Uvira, the Head of Social Affairs, the Head of Planning Services, the Head of the Art and Culture Department, the Head of Youth Services, district leaders as well as many domestic workers. After the several speeches, a band entertained the participants with a song written specially to raise awareness of domestic workers’ rights. A theater play then highlighted the violence that domestic workers are subjected to, and a young woman spoke about her journey as a domestic worker.

Regional report and video on domestic workers As part of the Domestic Worker Project awareness campaign, the regional survey report and a video are available on the website : http://invisibleworkers.eu/fr

IDAY-Mauritania

The Mauritanian Network for Education for All (RMEPT), an IDAY member, is not being outdone at the moment. After being visited by a World Bank representative in February 2016, the coalition was received by the United Nations Secretary General, Mr Ban Ki-moon, at the beginning of March. RMEPT was one of the 16 organisations selected to represent civil society at the meeting. In this meeting, Mr Ban Ki-moon reminded the audience of the essential role of civil society, which he described as a “ king without a crown ” and a key development player.

IDAY offices on the move

Two IDAY offices recently changed address. You will now find the IDAY-Kivu/DRC coordination team at Office I, Avenue Nyiragongo number 12, Murara district, commune of Karisimbi, Goma. In Kenya, the team was invited to move into PALM’s offices, situated at General Mathenge, Westland, P.O. Box 1498-00606 Sarit, Nairobi.

New fundraising intern Martina Giuffrida has been helping the IDAY team in Belgium since January 2016. As an intern with a solid university education and multilingual skills, she is dedicating 6 months to supporting the network’s fundraising activities.

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IDAY p. 3 / Spring 2016

Artemisia Annua against MALARIA Can a medical plant rid Africa of malaria ?

Why is IDAY - an education advocacy network - involved in health?

American anthropologist Jared Diamond observed that underdevelopment primarily plagues countries located around the equator where tropical diseases prevail. He therefore hypothesised that tropical diseases have a more depressing effect on these countries’ economy than the commonly accused poor governance. IDAY-Kenya succeeded in almost eliminating absenteeism in some Kenyan schools by controlling malaria, resulting in a spectacular rise in academic performance. Similarly, research conducted by J-PAL - the Poverty Alleviation Laboratory emanating from the Massachussets Institute of Technology (MIT) - established that deworming was the second most efficient way to extend the number of years that Kenyan children spend at school. Following a conference at the European Parliament on 16 June 2011, IDAY concluded that one could no longer talk of education quality in Sub-Saharan Africa without tackling the health aspects.

Why are the classic means against malaria inadequate?

The classic means – bed nets for prevention and the Artemisia Combination Therapy (ACT) pills to cure crises – used against malaria, one of the main debilitating diseases in Africa, are subject to resistance, often induce unpleasant side effects and are too costly for most people. The World Health Organisation (WHO) estimates that eliminating malaria in the world through those means would cost about USD 7 billion per year while the international community disposes of at best USD 2,7 billion. The actual results obtained with these methods have also been questioned. Hence this approach is not sustainable. As a promoter of low-cost investments, IDAY sought an alternative approach to “ kick malaria out of Africa ” as requested by several Kenyan youth. Artemisia annua meets this condition.

What is Artemisia annua?

Artemisia annua is a herb used effectively in China for over 2 000 years against various infectious diseases including malaria. It gained world recognition after it saved the Vietcong against malaria. As shown in the articles by Prof. Pamela Weathers and Dr. Rosine Chougouo Kengne, the plant offers a genuine polytherapy less sensitive to resistance than the medications.

IDAY p. 4 / Spring 2016

What are the components of IDAY’s program IDAY’s school gardens

Following IDAY-Kenya’s successful experience with an Artemisia annua cultivar found at the University of Kenyatta that proved well adapted to African ecological conditions, other IDAY members took up the idea, at times combining Artemisia annua with highly nutritious crops to simultaneously tackle malnourishment. IDAY is currently promoting 14 school garden projects in 8 IDAY member countries. These projects shall benefit some 140 000 children and teachers at a combined cost of € 700 000 (USD 770 000), for which IDAY is seeking additional outside financing of 400 000 € (440 000 USD). The projects include advocacy campaigns to convince governments to scale up these pilot initiatives throughout their countries. These school gardens give a new appeal to the participating schools, as they further contribute to community development. It enhances the motivation of parents to school their children as they can learn useful practices for their daily life.

