World Malaria Day 2014 – How Best to Invest in Malaria Prevention and Control

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Each year, April 25 provides an opportunity to reflect on the current status of the fight against malaria. We are in the middle year of the World Malaria Day theme of “Invest in the Future. Defeat Malaria,” which is set to last until 2015.

Funding for malaria control and prevention, as with all international public health endeavors, has always been perceived as a critical issue, but there is a refreshing diversity to the ways in which it is being discussed this World Malaria Day.  The U.S. Centers for Disease Control and Prevention (CDC), who spear-headed the successful eradication of malaria in the U.S. back in the 1950s, specifically mention their efforts to maximize effectiveness, and their strategies for using and evaluating new tools such that they can get the most impact per precious dollar spent.  The WHO has highlighted the importance of sustained political commitment, as a crucial factor related to ensuring continued financial support for malaria initiatives. The Global Fund to Fight AIDS, TB, and Malaria recently announced a new funding model, designed to enable “strategic investment for maximum impact.” [Read more…]

Mobile Technology Used to Fight Malaria Drug Counterfeiting

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African Social Enterprise mPedigree Networks has been running a program in Nigeria and Ghana that allows consumers to verify the authenticity of anti-malaria drugs by using mobile phone SMS technology. With the new service, patients taking a range of medication and send a free text message to get an instant response as to whether the medications are genuine.

Counterfeit medicines often contain the wrong quantity of active pharmaceutical ingredients, which can result in illness or death. The system assigns a code that is revealed by scratching off a coating on the drugs’ packaging. This code can be text messaged by the consumer or medical professional to a free SMS (short message service) number to verify the authenticity of the drug.

If the drug packaging contains a counterfeit code, the consumer will receive a message alerting them that the pack may be a fake, as well as a phone number to report the incident. Pharmaceutical safety regulators in Ghana and Nigeria are working to ensure that the concerns of users are promptly addressed.

“Counterfeit pharmaceuticals are a big problem for developing nations, particularly in Africa. It is important that we developed an African solution to an African problem, using the resources and technologies that are widely available and easy to implement,” said Bright Simons, founder, mPedigree Network. “It’s absolutely imperative that people can trust the authenticity of the drugs they are consuming, and this system will give them an easy and effective way of doing so.”

“Over the years, we have invested a huge amount of time and money in developing drugs which will protect the health of people around the world,” said Dr. Joseph Ikemefuna Odumodu, chief executive, May & Baker Nigeria, and president, West African Pharmaceutical Manufacturers Association. “It’s in both our and our customers’ interest that they receive the full benefit of that investment. This system will safeguard both of us now and in the future.”

HP is providing the hosting infrastructure for the service, as well as the security and integrity systems, through its data centers in Frankfurt, Germany. mPedigree Network is providing the business process interfaces that allow pharmaceutical companies to code their products for the system and to monitor use of genuine and counterfeit drugs.

The service, which was endorsed by the West African Health Organization, is expected to be available for other medications and in more countries in the near future. All GSM mobile network operators in Ghana and Nigeria are signatories to the scheme.

“Technology plays a critical role in solving many serious health problems around the world,” said Gabriele Zedlmayer, vice president, Office of Global Social Innovation, HP. “While Nigeria and Ghana are the starting points for this program, we are working to create a scalable infrastructure to be used by other regions where counterfeit medicine is a growing issue.”

In November 2010, mPedigree won the start-up category of the Global Security Challenge in London, becoming the first organisation in the Southern Hemisphere to win the award according to the organizers, and in February 2011, mPedigree won the 2011 Netexplorateur Grand Prix at UNESCO in Paris, for combating fake medicine in Africa through texting.

Sources: HP Press Release (12-10-10); Wikipedia (http://en.wikipedia.org/wiki/Mpedigree)
More information: mPedigree; BBC

ECOWAS Program to Eradicate Malaria

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QUESTION
Why can I find no mention on your website of the ECOWAS program to eradicate malaria in their countries?

