Could selling cheap malaria drugs in private stores harm children’s health?

There’s growing debate about the provision of ACTs, the artemisinin combination therapies, that are so effective in the treatment of Malaria.

Some, most notably The Affordable Medicines Facility-malaria (AMFm), are keen that such treatments become more readily available and accessible to the poor. One would think that such an aim is a good one, a bit of a ‘no-brainer’ but, as I’m learning, things are not always that easy.

There are others raising concerns, such as:

WHO recent guidelines state that malaria treatment has to be based on diagnosis by rapid diagnostic tests (which are both cheap and readily available). This guideline is ignored by AMFm, which will “train” shopkeepers to distribute ACTs to any parent who requests them.

Historical evidence clearly demonstrates that poor people cannot pay for a full course of cheap medicines. Chloroquine was an effective and cheap anti malaria medicine. Despite its low cost, poor people often bought incomplete courses. This was one of the reasons that (the) malaria parasite developed resistance to chloroquine and now the drug is virtually ineffective. AMFm aims to sell ACTs at a similar price to chloroquine but it is unclear what measures will be in place to ensure that ACTs will be protected from a similar fate.

At International Medical Foundation we are also of the view that treatment must be ‘evidence-based’ and we are seeking to find ways to make this work in our community programmes.

We are exploring how we can work with Village Health Teams in the community to achieve some of the successes seen already in Ethiopia and Zambia, as outlined by Dr Mohga Kamal-Yanni of Oxfam in the blog posting linked below:

WHO used to promote a programme of training community health workers on “integrated childhood illness management”. This meant that trained workers could diagnose and treat common childhood illnesses including pneumonia, diarrhoea and malaria.

You can read more of this by clicking on the image below to access Sarah Boseley’s blog at The Guardian.

WHO: 10 facts about Malaria

WHO: 10 facts about MalariaThose of you who have followed Dr. Richard’s posts from his time in Lira will know that malaria is a huge problem in that part of Uganda.

The WHO has published the following 10 facts about Malaria on its website here…

Fact 1
Malaria is a disease which can be transmitted to people of all ages. It is caused by parasites of the species plasmodium that are spread from person to person through the bites of infected mosquitoes. If not treated promptly with effective medicines, malaria can often be fatal.

Fact 2
About 3.3 billion people – half of the world’s population – are at risk of malaria. Every year, this leads to about 250 million malaria cases and nearly one million deaths. People living in the poorest countries are the most vulnerable.

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Richard Feinmann on malaria in Lira, Uganda

I am re-posting a recent update from Dr. Richard about Malaria, from the BMJ Blog here http://blogs.bmj.com/bmj/2010/05/25/richard-feinmann-on-malaria-in-lira-uganda/

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Working as a doctor in Northern Uganda I wonder where to start with healthcare. Since 75% of diseases in Uganda are preventable and since there are very few health workers and little money, especially in a country which is so Kampalacentric, one probably has to follow the government’s prevention line.

There is a feeling that much of what has been done in healthcare has not been sustainable. NGO’s are protective of their roles and are often unwilling to share or work together. Projects are completed and may not be evaluated and the district health office charged with overseeing care may be unaware of what is going on in their patch.

So when you are tasked with setting up a centre of excellence to deal with malaria it is not easy. Nets, sprays, education, vaccines, and medicines have all had many millions spent on them and yet last week in Lira there were 5000 new cases of malaria. This is an unbearable and unacceptable burden. Although there are so many health disasters in Uganda, malaria is the commonest and in my opinion the worst and most complex disease to deal with.

I had a boy recovering from 4+ malaria on a quinine infusion and I was talking to him and his mum. These were the responses: “No we don’t use nets. Yes we could afford them. My husband uses the only net we have. Treatment is easily available. People rarely die of it. My son has had 3 attacks this year. Everybody gets it. A fan and sprays are better than nets. Nets are too hot to sleep under. We live in a poor swampy area and the government won’t spray the mosquitos,” and so on. In other words, we may know what to do but it is not working.

The government plans to rely on village health workers. They are elected, health trained volunteers who look after just 20-30 householders. They have been trained to assess fever and when it might be appropriate to treat with anti-malarials. Sadly they receive no allowance and for unknown reasons they have not been supplied with the co-artem which was promised. I like the idea of decentralisation but should we be using anti-malarials without investigation when we are running out of active medications for falciparum malaria and resistance is increasing.

Apparently there is a global fund and presidential initiative to swamp the country with nets. 17 million nets are supposedly available. Driving up to Lira recently we tried to think of 101 different things people do with mosquito nets. People sell them or use them as bridal veils. Using them as curtains is popular. The most novel use was to put them over termite mounds to catch termites to eat.

I think a coordinated approach involving all NGO’s and the district health offices all working through village health teams could be sustainable. We need to have cheap, easily available testing and treatment. We need nets for everyone and if DDT (or alternatives) is considered safe then lets do it. But there is still a need for a huge educational programme to change culture and perceptions about malaria which must be on ongoing.