Clinical trials

Most research so far has been conducted in vitro without trials on humans at a scale and under the standards considered adequate by WHO to justify its approval of Artemisia annua as an anti-malaria treatment. The Kenyatta University and IDAY are proposing to test the use of natural extracts of Artemisia annua against malaria under a protocol meeting WHO’s requirements. The research would be conducted together with American and European universities. The 3-year trials would cost USD 2 million, of which 10% paid for by Kenyatta University. The purpose of this research is to convince WHO to include the use of natural extracs of Artemisia annua in its strategy to tackle malaria in Africa.

Colloquium

Strangely enough, although Africa is where malaria is affecting and killing most people (1000 children per day ; 100 000 pregnant women per year), colloquia on the use of Artemisia annua against the disease are rarely held in Africa, or only on a very small scale. IDAY wishes to organise a high-level colloquium with the participation of researchers and practitioners, doctors, agricultural engineers and representatives of WHO, to examine the way forward. Such a colloquium would cost € 60 000 (USD 66 000).

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Youth exchanges

Artemisia annua is a demanding crop in terms of light, water and pest control. Most growers fail their fist plantations. Aware of these challenges, Kenyan students who have mastered the cultivation techniques of the plant are willing to travel for 4-6 months to teach the cultivation techniques to youngsters of other IDAY coalitions.

Opinion / IDAY The exchange costs are usually included in the costs of the school garden projecs.

Through the implementation of these various program components, IDAY hopes to contribute to the eradication of malaria in Africa and to the significant improvement of education quality on the continent.

Sharing knowledge on Artemisia annua in Ouagadougou 7-9 November 2015 by David Amouzou, president of IDAY Togo

This international meeting more thank ever rekindled my interest in the culture and the promotion of Artemisia annua. I got 1.5kg of powder out of my last Artemisia annua crop, and more than 100 people received successful tea and Artemisia annua powder-based malaria treatmen. Currently over 20 very successful nursery are being potted. More than 5 000 plants are ready for planting, and 2 ha are available to layout the culture of Artemisia annua. The only missing element is a well for permanent irrigation of the plants. At the moment, an IDAY-Togo initiated program for the promotion of Artemisia annua in schools is seeking financial support so that it can be launched in the three northern regions of Togo.

Project for education-integrated health : Artemisia annua cultivated in school gardens in Bangangte (Western Cameroon) As a follow-up to my first research at the Université des Montagnes, current investigations headed by Dr. Kouamouo are studying the characteristics of Artemisia annua, its active components, its pharmaceutical effects, its preventive properties as well as the cultivation techniques and its use. The latter are based on the experimental cultivation of the plant by Cameroon farmers, in the arboretum of the University and in 7 schools of the Nde Department. On the ground, a project is currently being carried out by APESE, a multidisciplinary association for the promotion of health supported by the city of Bangangte and which just joined the IDAY-Cameroon coalition. The Departement of Nde is malaria-prone, a plague often fatal to the small children. Its crises cause frequent school absenteeism. IDAY supports the young Africans’ initiatives in particular through projects consisting in the growing of Artemisia annua in school gardens. The Cameroonian coalition adheres to this endeavour ! It foresees the progressive scale up of the experience to other areas. Artemisia annua is considered an ITM (Improved Traditional Medication) validated by the government. From 4 years of experience in cultivating the plant in school gardens, the following lessons have been learned : teachers are key to teaching the children; farmers and women groups must be receive proper training (workshops); a computer laboratory is needed to allow teachers to record, coordinate and own the project. Such projects imply several things: buying the cuttings, teaching the cultivation techniques to the pupils, watering regularly the plant in the dry season (in some schools that lacked water supply, the teachers invited the children to bring water-full container each day), buying the production equipment, drying