ANSWER
Thanks for bringing up ECOWAS. Since 2011, ECOWAS leaders have signaled a commitment to eradicating malaria in their region by 2015, and pilot programs are already underway in several countries, including Burkina Faso, Nigeria and Ghana. The program has centered on the use of larvicides for control of mosquito populations, thus reducing transmission. In April 2012, ECOWAS signed an agreement with Cuba in order to revitalize joint efforts to eradicate malaria in both West Africa as well as the Caribbean island. Soon after, Venezuela entered the agreement, pledging $20 million to the cause. These funds
will help support the construction of manufacturing facilities for biolarvicides in Nigeria, Cote d’Ivoire and Ghana, among other things.

In August, the Commissioner of ECOWAS emphasized the need for community engagement in the fight against malaria. A road map for measuring future progress was also drawn up by health advisers from the region; the next high-level ministerial meeting to evaluate the program will take place in West Africa, and will likely include Cuban and Venezuealan partners, in December 2012.

WHO recommends that Larviciding is indicated only for vectors which tend to breed in permanent or semi-permanent water bodies that can be identified and treated, and where the density of the human population to be protected is sufficiently high to justify the treatment with relatively short cycles of all breeding places.

URGENT HELP ON MALARIA

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QUESTION

I 25 yr old male from Lagos, Nigeria. I have been having frequent malaria since 2006 till present. My symptoms are always weakness of the body, feeling cold sometimes not always and also my mouth got better most cases. I have been to the hospital several times and the doctor told me my frequent malaria is because my blood genotype is AA and also am having a malaria parasites. I was given drugs and injection in most cases. It got to a stage I had to stop consulting the doctor and start making use of self description because the malaria goes and comes back and its cost me much money in going to the hospital every time.

The weakness is always my problem because will be restless and unable to study well even during my exams. I remember there was a period I sat down in front of my house and started crying cos I was fed up on getting weak during Xmas period while my mates were having fun. I also remember cases where I walked into one of the biggest pharmacy in my area and ask the guy which malaria drugs is the most expensive cos I was thinking the most expensive should be the most effective. He brought out some drugs which I paid some money.

I was free from malaria for the past 4 months not of recent I started having heavily symptoms mentioned above. I have taken several drugs like chloroquine 2-2-1 and Combisunate(arthmeter and lumefactrine),still yet no positive response.The Cold had stopped but my body is till getting weaker. I am just confuses don’t know what to do. I even thought of going for a HIV test soon cos I believe am not the only AA that stays in House. Others, I mean some of my family and neigbours do have often and it disappears immediately after taking some drugs.

I am fed up seriously and really don’t know what to do again.I hope you can help.

ANSWER

Thanks for your question. Getting infected with malaria doesn’t have anything to do with whether you are blood type A or O or anything else. Some people do have natural resistance to some types of malaria—for example a lot of people in sub-Saharan Africa are “Duffy negative” which means they are resistant to Plasmodium vivax malaria; other people carry the sickle cell gene, which also provides some protection.

However, it is not common to have so many repeated attacks of malaria. The first thing to do is to make sure you are protecting yourself sufficiently from mosquito bites. You can’t get malaria if you aren’t bitten by mosquitoes, and the type of mosquitoes that transmit malaria usually bite at night. As such, it is crucial to sleep every night under a long-lasting insecticide treated bednet. If you have one, it might need to be re-dipped in insecticide to make sure it keeps working effectively. Also, you should make sure all your windows and doors are properly screened to prevent mosquitoes from coming in; many people also do something called “indoor residual spraying” where they spray insecticide on the walls inside their house to kill any mosquitoes which might come in. If you live in an urban area, this might not be necessary if you can get good screens, or indeed if you have air conditioning (mosquitoes do not like cooler environments). Finally, you should try to wear long-sleeved clothing in the evenings and at night, again to stop mosquitoes from biting.

