Monday, May 19, 2008

Is it really malaria?

Monday, May 19, 2008 (The Daily Graphic Pg 27)

Article: Lucy Adoma Yeboah

FOR the first time in eight years, the annual event which was instituted in 2000, known as “Africa Malaria Day” was on March 25, this year, commemorated as the “World Malaria Day” on the theme, “Malaria-A Disease Without Borders”.
The idea of changing the Africa Malaria Day to the World Malaria Day came about when in May , 2007, the World Health Assembly, attended by delegates from all the 192 member states of the World Health Organisation (WHO), looked at the latest malaria reports and observed that the global awareness of the disease remained low in spite the high death toll and cost of it.
The World Health Assembly, therefore, resolved that instead of the Africa Malaria Day, the World Malaria Day would be commemorated each year to provide education and understanding of the disease and also spread the information on a year-long intensified implementation of national malaria-control strategies, which include community-based activities for malaria prevention and treatment in endemic areas.
The Africa Malaria Day, which hitherto was considered an African affair, was instituted in 2000 when the historic Abuja Declaration was signed by 44 African malaria-endemic countries, including Ghana, at the African Malaria Summit in Abuja, Nigeria.
This year’s commemoration of the first World Malaria Day on the theme “Malaria-A Disease Without Borders” is significant. That is so because according to the WHO, nearly 40 per cent of the world’s population is at risk of suffering from the disease. These are found mostly in Asia and Africa, with Africa south of the Sahara being at a higher risk of infection. Indeed, records have it that about 90 per cent of all the cases are recorded in sub-Saharan Africa which include Ghana.
One of the reasons for choosing the theme: Malaria-A Disease Without Borders is that, mosquito, the insect which transmits malaria carry the disease from country to country through airplanes and vehicles without any immigration checks.
Malaria has been noted to bring about poverty and underdevelopment due to the amount of money spent in managing the various episodes people living in endemic areas suffer. It is one of the main causes of absence from work and also school absenteeism among school children and teachers.
In his address at the World Malaria Day celebration in Accra, where hundreds of people made up of health personnel, community based non-governmental organisations (NGOs) in malaria control, corporate bodies, development partners, various sponsors of malaria control programmes in the country and the public were assembled, the Minister of Health, Major Courage E. K. Quashigah (retd) said there was the need for governments, corporate bodies and international institutions to unite for an aggressive scale-up of malaria control.
“Malaria has defeated us for so long, it is a time for us to defeat it and leave a nation free of this menace for our children to inherit”, the Health Minister stressed.
The well attended event was organised by the National Malaria Control Programme (NMCP), of the Ghana Health Service (GHS) with sponsorship from the United Nation’s Global Fund and a number of international and local bodies.
To be able to fight the disease, the health minister saw the need to begin the fight within the communities Ghanaians lived in, and called on the people to be responsible for their immediate surroundings and destroy the breeding grounds of mosquitoes.
Quoting from a well known statement made by the Greater Accra Regional Minister, Sheikh I C. Quaye, Major Quashigah said “Malaria does not respect immigration laws. The mosquito does not need visa to travel from country to country”.
One would not be wrong to state that the WHO might have learnt from Sheikh Quaye when it chose the theme for this year’s celebration as: “Malaria— A disease without border”.
To the Regional Minister, mosquitoes do not need visa to travel to his territory, the Greater Accra Region.
In her presentation, the Programme Manager for the NMCP, Dr (Mrs) Constance Bart-Plange, expressed disappointment that malaria continued to be considered the number one disease in Ghana in spite of all the efforts at reducing it, and wanted to know whether the high number of cases usually recorded at health facilities are actually malaria cases .
