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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

Cleaning up Africa’s health system- INESS shows the way

It is becoming increasingly important that health care providers forge closer links with their communities to ensure that health solutions are effective and tailor-made to meet the needs of the community. It is equally necessary that health care providers follow-up on patients after treatment to see how they are getting along after hospital visits for a more personalized care to make health interventions more effective.

This is exactly what the on-going Phase 4 studies by the INDEPTH Effectiveness and Safety Studies of antimalarials (INESS) is doing. The study is showing that it is no longer reasonable to just treat patients and forget about them.

INESS has created a platform for phase 4 trials to monitor the safety and effectiveness of drugs as it cannot be left to industry and manufacturers to monitor how their drugs are doing on the market.

The INESS study has introduced innovative ways of monitoring patients after treatment to determine progress, ensure adherence to instructions on drug intake and any possible side effects.

The big agenda
The INESS project is the largest phase 4 trials into anti-malarials to test and gather data on the safety and effectiveness of the drugs as part of Africa’s unfinished business. Over 30,000 patients have been followed up since 2009 when the projected started.

It is directed at bringing a “clinical finish” to effective health care delivery and to neatly tidy up the continent’s health systems with the big agenda of creating strong African institutions to shoulder the health burdens of the population.

The project is gathering real life facts on the ground for the effective treatment of malaria, which will help policy makers to base their decisions on malaria control on evidence and it is being done on modules which include access to drugs, adherence by patients, efficacy of the drugs, health provider compliance to treatment guidelines, community and provider acceptability of the drugs and safety of the drugs through reporting on adverse events in drug intake.

The INESS project, which could be described as a massive clean-up campaign of the continent’s health systems, took off in Ghana and Tanzania in 2009 as part of a vision not only to strengthen weak health facilities but also to create a platform to monitor and provide information on what is working and what is not working within the systems to help improve the overall health conditions of the population.

There are talks that the project may be expanded to serve as a platform for the collection of information on other diseases and drugs under natural conditions to see what is not working right to help address all kinds of health challenges plaguing the African continent.    

Since 2009, the project has not only unmasked what the hindrances are to effective treatment of malaria but also the systems and the providers who dispense health services.

The Principal Investigator of INESS, Professor Fred Binka, said anti malaria drugs lose their value because of the health system ineffectiveness and other factors. These include the population’s care seeking behaviour, patients adherence to instructions from the health facility and how health providers follow guidelines in confirming malaria before treatment with artemisinin-based combination therapies (ACTs).

In an interview with AMMREN at Ho in the Volta Region of Ghana, where he now heads a newly established University of Health and Allied Sciences, Professor Binka, expressed optimism that the situation can easily be solved with simple interventions, adding that discussions are underway to introduce some basic interventions that are sustainable.

He noted that just a phone call or text message from a health official asking how a patient is feeling after being treated at the health facility or to remind a patient to take the drugs and how to do so can make dramatic impact on adherence and effectiveness of malaria drugs. “These are part of the big agenda that the phase 4 study into anti malarials is seeking to address,” he noted.

Prof Binka disclosed that the study found out that some people find it difficult to adhere to treatment because when given about 3  drugs, with instructions to take one 3 times a day, one twice a day and another once a day, patients may end up taking only one of the drugs correctly and this affects adherence.

“We can send text messages to them to take the drugs. It is simple and does not cost much. It is possible to send text messages to tell patients that it is time to take your drugs and this improves adherence. We have found out on the safety aspect that patients are very happy to have someone call them from the health facility and ask them after treatment how they are and if they are feeling better, as it improves adherence,” Prof Binka disclosed.

Industry and regulation
“Effectiveness has a lot to do with the system and if the system is bad then good drugs could be ineffective.”

This was the response of Prof Binka when drug companies initially resisted  the INESS project as an independent group coming in to monitor and the safety and effectiveness of anti malarials and tried to put obstacles in the way.

Dr Gabriel Upunda, Chairperson of the Governing Council of INESS sharing his thoughts on INESS said industries do the phase 1, 2, and 3 of the drug development process in a controlled environment unlike the phase 4, carried out in a natural environment and with larger sections of the population.

INESS takes it from the phase 3 to the 4 to test the drugs under natural conditions.

The first phase of the INESS project was done in 5 sites in Ghana and Tanzania on drugs available to the countries by following up on them to see their side effects and desired effects of the drugs. In Tanzania it was artermether lumefantrine and in Ghana it was artesunate amodiaquine.

“We are now reviewing the results and to also see if INESS has done well in these countries. The platform created by INESS could be used to test HIV drugs, hypertension and diabetes that look further than where industry  have left off from the factories.”

Dr Upunda said countries in Africa are going to be prepared for an independent body to tell them the cost of the drugs, advantages and disadvantages of each available drug and the options coming to the market so countries can make informed choices on the drugs they want.

On some achievements, he said INESS has created an effective platform to test new anti malaria drugs and is also set to give a very independent report over the 3 years in the centres that it has been working.

On challenges, he said “We are not getting enough funding and Gates alone cannot move us forward. We need to generate funds from within Africa and get a sustainable budget from institutions. We need to market the project in all African countries and the platform could be used for non-communicable diseases and HIV/AIDS. Though the emphasis is on drugs, INESS could be used to test systems in countries, for instance delivery of services. Is it giving results?”

A Professor of Tropical Epidemiology at the London School of Hygiene and Tropical Medicine, Prof Peter Smith, views the INESS project as key to malaria control and involves a directed research aimed at directed interventions.

“It’s an important project in Africa and a mechanism to evaluate the effectiveness of new anti malarials introduced into the population. It can be used for drugs, vaccines, diseases and how effective drugs are and if not why? And why the drugs are not reaching people. Is it because of failings in the health system?”

He said the project links hospital attendance and the population because for instance it is important to find out why people are getting sick not only when they report to the hospital but within the communities and to also know why there are certain kinds of diseases and the need to address them.

He said there has been a decline in malaria in the past ten years but it is still an important health problem. We have to find out the reason for the decline and if bed nets distribution or other reasons could account for this.

Prof Smith said INESS is a long term platform for evaluation of drugs including new vaccines that will be coming on board. Currently there are no effective means of monitoring new interventions to assess safety among others.

- By Eunice Menka – Ghana


Iness Edition