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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

Realities in Dodowa

In the past, malaria patients had to endure not only the bitter chloroquine pill but also had to live with prolonged misery over the days required (sometimes 10 days) to complete the medication.

It just stands to reason that a patient already burdened with this debilitating disease is more likely to choose the easiest way out: opt for half treatment by kicking against swallowing several tablets within a required period of time.

This unhappy scenario made self-medication very appealing to malaria victims who sometimes resort to herbs and other ineffective therapies.

And so it was not surprising again, when reports started filtering in that malaria patients in Ghana were not complying with a new replacement for chloroquine because of the number of tablets involved in its administration.

This was one of the problems artesunate amodiaquine had to go through when it was first introduced onto the Ghanaian market. 

Earlier packages of the drug had been a double-dose of artesunate and amodiaquine with more tablets to take and this came with its own complications.

It is gratifying therefore that the INESS project was out to find out how health interventions, such as drug administration worked in real life when it comes out of clinical trials and on the market for use.

As a clinician who believes strongly in the proper treatment of every diagnosed case of malaria, Dr Alexander Adjei is all for the 3-day single-dose artesunate-amodiaquine considering its convenience with patients.

Sharing his thoughts on the treatment for uncomplicated malaria in Ghana, Dr Adjei says the drug is already on the market and is available in a package of 3 tablets to be taken once daily for 3 days.

 “What is needed is to educate the public on its use. It’s an excellent formulation because compliance is easy,” he added. 

Dr Adjei gave the recommendation in an interview on preliminary findings into a Phase 4 study into anti-malarial drugs at the Dodowa Health Research Centre (DHRC) in the Dangme West District of the Greater Accra region.

The Centre has joined other research sites in and outside Ghana to carry out the Phase 4 INDEPTH Effectiveness and Safety Studies of Anti-Malarials in Africa, (INESS) project.

The project enabled researchers to gather practical evidence for the effective treatment of malaria in order to allow policy decision to be based on the assessment of the effectiveness of anti-malarial drugs and their determinants in real life situations.   

Secondly, it is to evaluate the safety of new anti-malaria treatment through comprehensive pharmacovigilance within the context of African health systems.

There are a number of modules being used to address the objectives of the INESS project and these include access, adherence, efficacy, provider compliance, community and provider acceptability, cost effectiveness and the safety module, which consists of strengthening adverse events reporting.

Data linkage is another essential component of INESS, which seeks to upgrade the health and demographic data and merge it with biometric information of the community with the aim of linking these with data from health facilities for effect treatment and tracking of health outcomes of the population where the INESS projects operates in.

The first phase of the INESS project has ended and some preliminary findings show the importance of research in rolling out health interventions effectively.

Dr Adjei, who worked on the Efficacy Module of INESS at the Dodowa Centre, said the study under the efficacy module was to find out if two drugs, artesunate-amodiaquine and artemether- lumefantrine, were effective and safe in treating uncomplicated malaria.

He said during the study, patients who qualified to participant in the phase 4 trial, were picked and after laboratory confirmation of the presence of malaria, the single dose artesunateamodiaquine was given for 3 days.

These patients, he explained, were followed for 63 days, during which time blood samples were taken to see if they would be re-infected with malaria.

“No adverse events were recorded and preliminary findings are that the drug works under the Direct Observation Treatment.”

He said 218 patients were enrolled and out this number, 200 who were treated were followed during the 63 days.

Dr Adjei said after tests were conducted on them, no malaria was confirmed and 18, who were re-infected were treated again.

He gave high recommendation to the single dose artesunate-amodiaquine drug, which was one of the drugs used to treat uncomplicated malaria.

INESS has given a platform for the real life malaria stories to be told.  Gathering real life information and situational reports at the grass roots to drive policy is no doubt an important ingredient in bringing development to the people as interventions can then be based on what the realities are and how to meet the needs of the people, for whom those interventions are rolled out.   

On the safety of the antimalarials, Dr Alberta Amu, who chaired the Safety Committee of INESS at the Dodowa centre, said during the study there were some adverse reports after some people took the anti-malarials which involved dizziness, vomiting and some skin itches.

She however explained that these “were common ones and not serious ones as it could be the result of the disease, malaria, and not the drugs.”

She said during the study training sessions were held in all the health facilities and each facility had a focal person and forms given to the facilities to capture any adverse report.

“We investigated some forms that had been filled and forwarded it to the Food and Drugs Board (FDB) and they responded to us.”

She said it was too early for the FDB to conclude on some of these reports and make them available nation-wide as large numbers of the forms comes in at the end of each year.   

The cost of anti malarials is also a critical area that the INESS project looked at as it affects effective treatment of malaria and impacts on health delivery.

Mr Alexander Nartey, a Research Officer in charge of the Costing Module of INESS at Dodowa, said the economic module aims to come out with evidence on the cost of anti-malarials within the health system and to help planners roll-out drugs, especially the new ones.

He said there were direct costs and direct non-medical costs involved in treating malaria. The direct ones revolve around the cost incurred in going to the health facility for treatment.

Mr Nartey said the direct non-medical had to do with issues such as the cost of transportation to the facility and food since one had to eat well to take the drugs. The other was the indirect cost and loss of productivity if the person had to seek treatment and to get well.

“Preliminary findings show that in the Dangme West district it takes some 6 days to heal so for proper treatment of malaria the average is the loss of 6 days and this can be quantified in the loss of income as the person is at home,” he explained    

He said the costing aims at furnishing policy-makers with decisions on rolling out new anti malarial drugs.

Mr.Nartey said one other information that the study picked up was that people liked pre-treatment with anti malarials before seeking treatment at the hospital.

“Out of the majority of the people interviewed, 80 per cent sought care outside the home, but 40 per cent of this number had had some pre-treatment at home. The implication is that people treat without diagnosis so there are complications in managing the disease.”

These real life issues are key as they serve to give real life experiences which will inform how health interventions can be tailor-made to solve the challenges of cutting down on malaria deaths..

The formulation of the drugs, packaging, tastes of the drugs and costs, among others, are becoming relevant to effective treatment.   

Madam Doris Dadebo, whose 3-year old child, Delight, took part in the safety study, said the artesunate-amodiaquine given to treat her child was okay, however it nearly made the child vomit due to the bitter taste.

Perhaps, it would be best if in future all paediatric formulations of anti-malarials are flavoured in order to be more patient-friendly. 

- By Eunice Menka - Ghana

 

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