She mentioned some of the interventions as increase in the use of insecticide treated nets (ITNs), the use of malaria preventive drugs during pregnancy, indoor residual spraying (IRS) as was being piloted in Obuasi and its environs by AngloGold Ashanti and larviciding where mosquito larvae are killed through chemical application at their breeding grounds and also environmental management.
On management and treatment of the disease, Dr Bart-Plange said enough education had gone on to let the people to appreciate to receive proper treatment and pointed out that the country had always followed recommendations made by the WHO hence the promotion of the use of artesunate amoadiaquine.
Without denying the fact that Ghana is a malaria endemic country, the Programme Manager believed that there is the possibility that many of the diseases recorded as malaria in the country’s health facilities might not be malaria after all. Her reasons are that many diseases present symptoms similar to that of malaria so without proper diagnosis, one might be forced to conclude that all such diseases are malaria and record them as such.
To her, there is the need to differentiate between malaria and other fever-causing diseases and treat them accordingly.
She pointed out that fever, which is increase in temperature, is one of the main symptoms which is always taken as malaria, adding that not “all fevers are malaria”. Other symptoms such as headache, chills and vomiting are also associated with uncomplicated malaria and are always concluded as malaria.
Dr Bart-Plange added that diseases such as urinary tract infection, typhoid, tonsillitis, meningitis, influenza, viral hepatitis, HIV/AIDS, pelvic infections, appendicitis and beginning of pregnancy also show similar signs as those that manifest in malaria infection.
She went further to state that a sign such as change in behaviour which occurs in severe malaria is also found in mental disorder, typhoid psychosis and brain tumour; convulsions, which occur in severe malaria also occur in epilepsy and brain defects and another symptom, difficulty in breathing also affects people who have pneumonia and asthma.
Other forms of symptoms of malaria include reduced urine output which could also manifest in people who suffer from renal disease; severe anaemia could occur during worm infestation; coke-like urine could be side effect of certain medications and a health problem called haemolysis and also spontaneous bleeding which is a symptom of severe malaria is one of the symptoms of leukaemia.
Her point is; how then can any health worker conclude that one is suffering from malaria when he or she is showing any of these signs without conducting proper laboratory test to actually determine the cause of the patient’s ailment?
Dr Bart-Plange based her argument on the fact that only few fever cases are confirmed by laboratory tests as malaria and again pointed out that only 14 per cent malaria cases are confirmed through microscopy (laboratory test).
She expressed the fear that if other diseases are not properly treated but wrongly handled as malaria, patients are likely to die from the lack of adequate treatment, a situation which she said could lead to deaths which could have been prevented.
In order to actually detect and treat malaria, laboratory confirmation is crucial because according to Dr Bart-Plange said “not all fevers are malaria”.
Looking at the conditions of the country’s health facilities where there are usually the lack of staff and adequate laboratory equipment, one may ask whether it is possible for every patient who reports at a health centre, especially the public ones, to be tested through microscopy to determine exactly what is wrong with him or her.
That notwithstanding, it will save all us, as a nation, if individuals involved would make some efforts to go for laboratory tests if they realise that although they have been given adequate treatment for malaria, the symptoms remain. For all you know, your ailment might not be malaria but something else which needs a different treatment.
Laboratory testing is important in diagnosing diseases. That is the more reason why Dr Bart-Plange expressed appreciation for the role being played by President George Bush’s Malaria Initiative (PMI) which she said will support among other things, laboratory diagnosis as part of the fight against malaria in Ghana for the next three years.
The programme which is to commence this year will help in determining the actual number of people who suffer from malaria so as to know how to tackle the problem effectively.

