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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

In real-time

In line with the global determination to relieve mankind of an age-old disease which kills a child every 45 seconds, the 2011 malaria roadmap encourages the collection of real-time data to guide strategic planning and effective programming with available resources and also promote increased investment in malaria. Thankfully, stakeholders have ensured that Africa is up and running with the collection of vital data in real-time to enforce the fight against malaria.

One brilliant example is the work being done in four African countries namely Burkina Faso, Ghana, Mozambique and Tanzania, where the INDEPTH Effectiveness and Safety Studies of antimalarials (INESS) are on-going.

INESS is premised on the fact that malaria control is not just in diagnosing malaria and prescribing drugs to patients but also monitoring their treatment and recovery.

Scientists and researchers have long made the case that it is unfair that new drugs are offered for national policy decisions in Africa with as few as 6,000 patients partaking in drug trials before these drugs hit the market. Even worse, the patients are usually not followed-up over a longer period of time to check how they cope with treatment.

Then also is the worrying fact that the majority of drugs available in Africa today have been deployed on the basis of safety data generated in Europe, the USA or Australia.

This caused experts to raise concerns because safety issues can vary between populations, as illustrated by the story of metamizole which induced very adverse reactions in certain populations but not in others.

There is another argument that it is not appropriate to use data of European malaria victims to inform the use of a drug for malaria treatment in Africa. Not to mention the frequency of anti-malarials drugs use in Africa which may be considerably higher than in other parts of the world.

Against this background, the INDEPTH Effectiveness and Safety Studies of antimalarials (INESS) in the four African countries began a large scale Phase IV study to determine the effectiveness and severe adverse events in African health systems when the intervention is delivered through real-life situations.

Dodowa is one of three INESS sites in Ghana. The others are Navrongo and Kintampo. Tanzania has three sites namely Kilombero-Ifakara, Rufiji and Ulanga.

Dr Margaret Gyapong, Director of the Dodowa Health Research Centre (DHRC) in Ghana, whose team worked on INESS since 2009, speaks fondly of the uniqueness of working in real conditions, which is a novelty in the majority of research centres on the continent.

 “Usually we are into experimental trials and epidemiological studies but INESS being a Phase 4 study is implementing something in real life without trying to adjust the situation. One of the key things expected of us in this INESS study was to work with the health system as it operates every day.”

Dr Gyapong said “The WHO-recommended artemisinin-based combination therapies (ACTs) like artesunate-amodiaquine, have gone through different phases and now it was time to study them in large populations in real-time to further determine their efficacy and safety.”

The health researcher said the study which entailed modules such as safety, efficacy and provider compliance threw up some interesting findings.

“As part of the safety module people taking medications were monitored to know if they have had any adverse reactions.

In terms of effectiveness, Dr Gyapong said a drug may treat malaria very well under laboratory conditions, but by the time it reaches the community, some factors have affected its performance.

She described a situation where a dispensary may be prescribing drugs appropriately and the patient not abiding by the prescription, causing the drug not to treat malaria as expected.

The DHRC Director said the efficacy component of INESS is purely clinical with the clinician sitting in a consulting room screening general patients to check how efficacious the new anti-malarial has been.

“If someone came with signs of malaria and certain indicators, the person was taken aside, screened properly, blood samples taken and follow-up visits done. Then we would test how efficacious the anti-malarial proved to be.”

She said researchers went into communities to have group discussions with community members to find out what they think about the new drugs, about malaria, whether there is a seasonal pattern of malaria and what they do about it. Certain old practices still seemed to prevail.

“Some people are still using herbs while others are still depending on chloroquine. People are given the right medication but do not take it appropriately. We find out that sometimes there are shortages of the anti-malarials.”

 “Sometimes people who need access to the antimalarials are not able to reach the nearest health facility to get the medication. It could be due to transportation or even the cost of the drugs. So INESS is also looking at the barriers that affect the uptake of the new anti- malarials in the system” she said

“Through the effectiveness studies we are realising that there are a lot of system barriers that are affecting the uptake of anti-malarials within the health system. Maybe the diagnostics are not there so people are still being given presumptive treatment rather being diagnosed with malaria using the rapid diagnostic test (RDTs). Unfortunately, the kits sometimes do run short in the system.”