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the large qualtities of harvest (the plant reached 3 meter high) ; and conditioning, which proved difficult without machine. Some students from the Université des Montagnes have tried several conditioning options to address this issue. Once these conditions are met, the encouraging results achieved with Artemisia annua in Cameroon show that it is equally effective as the Chinese plant, as repellent around the houses and as treatment of the disease. It also gives teachers the opportunity to give practical classes in the schools1. One should also consider rewarding those who obtain the best results, and carrying out an epidemiological evaluation, possibly by university students. Artemisia annua represents a concrete contribution to the use of ITMs, lowers school absenteeism and achieves the objectives of the World Health Organisation (WHO) regarding child mortality. This approach alkows the local populations to initiate community health. It mobilises local professionals who become health agents, the children who learn the agricultural requirements of a plant and its impact on their health ; their relatives, to whom they communicate their new knowledge. APESE will seek to experiment the above dispositions in all Bangangte schools and scientifically evaluate each of the steps in the process over 3 years. The ultimate goal is to achieve the financial self-sufficiency of the production and distribution of Artemisia annua as ITM to the whole population throughout the year. By Dr. Rosine Désirée Nkuitchou Chougouo Kengne PharmD, Teacher/Researcher at the Faculty of Health Sciences of the Université des Montagnes in Cameroon. 1

Note by IDAY: this confirms the conclusions of the school garden pilot project conducted by IDAY-Uganda.

IDAY p. 5 / Spring 2016

Interview with Prof. Pamela Weathers1 A member of the Honorary Committee of IDAY , Prof. Pamela Weathers worked for many years on the features of Artemisia annua . We asked her about her research and the benefits of this ancient plant :

What do you consider to be the main findings of your research on the effectiveness of Artemisia annua against malaria ? In a first study, we observed that the dried leaves of Artemisia annua (WP) made artemisinin (ART) - the antimalarial drug isolated from the plant - much more bioavailable than ART orally consumed pure [1]3 . We were not expecting that result and it then led to other studies conducted by Mostafa Elfawal, then at the Rich lab at University of Massachusetts, Amherst, using parasite-infected mice. In those studies we observed that WP was more potent against the parasite than the pure ART : WP delivered much more ART within the animal’s serum [2]. These results were consistent with our first study. The WP also showed very different pharmacokinetics compared to pure ART, persisting longer, which was important. Next we tried to induce an ART-resistant parasite and challenged mice infected with that resistant parasite. WP showed a threefold greater resiliency against development of drug resistance compared to pure ART [4]. In other words at the same concentration of ART, WP took 3 times longer to generate resistance than pure ART ! These exciting results have led us to further study how WP-delivered ART becomes more bioavailable and in our current work funded by National Institute Health (NIH) using simulated digestions in test tubes, we have found that ART from WP becomes more solubilized in the presence of essential oils (EOs) (Desrosiers and Weathers, as yet unpublished). Furthermore, using the Caco2 intestinal cell model, WP accelerates the transportation of digested ART 50% faster than pure digested ART, unless EOs are also added to the pure ART. Thus, we now know that the EOs in the plant are critical for the enhanced bioavailability that we observed in our earliest mouse studies. Lastly, we showed that Artemisia annua can be consistently grown and prepared if the plant is clonally propagated from cuttings, and now we also know how ART and other phytochemicals in WP are altered when the dried leaves are processed and compressed into tablets [5]. This is important to quell worries that ART dosage may be inconsistent with the potential variability that can exist in different plant cultivars and field harvests.

What do you see as the key advantages and drawbacks of Artemisia annua as compared with the classic means of combatting malaria ? Advantages : Using the Artemisia annua plant is a simple and highly cost effective therapeutic with an estimated cost per treatment well below the World Health Organisation (WHO) threshold of USD 0.50 [6]. It can treat ART resistant malaria and minimizes emergence of artemisinin - resistant malaria [4]. From literature comparisons, WP works much better than ART monotherapy and at least as well as Artemisinin Combination Therapy (ACT)4 [Weathers et al. 2016, to be published]. A number of other neglected tropical diseases, e.g. leishmaniasis and schistosomiasis, are also susceptible to WP treatment [manuscripts in preparation from other labs] and thus could benefit from oral consumption of WP or treatment by natural extracts of the plant. Compared to ACTs, WP also has no measurable side effects. It can be delivered either orally or rectally [per unpublished reports for treated neonates in Mali]. Drawbacks : First and foremost is still the apparent unwillingness of WHO and the medical establishment to consider WP as a possible alternative therapy to pure ACTs, and this despite the growing body of evidence that shows efficacy and resilience against drug resistance . There are now several US FDA approved botanicals [7], Veregen® for treatment of warts, and Fulyzaq® for treating HIV diarrhea, so in the US there is now precedent and a regulatory structure to insure quality and efficacy of such complex plant material therapeutics. Another drawback would be the potential for counterfeit, however, this happens no matter what, so it is no different than the current problems with ACTS. Finally I worry about the use of low quality Artemisias. We still do not know what other phytochemicals in the plant are involved in both the enhanced bioavailability, efficacy and resilience against emerge of drug resistance5. Nevertheless, the lack of all that knowledge, which could take a decade to discover, does not preclude use of a well-defined herbal drug as we have shown could be used. The herb is safe, well-tolerated, been in common use for millennia and efficacious. People are dying because it has not been broadly implemented.

