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The Latest Edition of "Eyes on malaria" magazine will be out very soon!! | CALL FOR ARTICLES: AMMREN is inviting journalists / writers / scientists interested in reporting on malaria to send articles for publication in its international magazine “Eyes on Malaria” and for posting on its website. Please contact the AMMREN Secretariat for more details click here. Enjoy your stay!. Volunteers and interns urgently needed to work with an NGO working in the area of malaria and health. Apply through - ammren1@gmail.com / ammren1@yahoo.com. Journalists interested in reporting on and writing articles on health issues should please reply through this email: ammren1@gmail.com

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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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Getting a prescription is not the end but the beginning

For the past two days you haven't slept well. Your body is aching, your legs do not want to move willingly, a hammer is constantly knocking inside your head and your body feels hot. The pain killers you have been taking only give you a temporary relief. Deep in your heart you know it is time to pay your doctor a visit...

Does this sound familiar?
Anyone who has suffered Amalaria infection will understand that, malaria symptoms may mimic many other common infectious diseases prevalent in malaria endemic areas. It is difficult to diagnose malaria clinically, especially in children, without help from the health care provider.

This is one of the reasons malaria control programmes have strived to increase coverage of malaria diagnostics by introducing malaria rapid tests which can be performed at the point of care. These tests require minimal health system investments in terms of training of personnel, reagents and infrastructure (e.g. electricity, special rooms, etc.).
Treatment of malaria has an interesting history. The famous antimalarial agents used in the past such as Chloroquine and Sulphadoxine – Pyrimethamine (SP), are no longer advised as first line treatment of malaria due to their inability to clear malaria parasites in the body as required.

As a result, the World Health Organization now recommends the use of artemisinin-based combination therapy (ACT) for malaria treatment. These ACTs are required to be a combination of at least two medicines; an artemisinin compound with another medicine that has different modes of action in targeting the malaria parasite.

In the management of patients confirmed to have malaria, an appropriate and recommended medicine is mandatory. Getting a prescription of the right medicine (ACT) is just the first step in the management of the disease; so if you thought getting a prescription for malaria episode is the end of story - you better think again. Just like any other medicine or chemical, there are properties that determine how the medicine will perform. In fact, not adhering to these required properties, will do more harm than good.

The harm can be towards our own bodies and to the medicine in use as well as to the general population. Among the necessary properties of ACTs are, the recommended number of tablets to take, the frequency and timing of taking these medicines. All these must be clearly stated by the medicine manufacturers and well explained to the users of the medicine in question. The users may be health care workers, patients (adults) or caretakers of patients (for minors/ children, severely ill or elderly).

The fact that ACT was a new addition in the management of malaria and comprises of a combination of medicines, unlike the previous commonly used antimalarials, necessitated a thorough monitoring of its safety and how well it is delivered to those in need.

This is one of the reason the INESS study was conceived and introduced in 4 countries – Tanzania, Ghana, Burkina Faso and Mozambique - as a platform to assess the effectiveness and safety of ACT antimalarials in use in collaborating countries.

The INESS scientific approach was to assess ACTs from all aspects, beginning with their availability and accessibility by people, how it is prescribed and used by health providers, how the instructions are adhered to by patients and the outcome of the treatment episode.

Some interesting findings from the INESS studies in Tanzania showed that ACT use can be altered in relation to provider's factors and patients characteristics . As reported in the Malaria Journal in 2013, Majige Selemani and colleagues found that, providers work experience had significant influence in the way ACT is prescribed to patients.

Health workers with 3+ years of experience managing malaria patients were more likely to give a correct ACT prescription as compared to less experienced staff-perhaps due to less experience in interactions with patients.

This does not mean we should start asking for the work experience of providers when we visit health facilities, rather you should engage yourself in the discussions with the provider to better understand the given instructions while you also provide adequate narration of the illness episode.

Equally interesting were the results reported by Masanja and colleagues as published in the Malaria Journal of December 2013. The team assessed patients' characteristics that were prone to correct or incorrect dosing of ACT and found that two middle age or weight groups were significantly more likely to receive inappropriate ACT dosing as compared to the little babies less than 3 years old. The two middle groups are the older children of age between 3-9 years and the school going children between 9-12 years.

The ACT used as first line for malaria treatment in Tanzania is prescribed according to age and/or weight. What was more striking was that all age groups were more likely to be under-dosed. The best explanation provided was a possibility that the age-weight indices used to demarcate medicine dosage may not be applicable in this population. Nevertheless, majority of patients assessed (92%) received correct dosing by either weight or age criteria.

In summary, these findings from the INESS studies underscore the need for adequate doctor-patient consultation process, engagement of patients and caretakers in appropriate narration of the problem and dosing instruction to be adequately understood by providers, dispensers and patients (or caretakers).

Getting a prescription is not the end but, just the beginning of appropriate management of malaria. For better treatment outcomes, patients must also be engaged in understanding of dos ing ins tructions and be provided with relevant information related to the treatment given.

BY DR. IRENE MASANJA - IFAKARA HEALTH INSTITUTE, DAR ES SALAAM, TANZANIA

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