Until someone finds a vaccine or eliminates the anopheles mosquito then what else is there? What do you think?

Richard Feinmann is a 62 year old general and chest physician who retired a bit early after a serious health scare. He felt he had more to give and jumped at the chance to work with his health visitor wife in Uganda.

Fighting Malaria in Lira: Gloria Mercy

Assimwe Gloria Mercy was admitted onto our in-patient ward at Charis-IMC.

She is two and really sick with a temperature of 39.5 degrees and very unhappy. She has 4+ malaria and will be treated with i/v quinine.

Assimwe Gloria Mercy was admitted onto our in-patient ward at Charis-IMC.

Assimwe Gloria Mercy, one of our young Malaria patients at Charis-IMC.

She will get better but we need to develop a programme to try and prevent these admissions.

Malaria is a big health issue in Lira; it clearly causes distressing illness but also has a financial impact on families who can least afford it and leads to absenteeism from work and school. The impact of Malaria in young children lasts for years as it significantly affects their growth and general well-being; the time off school in these early years is hard to make up.

Charis-IMC is seeking ways to best reach the needy communities in and around Lira to implement Preventive, Promotive and Curative programmes to help improve the heath and well-being of those that are currently unable to get such help in any other way.

Fighting Malaria in Lira: Ronald

Dr. Richard sends this report from Charis-IMC, our Health Centre in Lira, north Uganda.

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Kisembo Ronald age 10, was admitted with bad malaria (we grade it +, ++, +++ and ++++ according to the number of Plasmodium Falciparum parasites in the blood film) Ronald was a 4+ with over 100 parasites per high power film. He was very sick and needed admission for intravenous quinine. After 4 doses he is now cured but his mum says he gets 3-4 attacks of malaria per year, missing school and has been admitted before. The family seem well educated but do not use nets and seem to view malaria as something that happens and not as a preventable disease.

70% of disease in Uganda is preventable (more than half is malaria) and we have 5,000 cases of malaria a week in a population of 50,000.

Just giving out nets is not enough. Education, monitoring and evaluation and checking that it is not just the man of the family using the net, as well retreating the net with insecticide are all part of the prevention plan.

Here you see Molly Awaco, one of our nurses looking after Ronald with his Mum on our ward at Charis-IMC.

Molly Awaco, one of our nurses looking after Ronald on our ward at Charis-IMC.

Molly Awaco, one of our nurses looking after Ronald with his Mum on our ward at Charis-IMC.

Bill Gates Speaks (on TED) About Fighting Malaria

I recommend that you watch at least the first 8 minutes of this video in which Bill Gates speaks about how his foundation is helping to fight malaria and why that is so important. He manages to get across a very serious message in a fun way. He says:

As recently as 1960, 110 million children were born, and 20 million of those died before the age of five. Five years ago, 135 million children were born — so, more — and less than 10 million of them died before the age of five. So that’s a factor of two reduction of the childhood death rate. It’s a phenomenal thing. Each one of those lives matters a lot.

I am one of those 110m, still here…

8 mins

World Malaria Day

CDC-JamesGathany

Today, April 25th, is World Malaria Day 2010.

About 3.3 billion people – half of the world’s population – are at risk of malaria. Every year, this leads to about 250 million malaria cases and nearly one million deaths. People living in the poorest countries are the most vulnerable.

One in five (20%) of all childhood deaths in Africa are due to malaria. It is estimated that an African child has on average between 1.6 and 5.4 episodes of malaria fever each year. Every 30 seconds a child dies from malaria in Africa.

Click here to read 10 facts about Malaria.

Uganda in double blow against malaria with local drugs

By MICHAEL WAKABI The EastAfrican

There are 3 interesting articles in today’s “The EastAfrican”

The World Health Organisation says half of the world’s population is at risk of malaria and an estimated 243 million cases led to an estimated 863,000 deaths in 2008.

A child dies of malaria every 30 seconds while the disease shaves as much as 1.3 percentage points off GDP in countries with high disease rates. In Uganda, it accounts for 40 per cent of public health expenditure, 30-40 per cent of in patient admissions and up to 60 per cent of outpatient health clinic visits.

QualityChemicals

As covered in these articles it now seems that good progress is being made by Quality Chemicals and Cipia in creating the necessary infrastructure to enable Uganda to manufacture its own anti-malaria treatments.

These developments are not only good news for the region’s poor, who bear the brunt of the killer disease, but also assures a new income stream for small-scale farmers in western Uganda, who have been contracted to grow the artemisia annua shrub, from which the artemisinin is extracted.

180 Treated at Lira Clinic in September

In September 180 people were able to get care at the Lira Clinic due to financial support from Suubi Trust. 86 of these patients were aged 18 and under. 38 were referred to the clinic by the staff at the Lira Primary School.

Most of the patients seen had malaria. It is becoming evident that a malaria prevention initiative would greatly benefit the people of Lira as it is affecting so many people yet it is a preventable disease.

You can read more about some of these patients here.