Dr Gyapong said INESS exposed doctors who are still giving presumptive treatment to patients. It thus compelled health providers in general to comply because the spotlight was on them.

“Being aware that their practices are scrutinised, health providers now tend to be more compliant in terms of prescribing not only the appropriate anti-malarials but also conducting tests to confirm malaria as a first step.”

INESS enabled the researchers at DHRC to improve on the follow-up of patients who visit the health facilities.

“If someone came to the health facilities and was diagnosed with malaria and received an anti-malarial, we followed up to the homes. We called them on phone to find out how they were doing after they took the anti-malarials and the community members were happy.”

According to Dr Gyapong the patients were amazed at the post-treatment attention they received.

“For the first time in their lives someone calls them after a visit to the hospital to find out how they were coping after they have taken medication.”

Dr Gyapong said INESS helped the researchers to link up properly with the National Malaria Control Programme (NMCP) because at stakeholder meetings NMCP staff visit the districts to check on malaria control efforts.

“INESS exposed real issues like shortages of anti-malarials in the facilities. And as we needed to collaborate with the NMCP about making drugs available in our districts, we forged closer links with the staff there. INESS created awareness at the NMCP, the Ghana Health service and even with the regional directors of health services within particular areas in the catchment area.”

“INESS brought us closer to the Food and Drugs Board (FDB). Prior to this study, we met only for short training or for periodic orientation and monitoring. But now we interact regularly, collecting and submitting forms. The health workers are able to submit their returns of the forms for adverse events reporting directly to FDB without passing through our research centre. We only get the necessary feedback. The district health directorate gets a copy and members are able to sit and discuss issues that arise.”

“One useful discovery of INESS is the “sms for life” where health workers are trained to send text messages by mobile phones once a week to be able to track stock levels of their anti-malarials, helping us put into context the situation with the anti-malarial requirements in communities.”

Dr Gyapong said the Greater Accra Regional Director of Health Services found “sms for life” very useful and implemented it with blood banks too.

“The blood banks are now texting information about the levels of blood within their facilities so facilities that have shortages can be restocked with blood. “ So, you can see that “sms for life” has moved from the district level right to the regional level.”

"Authorities have asked the DHRC to do an evaluation on the “sms for life” system to see how they can roll it out at the national level. So this system through the INESS study is filtering from the district level up to the national level.”

Dr Gyapong believes INESS has opened the eyes of all stakeholders to the need for research.

“At the last stakeholders meeting, we shared results from the study showing that some health facilities were still dispensing Chloroquine. Right at that meeting, the Director General of the Ghana Health Service issued a statement in print and broadcast media that any facility found to be dispensing Chloroquine will be penalised.”

Dr Gyapong said the DHRC is trying to improve computerisation to ease the pressure on the data linkage at the health facilities.

“Currently, if you go to many of our health facilities there are stacks of folders and sometimes people cannot find their folders even when they have their card. So the system was to ensure that people would have a biometric card so they can swipe it for information to pop up and then their cards will be found easily but it looks like it was an extra burden for the health system so they kept on asking us to bring our own staff.”

The health researcher said given the fact that the study thrives on local and district health facilities and personnel, INESS is exploring options to ensure that future research is easier to handle at these levels.

“We are trying to ensure that the district safety committee is maintained and also see that the health facilities still have that link with the Food and Drugs Board (FDB). We are also working to maintain the innovative “smsforlife” where stock levels of anti-malarials are sent by text messaging to the district to replenish stocks. This is great in ensuring that all facilities have adequate distribution of medication.

“We decided to revamp the district safety committee. Many districts need safety committees. And if someone takes any medication and reports adverse reactions, the district safety committee must do something about it.”

“This committee is led by the district pharmacist. At the time of the study this committee was not very functional. INESS made it more functional. Initially it appeared to be too much because the health facilities had to fill in a form issued by the FDB.”

According to Dr Gyapong health workers in the study areas are now filling the forms and sending them to the FDB for official feedback.

“They seem happy to be doing proper documentation on side effects they get whether as a result of an anti-malarial drug or as a result of something else. So the reporting systems in our areas are working. The district safety committee has been having regular meeting and they are taking a lot of initiative on their own to handle reported safety issues.”

- By Carlton Cofie - Ghana

Iness Edition