Coartem Treatment

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QUESTION

my husband has been taking coartem for 3 days now. He was fine yesterday and then last night the symptoms re-appeared like it was day one. Can I carry on with coartem and start another course? Or shall I switch to something else ? If so, what? We live in zambia by the way.

Thank you for your help.

ANSWER

If your husband still has strong symptoms after taking all doses of the Coartem, go back to see your doctor  or to the clinic for another blood test. If it is positive, then your doctor may recommend trying a different form of anti-malarial medication—artemisinin-based combination therapy (a group of medications that includes Coartem) is recommended as the first-line treatment against malaria, but a second line option could be atovaquone-proguanil (Malarone) or another medication. Please note that Fansidar (sulfadoxine and pyrimethamine) and chloroquine are not recommended for use in Africa as levels of resistance are high. 

It could be that the medication hasn’t had time to fully act, which is why it is important to wait until the full dose has been taken, and then to confirm that malaria is still present. Sometimes the side effects of anti-malarials can appear similar to malaria itself, such as nausea, chills, body aches, etc, so it is important not to start another course of treatment without further diagnosis.

We are actually very interested in learning about our readers’ experiences with anti-malarial medications, and so we would be very grateful if you might be able to take a few minutes to complete our malaria survey we are running on Malaria.com. We will post any findings that may be of interest to our readership on Malaria.com later this year—all submissions are completely anonymous. Many thanks for your time and help, and I hope your husband recovers fully soon.

Malaria in Kitwe Zambia

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QUESTION

Is it dangerous for my children two years old in Kitwe?

ANSWER

Kitwe has been part of the Roll Back Malaria campaign to control malaria in Zambia—the program has been very successful, reducing deaths by malaria by over 65% nationwide. However, there still is a risk of contracting malaria in most parts of the country, and so preventative measures should be taken when visiting or living in Kitwe, such as sleeping under a long-lasting insecticide treated bednet, wearing long-sleeved clothing in the evening and at night and screening doors and windows to prevent mosquitoes from entering.

Malaria and Nkadu Luo

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QUESTION

When did professor Nkadu Luo discover that female mosquito causes malaria?

ANSWER

Professor Nkadu Luo is a microbiologist and immunologist in Zambia. Most of her work has been on HIV/AIDS and sickle cell anaemia. She has also been a key figure in promoting screening of blood banks in Zambia for infectious diseases such as HIV and malaria. However, the discovery that female mosquitoes transmit malaria was made much earlier—taxonomists as early as the mid-19th century were aware of differences in the mouthparts between male and female mosquitoes of certain species, which allowed them to determine that they were feeding on different things (female mosquitoes who feed on blood have very specialised mouthparts, for example).

Then, in the late 1890s, a British doctor called Ronald Ross discovered that mosquitoes transmit malaria parasites when they feed on blood. Prof Luo probably learned about the cycle of malaria transmission during her extensive biomedical training.

In What Countries is Malaria Found?

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QUESTION

What countries can malaria be found in?

ANSWER

Malaria is found on every continent of the world except Antartica—however, regular transmission every year mainly only occurs in Central and South America, Africa, parts of the Middle East, Asia and parts of Oceania/the Pacific Islands.

The world’s highest areas of malaria prevalence and transmission occur in sub-Saharan Africa, followed by India, south-east Asia (especially the Indo-Pacific islands, such as Papua New Guinea) and parts of Central America and northern South America.

Based on the latest available data, the top five countries reporting the most annual malaria deaths were Kenya, the Democratic Republic of Congo, Cote d’Ivoire and Burkina Faso. However, the top five countries with the highest number of malaria cases per 100,000 members of the population were Guinea, Botswana, Burundi, Zambia and Malawi.

The Solomon Islands have the highest number of malaria cases per 100,000 outside of Africa, followed by Yemen. Note that these statistics are highly dependent on quality of diagnosis, treatment and reporting!

Is it Malaria?

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QUESTION

I was in Zambia 3-4 weeks ago and had yellow fever shot and malaria pills. A week ago I got a severe headache. I suffer from migraines now and then but it wasn’t one. The headache has not passed. 4 days ago I was feeling really ill. I was extremely tired and disorientated. I am nauseated, but not all the time. Have no appetite. I generally feel ill, like something isn’t right. Exhausted and almost confused. I just don’t have a fever and haven’t had the entire time—that’s why I haven’t been to doc for tests. Is having a fever the main symptom for Malaria? I am not pregnant and am generally a very healthy person.

Not sure if I should go for tests or just wait a few more days?

ANSWER

Fever is certainly a key symptom associated with malaria, due to the way the disease progresses through the human body. However, if you were taking malaria pills, it might be that they suppressed the infection sufficiently to reduce your symptoms. I would certainly recommend having a malaria test, if just for peace of mind. If you test positive you can immediately be treated, and if you are negative and still feeling unwell, you can discuss other possibilities with your doctor. One thought might be worm infections – helminths such as hookworm, roundworm (Ascaris or Strongyloides) or whipworm are very common in Zambia and are associated with symptoms of tiredness, listlessness, headache and nausea. The tests for these diseases are usually easy to perform from either a stool sample or blood test, and treatment is likewise very straightforward, with a single dose of albendazole or mebendazole for Ascaris, whipworm and hookworm, and a series of doses for Strogyloidiasis (this parasite can be harder to get rid of, though it is still very treatable. Ivermectin is another possible drug for this helminth).