Monday, May 12, 2008

The sickle cell disease — not a mysterious one

Monday, May 12, 2008 (Daily Graphic, Pg 27)
By Lucy Adoma Yeboah

SIXTEEN-year-old Master Gideon Asante was forced to abandon school at secondary level because both his teachers and schoolmates continually made fun of him for often complaining of ill health, a situation he felt too stressful to bear. Gideon was a sickle cell patient who often had crisis because conditions in the boarding school was not good for his health.
In another scenario, Maame Afia Asantewaa was considered a witch among the people she lived with in Ntowkrom. The reason was that she lost four out of the six children she had when they were very young. The accusation continued until one of the surviving children was tested and found to be suffering from the Sickle Cell disease, a disease which probably might have claimed the lives of all the four children who may not have had proper care.
The Sickle Cell disease is neither a new disease nor is it a mysterious one. It is not caused by evil spirits and it is certainly not a curse. The disease is not contagious. It does not change into another disease later in one’s life.
The Sickle Cell disease is not a condition one grows out of, yet it is not a disease that must kill in childhood. It is not a disease of only people of Africa and it is also certainly not a disease of only black people.
Due to the seriousness of the disease in mostly Africa, there are a number of groups that try to educate people on the issue and among them is an advocacy group called the Federation of Associations of Sickle Cell Societies with its headquarters in Nigeria.
As the group celebrates the annual Africa Day of Sickle Cell on May 10 this year, it has called on all Ghanaians, as well as the government and institutions, to be committed to Ss alleviating the plight of Sickle Cell patients.
According to the Sickle Cell Disease Association of America, the disease is an inherited blood disorder that affects red blood cells. People with the Sickle Cell disease have red blood cells that contain mostly haemoglobin “S”, an abnormal type of haemoglobin. Sometimes these red blood cells become sickle-shaped (crescent shaped) and have difficulty passing through small blood vessels.
It states that when sickle-shaped cells block small blood vessels, less blood can reach that part of the body. Tissue that does not receive a normal blood flow eventually becomes damaged. This is what causes the complications. There is currently no universal cure for the Sickle Cell disease.
Types of Sickle Cell Disease
There are several types of the Sickle Cell disease. The most common are: Sickle Cell Anaemia (SS), Sickle-Hemoglobin C Disease (SC), Sickle Beta-Plus Thalassemia and Sickle Beta-Zero Thalassemia.
What is Sickle Cell Trait?
The Sickle Cell trait (AS) is an inherited condition in which both haemoglobin ‘A’ and ‘S’ are produced in the red blood cells, always more ‘A’ than ‘S’. The Sickle Cell trait is not a type of Sickle Cell disease. People with Sickle Cell traits are generally healthy.
Sickle Cell conditions are inherited from parents in much the same way as blood type, hair colour and texture, eye colour and other physical traits. The types of haemoglobin a person makes in the red blood cells depend on what haemoglobin genes the person inherits from his or her parents. Like most genes, haemoglobin genes are inherited in two sets; one from each parent.
If one parent has Sickle Cell Anaemia and the other is Normal, all of the children will have sickle cell trait.
If one parent has Sickle Cell Anaemia and the other has Sickle Cell Trait, there is a 50 per cent chance (or one out of two) of having a baby with either the Sickle Cell disease or a sickle cell trait with each pregnancy.
When both parents have the Sickle Cell Trait, they have a 25 per cent chance (one out of four) of having a baby with sickle cell disease with each pregnancy.
A simple blood test followed by a laboratory technique called Haemoglobin Electrophoresis will determine the type of haemoglobin one has.
When you pass an electric charge through a solution of haemoglobin, distinct haemoglobin move different distances, depending on their composition. This technique differentiates between normal haemoglobin (A), Sickle haemoglobin (S), and other different kinds of haemoglobin (such as C, D, E, etc.).
Medical Problems
Sickle Cells are destroyed rapidly in the body of people with the disease causing anaemia, jaundice and the formation of gallstones.
The Sickle Cells also block the flow of blood through vessels resulting in lung tissue damage (acute chest syndrome), pain episodes (arms, legs, chest and abdomen), stroke and priapism (painful prolonged erection). It also causes damage to most organs including the spleen, kidneys and liver. Damage to the spleen makes Sickle Cell disease patients, especially young children, easily overwhelmed by certain bacterial infections.
Health maintenance for patients with sickle cell disease starts with early diagnosis, preferably in the newborn and includes penicillin prophylactics, vaccination against pneumococcus bacteria and folic acid supplementation.
Treatment of complications often include the use of antibiotics, pain management, intravenous fluids, blood transfusion and surgery, all backed by psycho-social support. Like all patients with chronic disease, patients are best managed in a comprehensive multi-disciplinary programme of care.
Discovered and studied during the first half of the 20th century, Sickle Cell disease is still not very well known and appreciated by the population of Africa where it constitutes the number one genetic disease.
The disease is considered the number one cause of mortality among those less than five years of age and also tops the list, although it is not counted among the six childhood killer diseases.
Sickle Cell is a major cause of absenteeism and low productivity, and causes a lot of harm to the development of countries where it renders unproductive, their productive labour force.
Due to its serious progression and debilitating character, the morbidity that it brings in its wake, makes it a very serious public health problem.
Of every million children born in Ghana, no less than 30,000 inherit an abnormal gene relating to haemoglobin formation from both parents resulting in the disease. More than 20,000 of this number are likely to suffer from the sickle cell disease. – (F.I.D. Konotey-Ahulu-The Sickle Cell Disease Patient, 1991).
In Ghana, the Sickle Cell disease is considered by the public as a rheumatic disease, recognised in various languages and is described based on the grinding bone pain experienced by the patients.
Some of the local names are ‘twetweetwe’ in Ga, ‘sasabro’ in Twi and ‘Nudui” in Ewe.
Some of the untruths that are making the rounds are that only black people have Sickle Cells; that patients never live beyond the age of 20; that sickle cell patients have a low Intelligent Quotient ( IQ) and are therefore incapable of higher education. Another untruth is that people with Sickle Cell traits stand the danger of having ‘sickle cell crisis’ when they fly in unpressurised aircraft and that sickle cell diseased women cannot have children.
According to health experts, by the nature of the disease, hospitalisation is quite frequent if parents and patients do not have any knowledge of the management of the disease at home.
Families living with the disease are mostly in the low-income group and therefore, struggle to meet the high cost of admissions and treatment. Sickle Cell patients are not given any considerations at all in the payment of medical and laboratory bills and because they cannot afford these high bills, they are not sent to hospitals until their condition becomes very critical.
For those who have to be transfused, which is a common treatment option, it is a major problem accessing blood.
In view of the above, there is the need for well set-out health centres in at least all regional capitals to cater for the medical and psycho-social needs of sickle cell patients. They need to get some relief from this painful disease.