WP = Whole Plant of Artemisia annua, a natural treatment and composed of the dried leaves ART & ACT = artemisinin pharmaceutical extracts, a component of the plant. It is important to distinguish “ Artemisia ”, the plant from “ artemisinin ” a chemical component of the plant2.

IDAY p. 6 / Spring 2016

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Interview / Pamela Weathers Pamela J. Weathers, Ph.D. is a Professor in the Biology and Biotechnology Department at Worcester Polytechnic Institute with a joint appointment in Biomedical Engineering She has over 50 years experience working on plants, roots, algae, and bioreactor development. She is an internationally recognized expert on Artemisia annua and artemisinin, having worked with the plant and its phytochemicals including the antimalarial drug, artemisinin, for over 25 years

What are for you the main steps still needed to ensure a wider support for the use of Artemisia annua to combat infectious diseases in Africa? We need to see high quality clinical trials, first for malaria, with results published and disseminated in high quality peerreviewed journals. Once peer-reviewed, the results are then irrefutable and it will be much easier to obtain the investment needed to take the drug into production for delivery to patients. Treatment of other ART-susceptible diseases would then become possible.

What made you become interested in the plant and give IDAY your support? I began working with the plant in the early 1990s to satisfy the interest of an undergraduate student project. I really knew nothing about the species having mainly worked with algae. Over the years I became more intrigued with the moral issues surrounding treatment of especially impoverished people. That concern eventually led to our experiments to see if ART could readily pass via oral consumption of WP into the bloodstream of mice. We were totally surprised by the results and the project ballooned into our current efforts. Now my goal is several fold : • Provide a sound scientific explanation for the highly beneficial results of our seemingly simple therapeutic delivery method of WP. • Bridget the gap between more traditional ethno medicine and so-called modern/Western medicine. • Speed the translation of this simple therapeutic treatment and use of WP by patients I became aware of IDAY because the coincidence of the findings of the 2005 ICIPE report [8] and IDAY’s evaluation report of 2014 [9] showing the efficacy of the WP method in human malaria patients. Basically we were “ inventing ” the same technology, but on different continents ! This was a convergence of ideas… geographic evolution of an identical idea, but originating simultaneously on two distant continents. Working together makes so much more sense. Indeed many more studies are emerging or have been published showing similar efficacy in humans, e.g. [9] [10].

Do you support IDAY’s recommendations to hold a colloquium in Africa with researchers, doctors, growers, politicians and WHO representatives to thrash out the outstanding issues related to the use of natural extracts of Artemisia annua against malaria in Africa? That is a reasonable approach, but only if the governing regulatory bodies (WHO etc.) also participate. Otherwise, we just keep talking to ourselves. It is quite unconscionable that this well studied plant and other efficacious medical plants are not taken more seriously by WHO and Western medicine. The science says this works… : what is the problem ? Plant Biologist Pamela Weathers was honored in February 2015 as a Fellow of the American Association for the Advancement of Sciences, the world’s largest general scientific society, for her contributions to plant biology and her research on a plant-based antimalarial treatments.

Artemisinin, was identified in 1972 as an anti-malaria component of Artemisia annua by Dr. Tu Youyou who received the Nobel Price of Medicine in 2015.

Figures in brackets refer to the bibliography supplied by Professor Weathers.

The standard medication recommended by WHO and distributed widely with financial support of several large US foundations at considerable cost.

5 Note by IDAY : it is noteworthy that the two European countries hosting the main pharmaceutical companies producing ACTs – France and Belgium – forbid the sale of Artemisia annua, while it can be found in nature shops and pharmacies in particular in Germany and Austria.