Contrasting Patterns of Malaria Drug Resistance Found Between Humans and Mosquitoes

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A recent study has detected contrasting patterns of drug resistance in malaria-causing parasites taken from both humans and mosquitoes in rural Zambia.

Parasites found in human blood samples showed a high prevalence for pyrimethamine-resistance, which was consistent with the class of drugs widely used to treat malaria in the region. However, parasites taken from mosquitoes themselves had very low prevalence of pyrimethamine-resistance and a high prevalence of cycloguanil-resistant mutants indicating resistance to a newer class of antimalaria drug not widely used in Zambia.

The study was conducted by researchers at the Johns Hopkins Malaria Research Institute and their Zambian colleagues and the findings were published November 7, 2011 in the online edition of the journal PNAS.

Surveillance for drug-resistant parasites in human blood is a major effort in malaria control. Malaria in humans is caused by the parasite Plasmodium falciparum, which is spread from person to person through the feeding of the Anopheles mosquito. Over time, through repeated exposure to medications, the parasites can become less susceptible to drugs used to treat malaria infection, limiting their effectiveness.

“This contrast in resistance factors was a big surprise to us,” said Peter Agre, MD, an author of the study and director of the Johns Hopkins Malaria Institute. “The contrast raises many questions, but we suspect that the malaria parasite can bear highly host-specific drug-resistant polymorphisms, most likely reflecting very different selection preferences between humans and mosquitos.”

For the study, Sungano Mharakurwa, PhD, lead author and senior research associate with the Johns Hopkins Malaria Research Institute in Macha, Zambia, conducted a DNA analysis of P. falciparum found in human blood samples to those found in mosquitoes collected inside homes in rural Zambia. In samples taken from human blood, pyrimethamine-resistant mutations were greater than 90 percent and between 30 percent to 80 percent for other polymorphisms. Mutations of cycloguanil-resistance were 13 percent.

For parasites found in the mosquito midgut, cycloguanil-resistant mutants were at 90 percent while pyrimethamine-resistant mutants were detected between 2 percent and 12 percent.

“Our study indicates that mosquitoes exert an independent selection on drug resistant parasites—a finding that has not previously been noticed. If confirmed in other malaria endemic regions, it suggests an explanation for why drug resistance may appear so rapidly,” said Mharakurwa.

Worldwide, malaria afflicts more than 225 million people. Each year, the disease kills approximately 800,000, many of whom are children living in Africa.

Authors of “Malaria antifolate resistance with contrasting Plasmodium falciparum dihydrofolate reductase (DHFR) polymorphisms in humans and Anopheles mosquitoes” are Sungano Mharakurwa, Taida Kumwenda, Mtawa A. P. Mkulama, Mulenga Musapa, Sandra Chishimba, Clive J. Shiff, David J. Sullivan, Philip E. Thuma, Kun Liu and Peter Agre.

The Johns Hopkins Malaria Research Institute is a state-of-the-art research facility at the Johns Hopkins Bloomberg School of Public Health. It focuses on a broad program of basic science research to treat and control malaria, develop a vaccine and find new drug targets to prevent and cure this deadly disease.

Funding was provided by the Johns Hopkins Malaria Research Institute, the Bill & Melinda Gates Foundation and the National Institutes of Health.

Source: Johns Hopkins University

Global Fund Responds to News Stories About Corruption in Grant Spending

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Officials from the Global Fund to Fight AIDS, Tuberculosis and Malaria are criticizing recent media reports of misuse of Global Fund grants. They say the reports are based on incidents that occurred and were acted on last year and contain no new revelations.

The media reports claim corruption is taking a big bite out of the billions of dollars of grant money disbursed by the Global Fund. And, they contend as much as two-thirds of some grants are used fraudulently.

The Fund’s Executive Director, Michel Kazatchkine, says the Global Fund has zero tolerance for corruption and actively seeks to uncover any evidence of misuse of its funds.

He says the incidents referred to in recent media reports concern the grave misuse of funds in four of the 145 countries that receive grants. He says those cases figured prominently in last year’s Inspector General’s report.

“As a result, immediate steps were taken in Djibouti, in Mali, in Mauritania and in Zambia, to recover misappropriated funds and to prevent future misuse of grant money,” he said. “In total, the Global Fund is demanding the recovery of $34 million unaccounted for in these and other countries out of a total disbursement of $13 billion.”

Kazatchkine says criminal proceedings are underway in Mali, Mauritania and Zambia. He says the Fund has suspended relevant grants in Mali and Zambia and ended another grant in Mali.

Kazatchkine says transparency is a fundamental principle behind all of the work of his organization. He adds the Global Fund is fully accountable to its donors about all of its expenditures and is committed to preventing any misuse of its money.

”What is of concern to me, of course, is that this shakes beyond that a global public opinion somehow at a time when governments are under pressure to cut public expenditures and where millions of lives that depend on the Global Fund and the hope the Global Fund is bringing to the world could thus be at risk,” said Kazatchkine.

