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TIPS ON MALARIA

  • HOW CAN MOSQUITOES BE CONTROLLED?

    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.

  • HOW CAN I PROTECT MYSELF FROM MOSQUITO-BORN DISEASES?

    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.

  • WHO ARE AT RISK?


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.
     

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  • Volume 1

“African Scientists DARE malaria in their quest for a FINAL PANACEA”

BY CLARE B. YAKUBU- GHANA

“It is simply not possible to identify all the side effects of drugs before they are marketed. The difficulty is not a failure of the drug  development process or of the drug-approval process; it is the expected consequences of the biological diversity of humans and the fact that low-frequency adverse effects are unlikely to be detected in the few hundred or thousand patients studied in trials before a drug is approved”.  Wood A. J. J!

African Scientists are once again poised  to  lead  in a  research  to  investigate  the  effectiveness  and safety of anti malarial drugs in use in Africa. The project known as  the  In-depth Effectiveness and Safety Studies of Anti-malarial Drugs   (INESS) in Africa  is a platform  that will create  the missing  final section  (phase  iv)  of  the  drug  development process  for  Africa  and  ensure  rapid  access  to practical evidence on treatment effectiveness and safety.  Disclosing  this  in  an  interview  with AMMREN,  the  Dean  of  the  School  of  Public Health, Prof. Fred Binka said  the purpose of  the project  is  to  minimize  the  time  gap  between licensure  and  adoption  of  new  anti-malarials  by
providing objective effectiveness and safety data, under real life settings that will help inform global, regional  and  national  policy  and  practices.  The project  will  also  enhance  capacity  in  Africa  to monitor  local  health  systems  in  order  to  track costs, effective  coverage, and effects of new or al ternat ive  post-registered  ant i   malarial   treatments.

The malaria  burden  in Africa  is  so  huge  that  a combination  of  tools  and  methods  are  being employed  to  deal with  the  pandemic. Currently, malaria is one of the leading killer diseases in the world. Ninety per cent of all deaths due to malaria occur  in Africa. According  to  the newly  released WHO  Malaria  Report  2008,  “there  were  an estimated  247 million malaria  cases  among  3.3 billion  people  at  risk  in  2006  causing  nearly  a million deaths, mostly of children under 5 years. One hundred and nine countries were endemic  for malaria  in 2008, 45 within  the African  region”.
 
To  combat  the  malaria  burden  therefore,  a number  of  strategies  are  being  used  in  Africa including long-lasting insecticide treated bed nets (LLIN)  and  artemisinin-based  combination therapy  (ACT),  supported  by  indoor  residual spraying  (IRS)  and  intermittent  preventive treatment in pregnancy (IPT). One of the greatest challenges facing Africa in malaria eradication is drug  resistance  which  has  led  to  increase  in malaria  cases.  Cheaper  drugs  such  as chloroquine  and  a  host  of  others  have  been complemented  by  newer  and  more  expensive drug combinations such as the ACTs to slow the development  of  resistance. 

The ACTs  currently recommended by WHO in its treatment guidelines include  “arthemether-Lumefantrine,  a  first  ling anti-malarial  drug  for  Tanzania,  artesunate  + amodiaquine,  first  line  anti-malarial  drug  for Ghana, artesunate + mefloquine and artudnate + sufadoxine-pyreimethamine (SP). For vulnerable groups such as pregnant women and children, the SP and artemisinin based suppositories are used.

But in severe malaria, artesunate/amodiaquine or tablet  quinine  is  given  in  the  first  and  second trimesters while rectal artesunate is used for pre-referral  treatment at  the primary  level of care.

The  introduction  of  the  ACTs  in  some  African countries however has not been without problems. For example  in Ghana,  there had been reported adverse reactions with the drug policy change. It was  linked  to  the  co-formulation  of  locally manufactured AS + AQ with 200 mg artesunate and 600mg amodiaquine  in a single  tablet. This  led to  the  withdrawal  of  the  locally  manufactured product  from  the Ghanaian market.

Again recently  in Western Cambodia,  there has been  evidence  of  artemisinin-resistant  malaria where  the  malaria  parasite  is  already  showing resistance  to  the  ACTs  meaning  that  different types of ACTs will have  to be  introduced  to deal with  the problem.

Apart  from  this,  other  challenges  including geographical  and  financial  access  to  safe, efficacious  and  quality  ACTs,  poor  clinical diagnosis  and  prescriber  non-adherence  to  the treatment  policy  and  guidelines,  poor  patient compl iance  with  treatment  regimen  and inadequate  reporting  (active  and  passive)  of adverse reactions to anti-malarial drugs have led to many  resorting  to monotherapies, which  has also made the monotherapies no longer effective thereby giving  fears of another parasite resistance and    the  introduction of many more ACTs.

Dr. Aziza Mwisongo Project Manager, INESS
With  the  deployment  of  the  many  new  anti-malarial drugs into African markets, the need has arisen  for  African  scientists  to  investigate  the effectiveness and  safety of these drugs in real life settings  in order  to provide better policy options  for the array of anti-malarial drugs  currently on  the African markets.

The  African  Scientists-led  initiative,  INESS PROJECT  will monitor  the  products  throughout the  products'  life  cycle;  look  at  availability  of background levels of acceptability and availability and management of  fevers and or malaria. Four countries are  involved  in  the project  Mozambique, Burkina Faso, Tanzania and Ghana.

The project will begin  first  in Ghana and Tanzania and  later move  to Mozambique  and Burkina Faso. Three health  research  centers  in  Ghana  which  are running demographic surveillance systems under INDEPTH's  Network,  Kintampo,  Dodowa  and Navrongo, will provide  the platform  for  the studies.

The  INESS Project  is another key project under INDEPTH's  Network  apart  from  the  Malaria Clinical  Trials  Alliance  (MCTA).  The  Deputy Executive  Director,  Dr.  Ayaga  Bawah  said INDEPTH's  Network  started  with  18  sites  but today  it  can boast of 34  sites.  “We are working together to understand population dynamics. Vital statistics are unavailable in parts of our world so INDEPTH  is  helping  countries  to  understand them”, he added.

INESS  will  investigate  all  anti-malarials  in  the system to put them in proper public health system context  to  ensure  that  they  are  safe  and  used appropriately. Protocols have been developed and submitted to the Ghana Health Service for ethical review  before  the  project  takes  off  by  the  last quarter of  this  year. Malaria Medicine Ventures, the Gates Foundation among other local partners such  as  the  School  of  Public  Health  of  the University of Ghana will collaborate to ensure the implementation of  the project.
 
Prof.  Binka  was  happy  that  “African  scientists once again will contribute towards  looking at how effective we can  reduce  the burden of malaria, one of  the major burdens on  the continent”.  

This  statement  by  Wood  AJJ  et  al  (1998) emphasizes  the  need  to  monitor  the  drugs  to ensure  their  safety,  “It  is  simply  not  possible  to identify all  the side effects of drugs before  they are marketed. The difficulty is not a failure of the drug development  process  or  of  the  drug-approval process;  it  is  the  expected  consequence  of  the biological  diversity  of  humans  and  the  fact  that low-frequency adverse effects are unlikely  to be detected in the few hundred or thousand patients studied in trials before a drug is approved”. INESS indeed  is a must  for Africa.
 

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Third Edition