FOROYAA Newspaper (Serrekunda)

Gambia: One Child Dies of Malaria Every 30 Seconds in Sub Saharan Africa--Dr. Azadeh

How effective is the new anti-malaria drug called Coartem in Africa including the Gambia? Asked Dr. Azadeh, Senior Lecturer School of Medicine and Allied Health Sciences, University of the Gambia, cum consultant obstetrics and gynaecology, BAFROW Medical Centre. Read on to find out the possible answers.

Preventable and curable, malaria remains a devastating disease infecting millions of people each year and causing an estimated over one million deaths, its tool is heaviest among the young children in the Sub Saharan Africa.

Malaria is more than an ordinary disease on African continent. It has major implications on all essential aspects of our life - as individual, as families, as communities and as a nation.

Malaria parasite had developed resistance to the older anti-malaria drugs such as chloroquine on which African countries had relied on for decades. In some countries, cure rates had dwindled as low as a single patient for every 10 patients treated. Physicians were desperate for an effective new medicine.

Working with the partners in china, Novartis had developed coartem, the first of a new class of anti-malaria medicine, known as ACT. A component used for centuries in traditional Chinese medicine to treat fever. It has been reported that in clinical trials coartem achieved cure rates of up to 95%, even in areas of multi drug resistance.

During 2006, more than 62 million treatment courses of coartem were delivered to more than 30 countries across Africa, helping to save an estimated 200,000 lives.

In Zambia, the first country in Africa to adopt coartem as first- line therapy against malaria, a survey of more than 100 health centres demonstrated substantial improvement in availabilities of the drug at remote health care facilities as well as in the proportion of children who were treated with coartem, compared to result of similar national survey in 2004.

Malaria disease is a parasitic disease; this means that it is caused by a parasite, a tiny organism that lives in or on other organisms called a host. This parasite host is a mosquito. The parasite is transformed to a potential victim when he or she is bitten by the mosquito. Though treatable and preventable, annually this disease kills over one million around the world, even in the USA seen each year an average of 1,300 cases.

Signs and Symptoms:

The Symptoms of malaria can vary greatly, from no symptoms at all to start or mild to extremely serious and may even result in death. Malaria is often put into two different categories:

One is uncomplicated and the other is complicated

Incubation period:

Incubation period is from the time been bitten until the time symptoms appearing. Depending on the type of parasite the incubation period can range anywhere from a few days up to about 30 days. Some types of malaria can delay onset of symptoms for up to one year.

Uncomplicated Malaria:

The general (but very infrequent) attack of Malaria usually continues 6-10 hours. There are 3 phases to this and these usually return 2 to 3 days depending upon the type of parasite. There are 4 types:

a. The cold phase (shivering, feeling cold)

b. The hot phase (vomiting, fever, headache, convulsions in children)

c. The sweating phase (sweating, normal temperature, sleepiness)

However, more often the affected person usually has the following signs and symptoms: chills, fever nausea and vomiting, headache, general uncomfortableness and body aches. There may also be: Enlarged spleen, fever, perspiration, general weakness. In P. Falciparum Malaria there may be these added findings: enlarged liver, mild jaundices, and increase respiratory rate.

Complicated Malaria:

This usually occurs where there is either low or no immunity to this disease, including locations where Malaria Disease is rare or immunity is low because of other health risks. Complicated Malaria results in blood and organ disorders, including fluid on the lung, and loss of kidney function.

In all areas of the world complicated Malaria Disease is an emergency and should be treated as quickly and intensely as possible because without treatment other major medical problems appear and eventually death does occur. As with other conditions pregnancy is complicated by the disease resulting in possible early miscarriage is the disease is severe enough.

In addition, relapses are also known to happen, even months and years after the first attack. This is due to one genus of parasites having disease has been cured. There are medications that are able to prevent this and should be started as soon after the first attack as possible.

Treatment of Malaria disease

Diagnosis should be confirmed before any treatment is started. Laboratory tests should be performed and treatment must start as soon as possible. Not doing this should be reserved only for special cases, limiting it to those situations where clear suspicion of a very extreme cause is determined and luck of facilities necessitates doing so

Treatment:

Coartem is used to treat malaria and is a fixed dose oral combination of artemether (20mg) and lumefantrin (120 mg) two Anti-Malarias.

Coartem is specifically indicated for the treatment of acute, uncomplicated malaria infections due to plasmodium falciparum, extremely common in the Gambia in patients of 5kg bodyweight and above.

Coartem is supplied as a tablet designed for oral administration and should be better taken with food. In the event the patient is unable to swallow the tablets, such as infants and children, the tablets may be crushed and mixed with a small amount of water. The recommended initial dose of the drug is as follows:

Adult (aged 16 years and above)

A 3-days treatment schedule of 6 doses is recommended for adult patient with a bodyweight of 35kg and above. The tablets should be administered the following day: 4 tablets as a single initial dose, 4 tablets again after 8 hours and then 4 tablets twice daily (morning and evening) for the following two days (total course of 24 tables).

Paediatrics (below 16 years of aged)

A 3-days treatment schedule with a total of 6 doses is recommended as below:

5kg to less than 15kg bodyweight: one tablet as an initial dose, one tablet again after 8 hours and then one tablet twice daily (morning and evening) for the following two days (total of 6 tablets).

Important information about Coartem:

- Coartem is used to treat malaria. Do not use Coartem to prevent malaria.

- Do not use this medicine if you are allergic to the drug.

- Before using Coartem, tell your Doctor if you have a history of heart disease, liver or kidney diseases.

- Take advice about the drug if you are suffering from a long-standing other diseases.

- Coartem should not be taken in early pregnancy, it is not known whether Coartem is harmful to an unborn baby.

- Tell your Doctor if you are pregnant or plan to become pregnant during treatment.

- This drug can make birth control pills less effective.

- No medicine is 100% effective in treating malaria. For best result, keep using the medicine as directed.

- Tell your Doctor if you have fever, vomiting, or diarrhoea during your treatment

Conclusion

- Malaria kills thousands of people every day worldwide unnecessarily. With immediate and correct treatment people are able to recover from this disease with no problem.

- Malaria remains leading cause of morbidity (illness) and mortality (death)- much more than HIV/AIDS!

- More than 90% of the nation is highly endemic

- More than 50% of population experiences high transmission levels of 50 or more infective mosquito bites per person per year.

- Focus on a rapid increase of coverage with preventive measures namely; indoor residual spraying & insecticide nets.

Seek advice about this deathly disease from Medical Professionals across the country or better still contact Dr. Azadeh at email:

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