Kazatchkine says the lives of 4,000 people suffering from AIDS, tuberculosis and malaria are saved every day as a consequence of the grant money disbursed by the Fund.

He says the Fund and the Office of the Inspector General are strengthening efforts to prevent fraud. He says so-called higher risk countries are being closely monitored to make sure none of the money goes astray.

Source: VOA

WHO’s World Malaria Report Shows Rapid Progress Toward Targets

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A massive scale-up in malaria control programmes between 2008 and 2010 has resulted in the provision of enough insecticide-treated mosquito nets (ITNs) to protect more than 578 million people at risk of malaria in sub-Saharan Africa.

Indoor residual spraying has also protected 75 million people, or 10% of the population at risk in 2009. The World Malaria Report 2010 describes how the drive to provide access to antimalarial interventions to all those who need them, called for by the UN Secretary-General in 2008, is producing results.

Downward trend in malaria

In Africa, a total of 11 countries showed a greater than 50% reduction in either confirmed malaria cases or malaria admissions and deaths over the past decade. A decrease of more than 50% in the number of confirmed cases of malaria was also found in 32 of the 56 malaria-endemic countries outside Africa during this same time period, while downward trends of 25%–50% were seen in eight additional countries. Morocco and Turkmenistan were certified by the Director-General of WHO in 2009 as having eliminated malaria. In 2009, the WHO European Region reported no cases of Plasmodium falciparum malaria for the first time.

Results: the best in decades

The WHO Director-General, Dr Margaret Chan, highlighted the transformation that is taking place, “The results set out in this report are the best seen in decades. After so many years of deterioration and stagnation in the malaria situation, countries and their development partners are now on the offensive. Current strategies work.”

“The phenomenal expansion in access to malaria control interventions is translating directly into lives saved, as the WHO World malaria report 2010 clearly indicates,” said Ray Chambers, the UN Secretary-General’s Special Envoy for Malaria. “The strategic scale-up that is eroding malaria’s influence is a critical step in the effort to combat poverty-related health threats. By maintaining these essential gains, we can end malaria deaths by 2015.”

Strategies to fight malaria

The strategies to fight malaria continue to evolve. Earlier this year, WHO recommended that all suspected cases of malaria be confirmed by a diagnostic test before antimalarial drugs are administered. It is no longer appropriate to assume that every person with a fever has malaria and needs antimalarial treatment. Inexpensive, quality-assured rapid diagnostic tests are now available that can be used by all health care workers, including at peripheral health facilities and at the community level. Using these tests improves the quality of care for individual patients, cuts down the over-prescribing of artemisinin-based combination therapies (ACTs) and guards against the spread of resistance to these medicines.

Fragility of malaria control

While progress in reducing the burden of malaria has been remarkable, resurgences in cases were observed in parts of at least three African countries (Rwanda, Sao Tome and Principe, and Zambia). The reasons for these resurgences are not known with certainty but illustrate the fragility of malaria control and the need to maintain intervention coverage even if numbers of cases have been reduced substantially.

Work remains to attain targets

The report stressed that while considerable progress has been made, much work remains in order to attain international targets for malaria control.

  • Financial disbursements reached their highest ever levels in 2009 at US$ 1.5 billion, but new commitments for malaria control appear to have levelled-off in 2010, at US$ 1.8 billion. The amounts committed to malaria, while substantial, still fall short of the resources required for malaria control, estimated at more than US$ 6 billion for the year 2010.
  • In 2010, more African households (42%) owned at least one ITN, and more children under five years of age were using an ITN (35%) compared to previous years. Household ITN ownership reached more than 50% in 19 African countries. The percentage of children using ITNs is still below the World Health Assembly target of 80% partly because up to the end of 2009, ITN ownership remained low in some of the largest African countries.
  • The proportion of reported cases in Africa confirmed with a diagnostic test has risen substantially from less than 5% at the beginning of the decade to approximately 35% in 2009, but low rates persist in the majority of African countries and in a minority of countries in other regions.
  • By the end of 2009, 11 African countries were providing sufficient courses of ACTs to cover more than 100% of malaria cases seen in the public sector; a further 5 African countries delivered sufficient courses to treat 50%–100% of cases. These figures represent a substantial increase since 2005, when only five countries were providing sufficient courses of ACT to cover more than 50% of patients treated in the public sector.
  • The number of deaths due to malaria is estimated to have decreased from 985 000 in 2000 to 781 000 in 2009. Decreases in malaria deaths have been observed in all WHO regions, with the largest proportional decreases noted in the European Region, followed by the Region of the Americas. The largest absolute decreases in deaths were observed in Africa.

In summary, the report highlights the importance of maintaining the momentum for malaria prevention, control, and elimination that has developed over the past decade. While the significant recent gains are fragile, they must be sustained. It is critical that the international community ensure sufficient and predictable funding to meet the ambitious targets set for malaria control as part of the drive to reach the health-related Millennium Development Goals by 2015.

Full Report:  World Malaria Report 2010

Source: World Health Organization (WHO)