Malaria takes a terrible toll on Timor-Leste's population. Mortality rates for children under 5 are estimated at about 12.5%, and government statistics show that up to 30% of childhood deaths could be attributed to malaria. Pregnant women with reduced resistance to disease are also at greatly increased risk, contributing to one of the highest maternal mortality ratios in the world. Antimalarial drugs can be costly, and in many places the malaria organism has developed a resistance to standard treatments. In support of the Ministry of Health's national malaria strategy, USAID is funding a pilot project to test the suitability and effectiveness of growing a special hybrid of Artemisia annua, which could prove to be a key element in a new first-line treatment protocol for malaria (see http://www.usaid.gov/press/frontlines/fl_jan05/fl_jan05.pdf).

The project test plot is located up in the hills behind the capital, Dili, where the Xanana Gusmao Foundation (XGF) is working with anamed (Action for Natural Medicine), an international NGO that specializes in introducing medicinal plants in tropical countries. Anamed had developed a hybrid of Aretimisia specifically for tropical climates. The project has two phases: the cultivation of 500 hybrid Artemisia plants to harvest and dry, and the extraction and testing of the primary antimalarial component, artemisinin, to see if the plants produce sufficient quantities of this active drug alkaloid.

Artemisia annua (also called wormwood) is native to subtemperate parts of Asia and is now cultivated around the globe. In China it is known as qing hao and has been used for centuries to treat fevers. Its specific antimalarial properties have been known for at least 35 years. The World Health Organization currently recommends the extract artemisinin, qing hao su in Chinese, as a part of a first-line treatment regimen that combines it with a variety of other antimalarial drugs in Arteminisinin Combination Therapy (ACT). According to USAID/Timor-Leste's Senior Program Manager, ACT not only reduces fever quickly, but also eliminates malaria parasites from the patient's blood, thus reducing transmission back to the mosquito vector. By curing the disease quickly and effectively, ACT significantly reduces the likelihood of the dangerous and costly possibility that malaria will develop resistance to the new treatment.

Currently there is a worldwide shortage of artemisinin because of the huge demand for ACT, particularly in Africa. If trials show that Artemisia annua can flourish in Timor-Leste, the potential for local farmers to help fill the gap in an emerging market offers significant economic opportunity.

Through its grant of $17,100 to XGF, USAID/Timor-Leste will help scientists determine if the special tropical hybrid of Artemisia can grow well in Timor-Leste's climate and produce adequate quantities of artemisinin. With positive results, Artemisia annua could join the other tools, such as insecticide-treated mosquito nets, that the Ministry of Health uses to reduce the impact of malaria outbreaks in Timor-Leste.