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    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.


    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.


    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

“SOMEONE Has To Monitor The Safety Of Drugs”


The safety of drugs continues to be of great concern in Africa. Experts say Tmost deaths on the continent can be prevented  if  some  attention  is  paid  to drugs used  in  treating various ailments.

The INDEPTH Network Effectiveness and Safety Studies of antimalarials (INESS) in Africa  is the recent study that wants to tackle  this problem.

Prof. Fred Binka of  the School of Public Health,  University  of  Ghana,  and  a leading member of the INESS team talks more about  the project.

Q: Can you please  tell us about  INESS?

A:  INESS  is  an  abbreviation  for  the INDEPTH  Network  Effectiveness  and Safety Studies of Antimalarial  in Africa. This  is  a  study  that  is  trying  to  look  at safety  of  anti-malaria  drugs  and  their effectiveness  in  real  life  situations.  For the  first  time  we  are  trying  to  collect systematically information on the safety of  anti-malaria  drugs  used  in  Ghana, Ta n z a n i a ,   B u r k i n a   F a s o   a n d  Mozambique.

Q:  Why  INESS?  People  have  been taking  drugs  over  the  years. Why  this study now?

A: Safety of drugs is something that we should  not  take  for  granted.  As  we continue  to  say,  before  you  register  a drug you would have only deployed this drug to about 3000 people maximum but when  it goes to the  larger population,  it's a different story.  It  is  important that after registration  there  must  be  a  way  to monitor  how  the  drug  works  in  the population.  So  this  is  what  INESS  is about.  The  study  is  being  done  now because  there  is  funding  for  it.

Q: How  long  is  this project going  to be?

A: This project is four years. Beyond the study, we want to create a platform on which to monitor the safety of all drugs. If we do this well, there's no reason why it  should  not  continue  because  new drugs will be coming on board and as  I have  indicated  elsewhere,  it's  not  only drugs. We expect the new vaccines to be developed.  Someone  has  to  monitor their  safety.  So  when  we  have  this plat form,   i t   provides  a  way  of  systematically collecting  this  information for  the safety of drugs and vaccines.

Q: How many people are going  to be involved  in  this project?

A: There are going to be many people. This is an international project targeting a number of Districts in Ghana, Tanzania, Burkina  Faso,   and  Mozambique.Strategically for the trials, we are aiming to follow up 10,000 treatments and then we think that within 10,000 treatments we should be able  to  find whether any hidden side effects can be detected.

Q: Which drugs are you going  to use?

A:  We  are  starting  first  with  the atersunate-amodiaquine  in  Ghana  but we want  to use  the combined one. We don't  want  to  use  the  packs.  At  the moment, when  you  take  the drug,  you can  tell which one  is  amodiaquine  and which one is atersunate. The type we are going to use are all in one tablet so you cannot  differentiate  between  the
atersunate and  the amodiaquine.

Q: Do  you have a name  for  that new drug?

A: We haven't got a name. We don't want to be the ones to make the name public. We hope that the Ghana Health Service, when  it  starts  deploying  the  drug, will come up with a name for it. But we will make suggestions.

Q: What do you hope to achieve at the end of  the study?

A: We expect that we will have a  lot more people  trained  in  the  deployment  of drugs. We will have the public educated in such a way that they know that drugs are  beneficial  but  they  do  have  side effects and that people will report them. This is important. It's not to say the drug is bad but we need to address the effects of people suffering quietly and  in some cases  dying  f rom  taking  drugs.  Something can be done about these side effects  if we  find  them  so  this  study  is very  important.

Q: Who are going to be involved in the study?  Are  they  children,  adults,  and patients?

A: At the moment, we are going to look for people across the range of children to adults who seek treatment for malaria at health  facilities.  In  this  case, once  they are  given  the  anti-malarials,  we  will follow them up to see what happens to them.

Q: Most people suffering from malaria seek  treatment  from  private  health facilities.  Is  this not a challenge?

A:  Yes,  it  is.  In  fact  this  is  the biggest challenge. We are going to actively seek public participation. As you pointed out, most people go to the private sector and a smaller proportion goes to the public health facilities. So we are going to work with  the  local  private  providers  in  the districts.  In some of  the districts,  these health  facilities  are  the  only  ones  that provide  services.  So  we  are  going  to recruit them. And the good news is that most of the districts are willing to make available  these  drugs  to  the  private
sector providers. So this will be good. We have good quality drugs being imported by  the government. These drugs get  to the private sector and the private sector can give them to those who need them most.

Q: Will  the drugs be  free  to both  the private and public sector?

A: Yes. What we intend to do actually is to  try  and  have  a  system  where  we actually  give  the  drugs  to  the  private sector . They will sell  it because they need to make profit to continue to survive. But the prices at which they will sell it will be moderate since they start with zero cost. And then they put the mark-up for their logistics  and  their  profit.  But  then  we expect  them  to  provide  us  with information.  So  in  a  way  they  don't provide  us  with  information  but  now they will provide us with  information and we will give them the drugs so we think that that is where we equalize the cost.  So the cost of getting that information is important. That is how we hope to start. If  it doesn't work we will come up with some other methods of  trying  to make this work.

Q:    I am wondering whether you will get  the  correct  information  from  the private  sector where  their  business  is just  to  sel l   and  not  to  record information.

A: That is so important. And that's why we are trying to deploy these studies in the  di s t r i c t s   where  there  a redemographic  surveillance  systems.  The major  information we  are  going  to  askthe private sector to do is to identify the people. Once we identify the people, we will visit a proportion of those people in their homes and we will corroborate the
information  that  they  collect. We'll  go back  to  check whether  they  are  safe, their  safety  issues,  whether  they've taken  the drugs according  to how  they were  supposed  to  take  them,  issues of adherence,  issues  of  compliance.  So these are all built  into the system. So  if we  can  identify  the people  there  is no reason why we will not make progress with our studies.

Q: Using  the  same people  for  several studies, won't this cause a problem to
the health of  the participants?

A: The reverse  is true. And this has been documented  scientifically.  The  lives  of people  in  these  places  have  improved remarkably  compared  to  those  areas where there are no research studies. In fact, Kassena Nankana District will meet the Millennium Development Goals even if Ghana does not. They are almost there.   Number two, most of the  interventions that are put in place in these districts are different. The third advantage has to do with  the  training  that  is  provided  the young men and women who engage  in the  various  research  projects. Most  of them who took part in the various trials in  the Kassena  Nankana  district  have become  international  researches  with high  repute  It  is  best  to  go  back  to research  communities  to  interview  the chiefs, opinion  leaders and  talk about  the transformation  that has occurred. 

Q: What  happens  when  the  drug  is found  to be unsafe?

A: This is a very important question. If we find the drug to be unsafe, we will be the  first to push that  it  is withdrawn. That is  why  in  deploying  the  drug  we  are bringing  all  the  stakeholders  on  board. There  is nothing to hide. The  information will be shared constantly. All information will be given  to  the Food and Drugs Board to share among other stakeholders  for all to see what  is going on.  If we  find that the drug  is unsafe,  it  is our duty  to protect our people.

Q: Are  there any  legal  implications?

A:  Wel l ,   there  are  no  big  legal  implications in finding whether the drug is  safe  or  not.  There  might  be  legal implications for those who take the drug and have problems with it. If somebody took the drug and it can be proved that through the drug someone was harmed or lost a limb that is when there will be legal  implications.


Third Edition