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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

Let’s report adverse effects

The drive to build robust malaria surveillance systems to complement testing and treatment of patients is indeed one healthy WHO directive.

It enjoins professionals to test, treat and track every reported case of malaria in order to prevent resurgence and resistance problems and further reinforce the combat against the killer disease.

And while communities have been used to just receiving prescriptions and instructions from medical experts, the time has now come for them to give some information back to health researchers to help enhance the quality of care they receive.

The new regime is so crucial that when communities refuse to co-operate it becomes a little frustrating to health professional who find it unthinkable that the very beneficiaries of vital interventions would throw spanners in the works.

One such example is the frustration faced sometimes by INDEPTH Network’s Phase 4 studies into antimalarials in Africa.

The project known as INDEPTH Effectiveness and Safety Studies (INESS), has shown that while unexpected effects of anti malarial drugs may be going on in communities, very little of it is reported because people do not deem it important to report any side effects to the health facilities after taking medication given them.

Yet, that information is extremely vital because it is with such information that researchers and health workers are able to give feedback to the manufacturers of these drugs. It is also with such information that these drugs can best be reconstituted to make them user-friendly so that people will comply with the treatment.

These concerns were raised by Dr. Seth Owusu-Agyei, Director of the Kintampo Health Research Centre (KHRC), when the AMMREN team met him in the Brong-Ahafo Region.

The centre is one of the three research sites in Ghana where the INESS project is being undertaken.  Dodowa Health Research Centre and the Navrongo Health Research Centre are the other centres.

“The location of these centres gives a very comprehensive outlook for Ghana. Navrongo is in the Northern belt, Kintampo is in the middle belt and Dodowa is in the coastal belt. When we talk about the major ecological zones, it’s clear that we’ll be able to get data to represent each of these major ecological zones.”

Dr.Owusu-Agyei said there is the need to find out how the new and efficacious anti malarial drugs in Ghana perform in the health system aside of their ability to cure.

“Sometimes efficacious artemisinin-based combination therapies (ACTs) are recommended as a national policy but when you put them in the health system they are not able to function properly because of several factors within the system.  “These factors include adherence to the recommended medication and compliance by the prescriber on how the medication should be given to a child,” he said.

“Side-effects like drowsiness may also prevent a patient from continuing the medication. This can affect the effectiveness of the drug. INESS therefore uses malaria as a model and in the process looks at the new anti malarial that is recommended for use in Ghana to see its performance in the system.” he noted.

Dr.Owusu-Agyei said, when the anti malarial drug was assessed within the health system, some lapses were detected. “It was found out that from the over 90% protection that it could give, it reduces to about 10%. We’ve looked at the various stages.”

These lapses, he said, have been communicated to the appropriate authorities like the National Malaria Control Programme (NMCP) and the shortcomings that were observed have all been taken into consideration. This will lead to education of the patients, the mothers who are bringing in the children to the hospitals and also retraining for staff who are prescribing the medications to them.           

The Director of KHRC lamented that reporting unfavourable effects of anti malarial drugs must be encouraged in order that producers of these drugs will be communicated to appropriately. This will help in checking the composition of the drugs to make them user- friendly for people to adhere to treatment.

Dr.Owusu-Agyei has appealed to communities to report to the nearest health facility any side effect that they come across when they take these drugs.

He lauded the INESS project’s initiative of following patients up into their homes to check on how they are taking the drugs and responding to treatment.

“Many a time, the patients do not understand the instructions about the medication given to them and this has led to the training of health personnel in the best ways that they have to deal with the patients. Research activities carried out are extremely relevant to the country at large.”

“This is because in almost every health facility in the country, the number one killer is malaria. Hence, if there are activities focused on drugs that will be used to treat malaria, treated bed nets and malaria vaccines that will be able to prevent malaria, then we can make significant progress.”

Dr.Owusu-Agyei said data collection on the INESS project ended in June but the lesson learnt from it will continue to be studied.