Bibliography 1. Weathers PJ, Arsenault PR, Covello PS et al. Artemisinin production in Artemisia annua : studies in planta and results of a novel delivery method for treating malaria and other neglected diseases. Phytochemistry Reviews 2011 ; 10 : 173-183 2. Elfawal MA, Towler MJ, Reich NG et al. Dried whole plant Artemisia annua as an antimalarial therapy. PLoS ONE 2012 ; 7 : e52746 3. Weathers PJ, Elfawal MA, Towler MJ et al. Pharmacokinetics of artemisinin delivered by oral consumption of Artemisia annua dried leaves in healthy vs. Plasmodium chabaudi-infected mice. Journal of Ethnopharmacology 2014 ; 153 : 732-736 4. Elfawal MA, Towler MJ, Reich NG et al. Dried whole-plant Artemisia annua slows evolution of malaria drug resistance and overcomes resistance to artemisinin. Proceedings of the National Academy of Sciences 2015 ; 112 : 821-826 5. Weathers PJ, Towler MJ. Changes in key constituents of clonally propagated Artemisia annua L. during preparation of compressed leaf tablets for possible therapeutic use. Industrial Crops and Products 2014 ; 62 : 173-178 6. Weathers PJ, Towler M, Hassanali A et al. Dried-leaf Artemisia annua : A practical malaria therapeutic for developing countries ? World Journal of Pharmacology 2014 ; 3 : 39-55 7. David B, Wolfender J-L, Dias DA. The pharmaceutical industry and natural products : historical status and new trends. Phytochemistry Reviews 2015 ; 14 : 299-315 8. ICIPE. Whole-leaf Artemisia annua-based antimalarial drug: report on proof-ofconcepts studies. In, Nairobi, Kenya. Nairobi, Kenya ; 2005 9. Kenya - Artemisia annua School Garden Project. Evaluation Report by an Independent Team of Researchers. IDAY - January 13-26 2014 10. Onimus M, Carteron S, Lutgen P. The surprising efficiency of Artemisia annua powder capsules. Medicin Aromat Plants 2013 ; 2 : 2167-0412 Added by IDAY : See also the numerous publications on the subject in particular by Pierre Lugen in “ Malaria World ”.

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IDAY p. 7 / Spring 2016

Gardens for the SCHOOLS OF THE Nyarugusu refugee camp The Nyarugusu refugee camp in the north of Tanzania on the Burundi border hosts about 170,000 people coming mainly from the DRC and Burundi. Due to dilapidated sanitary conditions, malaria is rampant in the camp. It has a significant impact on the education of the children and youth. In fact, the disease is a major cause of school absenteeism for children as well as teachers, and greatly hinders the children’s’ ability to learn. Treatment costs also burden the whole community heavily. Inspired by the school gardens implemented by IDAY member organisations in several African countries, IDAY-Tanzania members in the Nyarugusu camp have undertaken since 2015 to tackle this problem in order to improve access to school and the learning conditions for the children living in the camp. Their goal? Eradicating malaria and improving nutrition for the 60 000 primary and secondary school pupils in the camp. Through the creation of school gardens and school canteens, they propose a sustainable, lower cost approach that mobilises the students and the community.

The gardens, which will be maintained by youth clubs, will include highly nutritious plants as well as Artemisia annua for the prevention and treatment of malaria. An awareness campaign will be carried out on the use of Artemisia annua against malaria and to encourage its cultivation by the families themselves. The project also includes the installation of closed furnaces to reduce wood consumption (-50%) in the canteens, thus reducing costs for families. Cultivation of Artemisia annua already started in the Nyarugusu refugee camp, but it was made difficult by bad weather and the doubling of the camp population in 2015. The project will thus allow IDAY-Nyarugusu / Tanzania to relaunch the initiative and, with appropriate resources (€55 855 sought over 3 years) and the support of camp authorities, ensure its sustainability in the long run. The project also falls within the the IDAY-Tanzania coalition’s campaign to promote school gardens and Artemisia annua nationally. Exchanges with IDAY coalitions involved in the cultivation and use of Artemisia annua in other African countries are also foreseen with the aim of mutual reinforcement and to nurture a real ownership of the approach.

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