Finally, I think it is important to make sure that you are diagnosed properly. In many places I have been to, hospitals don’t do a proper check, but if someone has even a few of the symptoms of malaria, they just give them treatment. This is not good—you need a proper diagnosis, both to see what kind of malaria you have (so you can get appropriate treatment) and also to make sure you actually have malaria, and not something else which is being ignored because they think you have malaria!

In fact, your symptoms of fatigue, weakness and cold are not very typical of malaria, which is usually characterized by very high fever interspersed with chills, nausea and body aches. As such I think you might want to talk to a doctor about other possible explanations for your symptoms, especially since they are so persistent.

Finally, in Nigeria, you should NOT be given chloroquine to treat malaria, unless your case is confirmed as not being caused by Plasmodium falciparum. Virtually all the Plasmodium falciparum in Africa is resistant to chloroquine, and so it is no longer an effective treatment. Instead, first-line treatment for malaria is recommended as an artemisinin-based combination therapy, such as Combisunate which you mention above.

What to do while on malaria medication

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QUESTION

Good day, I’m a 27yr old male currently in Nigeria. I would like to know my do’s and don’ts while on malaria medication. I ask this so I know what to forego in my athletic lifestyle- I visit the gym 3-4 times a week and have recently started horse riding.

ANSWER

There isn’t any restriction on the kinds of activities you can enjoy while on malaria medication! You should be able to continue with your normal healthy lifestyle. However, be aware that the foods you eat may have some impact on your body’s ability to uptake the anti-malarials. For example, it is recommended to take Malarone (atovaquone-proguanil) together with some food containing fat, as this aids absorption and reduces side effects. Conversely, if you are taking doxycycline, you should NOT take it within a few hours (and certainly not at the same time) as dairy products, as the calcium in milk can inhibit uptake of the drug.

Free Medical Care for Malaria

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QUESTION

Can you get free medical help for someone In Nigeria that has malaria?

ANSWER

Theoretically, the Nigerian government should provide basic services, including malaria diagnosis, through primary care clinics which are administered by local government. In addition, Nigeria has recently instituted a National Health Insurance program, which again should assist in providing health care to many sectors of the population. However, in practice, public health care in Nigeria is still hugely underfunded and not very comprehensive—the World Health Organization (WHO) recently ranked it 187 out of 191 country health systems worldwide!

As such, I would be wary of the quality and accuracy of malaria diagnosis and treatment if you obtained it for free in Nigeria—while you might get perfectly decent care, the statistics suggest the chances of this are slim. You would probably be better off looking for a private clinic, where I imagine the cost will still be quite reasonable (especially if you are part of the National Insurance program there) and the quality of care might be more reliable. Having said this, I have no personal direct experience with health care in Nigeria, public or private, so if other readers of this site have other information, please share it in the comments section below.

Malaria in Africa

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QUESTION

How many in Africa have been affected by Malaria?

ANSWER

In 2010, there were approximately 174 million cases of malaria in Africa. However, some people may present with more than one case of malaria per year (especially young children), so the number of people affected is likely considerably lower. However, 90% of deaths from malaria occur in Africa, and 60% in just six countries: Nigeria, DR Congo, Burkina Faso, Mozambique, Cote d’Ivoire and Mali. The good news is that malaria mortality has dropped by 33% in Africa since 2000, which is a very encouraging trend, though the aim of organizations such as Malaria No More is to fully eliminate deaths from malaria globally by 2015.

Celebral Malaria and Blindness

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QUESTION

I live in Nigeria. Good friend of mine complained of headaches in Dec 2011. Did an MRI went to Germany had a general check up. Back in Nigeria in January, headaches increase, she gets blind in one eye, following day the other eye, now in Germany where they have induced her into a coma. They said that she got a brain Haemorrage from the malaria. Can malaria bring blindness. What are the chances of surviving and getting back eyesight.

ANSWER

Although rare, brain hemorrhage is sometimes associated with severe cerebral malaria (caused by infection with Plasmodium falciparum, the most deadly form of malaria). This bleeding in the brain could cause blindness—whether the visual impairment is permanent or not depends on the extent of the bleeding and how much damage it caused.