He said there were several lapses that were picked and so the education and the training are going to continue. There will also be continuous benefit from the deficiencies seen and the training input that has been made.

On the impact of INESS, Dr. Owusu-Agyei said the project offered the convenience of having children report at the local hospital for treatment and followed up into their homes to check how well they are doing.

“I think that is a major achievement. In the process, we were able to check whether they were complying with the treatment. Even at the dispensary, we found that the complete message is not given to the mother. Patients have unhappy memories of someone in an obscure building with a small window telling them 1, 2, 3 times daily. The mother goes out and is completely confused about exactly what to do with the drug given at the dispensary. So, it raises the need to give training to these health personnel in the best ways they have to deal with the patients.”

He said the researchers are in regular dialogue with the community members and given the fact that the number one killer is malaria, the community sees the KHRC as doing a great job into drugs.

“Not only do we concentrate on malaria. We look at sexual reproductive health issues, family planning and how best to raise your baby so that your children are always healthy. What is emerging from the databases in the health facilities these days is that, non communicable diseases are on the ascendancy. You have people who are hypertensive or diabetic and I think it should be a big worry for us. If communicable diseases are being tackled and we see a downward trend, there is no reason we should allow non-communicable diseases to thrive over that and then create major problems for us in the future.”

Dr. Owusu-Agyei said INESS complements the work of the NMCP in that research findings are shared with the national agency about the performance of the drug within the health system.

The term ‘health system’ is where the patient comes to see the doctor, some laboratory checks are done, the drugs are given, taken home, and is supposed to be taken regularly.”

 “When we assessed the drug within the health system, we found out that from over 90% protection that it could give, it reduces to about 10%. We’ve looked at the various stages. How compliant the prescriber was, that is, the doctor or the person who prescribed the drug to this child. How the mothers adhered to giving the drugs to the patients and when they were supposed to report back for us to check whether the child was completely healed or not”

“We realized that there were major lapses. We have communicated this because the line of this study was to be in continual dialogue with the staff of the NMCP. So in the dialogues, we have communicated back and the shortcomings that we observed have all been taken into consideration. This will lead to education of the patients, the mothers who are bringing in the children to the hospitals and also retraining for staff who are prescribing the medications to them.   This is going to make a major impact.”

“The process has not reached the stage where it will lead to a policy change on recommended drugs. But it is actually showed gaps we did not know about. For example, the first line antimalarial drug is artesunate-amodiaquine. This drug is very efficacious. By that I mean it is able to cure over 95%. That is, if you took 10 children, over 9 out of the 10 will be cured using this drug. But that is when the drug is taken appropriately.”

The safety module of INESS used three approaches for generating safety information. It used the spontaneous adverse event reporting (SAER) system, active cohort monitoring (including health and demographic surveillance data) and adherence to prescriptions.

INESS worked with the national authorities to further train health workers in the INESS sites as well as to promote the reporting system and encourage its use.

The normal SAER system used routinely by the national drug regulatory authorities in Ghana and Tanzania was characterized by poor reporting, absence of forms and lack of knowledge amongst health workers about the reporting system. Feedback also appeared to be low.

INESS led to a thorough training and capacity building among health workers, increased interest in the SAERs resulting in a sharp increase in reports. In addition, there are currently reporting forms in all the INESS sites paving way for sustained increased reporting.

The public health impact of the increased reporting in INESS sites have been the picking up of events of importance leading to, in one case in Ghana, action by the national regulatory authority, the Food and Drugs Board, to further restrict the supply of one medicinal product which was being used to terminate pregnancy contrary to national regulations.

Dr. Owusu-Agyei says the gains made as a result of INESS should be sustained through continuous training, regular feedback and provision of reporting forms to ensure that the SAERs continues to work.

“The findings of the INESS project exposed several lapses and deficiencies in health delivery, which will inform future education and training of health care workers” he said.

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