I have found one case in the literature where severe malaria caused a brain hemorrhage which resulted in permanent blindness, and the authors report their case is only the second they have heard of, so this is rare indeed. Similarly, her survival will depend on how well she responds to treatment, which will likely be intravenous quinine, at least at first. Given that she is in Germany, where health care is excellent, I would say her chances are as good as they would be anywhere else in the world. I hope she makes a full and swift recovery!

How long do I need to carry a Malaria Risk Card

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QUESTION

Hello, 13 months ago I worked in Nigeria, Africa for a period of 6 weeks. During which time I took Malarone tables daily. I think I was only bitten once or twice when there – but have never had Malaria. I currently carry a Malaria Risk Card in my wallet. At the time I was told I could potentially contract Malaria up to a period of 2 years after exposure – is this correct, or can I now remove the Risk Cards from my wallet?

ANSWER

If you never had malaria while you were in Nigeria, then you certainly would not still be at risk from it now. The only case in which you might still be at risk is if you had been diagnosed with either Plasmdodium ovale or P. vivax (two of the five forms of malaria that infect humans) – these can cause relapses months or even years after initial infection.

However, as I said above, since you did not have malaria at all, this does not apply to you. It is true that malaria has a latent phase, and so can sometimes only start to cause symptoms after someone returns home from a malarial area, but this period is usually one or two weeks, and certainly not months or years!

Diagnosed with Malaria in Nigeria

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QUESTION:

Hi my twin sister is in Nigeria on a 5 month missions trip. She has just been diagnosed with Malaria, they believe she got it a year ago in El Salvador and that it has been dormant in her system, she has week kidneys and has chronic high blood pressure due to childhood illnesses she has had her whole life. She is in the Northern part of Nigeria and the hospitals there are no real help, my questions is…. in your opinion should come home now to recover?? I am sure the type of Malaria she has, I have been doing lots of research and I am extremely concerned for her health. She has always had health issues and I am wondering if the malaria will be even worse for her given her pre-existing health conditions. It is very hard to reach her so I am not able to ask her many questions, I know she is in pain, can’t keep food down and currently is not being treated in a hospital. Any thoughts or recommendations would be appreciated!!! ASAP Please! Thank You! Tasha

ANSWER:

Hi Tasha, I answered your question directly in response to the comment you made on the Malaria Symptoms post, but here it is again:

Sorry for the slow reply, I’ve been travelling. It sounds like your sister really needs urgent medical attention, and is not receiving that where she is in northern Nigeria. If possible, I would try to encourage her to seek further medical help, either in the area she is in or, if she is able to travel, in one of the major cities. If they have accurately diagnosed the type of malaria she has (which is presumably how they suspected she was infected in El Salvador, since it is likely not a species of malaria that is commonly found in Africa), it will be straightforward to give her treatment, but any physicians she sees must be made aware of her existing health conditions. If she has Plasmodium vivax, which is often found in Central America, she should also look into taking a course of drugs (called primaquine) which will prevent further recurrence of the disease at a later date. Hope this has been of some help and that she is on the road to recovery already.

AND:

In addition to the above, I have just received some advice from a medical doctor who is involved with our website:

If she contracted it in El Salvador, then Plasmodium vivax most likely and not a particularly resistant strain (generally chloroquine sensitive west of Panama Canal). I think this could be easily treated in Nigeria so long as the diagnosis is clear and there are drugs available – almost any standard regimen would be effective. Did she have anything with her for prophylaxis or stand-by treatment? Chloroquine/mefloquine/Malarone shouldn’t need much adjustment for her kidneys, but it would help to know what her renal function is (GFR/Creatine). The pain and nausea/vomiting present a problem in keeping the medication down, however, even IV hydration is an option if she is becoming dehydrated from the illness. In general, more details are needed, as worsening kidney problems from hydration or gall bladder problems from not eating could complicate the picture, even if the malaria is treated. I don’t know where home is, but she should at least get to a town where basic blood work can be obtained, and anti-nausea medication/IV fluids are available.