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Malaria, the African Hippopotamus
A GNA Feature by Eunice Menka
Widespread belief that
standing in the sun, eating sweet and oily foods, poor
environmental sanitation and consumption of unripe fruits
together with deep cultural belief in witchcraft has greatly
impacted on the prevention and treatment of malaria across
Africa.
Accra, Dec. 19, GNA - Malaria is one of the most ancient
tropical and sub-tropical infections known, dating back to
the fifth century B.C.
Although, there is widespread knowledge that mosquitoes
cause malaria, many African societies have traditional
perceptions about the causes and management of the disease.
It is, therefore, not surprising that everybody in Africa
can treat malaria. Of course, this depends on one's
perceptions about the causes of the condition. Right from
the household level, where self-medication is common, to
witchdoctors and herbalists, who prepare concoctions to
treat the disease, there are various medications and
preparations to treat malaria.
Some people in Ghana believe that
they suffer from malaria because they exert themselves too
much while working under the hot sun.
"In Banjul, some people believe that if you drink lots of
sour milk during the rainy season you would get malaria," Mr
Faal Momodou, a journalist with the Gambian Point newspaper,
told the GNA in an interview.
In some parts of Togo, it is believed that one suffers from
malaria from eating too much palm oil.
Widespread belief that standing in the sun, eating sweet and
oily foods, poor environmental sanitation and consumption of
unripe fruits together with deep cultural belief in
witchcraft has greatly impacted on the prevention and
treatment of malaria across Africa.
There are various interventions, therefore, to treat the
condition depending on perceptions about the disease. These
include drinking coconut juice; applying regular enema;
drinking liquid from boiled pineapple peels and boiled neem
tree leaves.
Others believe that taking in large amounts of concoctions
of herbs would treat malaria.
The truth about the causes, diagnosis and treatment of
malaria across the Continent are largely surrounded by myths
and conceptions just like the hippopotamus, which lives
largely submerged by water with only the ears sticking out.
Perceptions and myths about the causes and treatment of
malaria, which has hindered the effective management of the
disease, largely within the communities, could be likened to
the hippopotamus, which has a large part of its body
submerged in water.
"Malaria is unique because its roots lie in human
communities," Dr Margaret Gyapong, a malaria expert at the
Dodowa Health Research Centre in the Eastern, said in a
presentation at a workshop on malaria in Accra.
Early work on malaria, she said, focused on vector control.
"Work done was without reference to human behaviour and
belief system. Too often behavioural and socio-cultural
aspects were an afterthought. Lack of attention to these
aspects is some reason for the failure of early attempts at
malaria control."
She said perceptions about the disease causation affected
how communities sought treatment for the disease.
As a result of such myths, decisions to seek treatment for
malaria at health facilities are often the last resort.
"The relatively few patients, who have any contact with the
health services, represent the 'ears of the hippopotamus,'"
Dr Gyapong said.
"Usually, victims of malaria seek medical examination and
treatment from health facilities when the initial attempts
have failed resulting in late presentation.
"Very often treatment of malaria in Ghana occurs at home
with only a few of such home-based treatments being correct
and complete," Dr Gyapong said.
A Medical sociologist at the Noguchi Memorial Institute for
Medical Research (NMIMR), Dr Collins Ahorlu said perception
about a disease affected prevention activities.
"If the perception within the communities is that malaria is
not caused by mosquito but by witchcraft then drug
intervention is not an option for people of that community,"
he said.
Dr Ahorlu said health education was what was needed at this
point to help the communities to appreciate the need for
better management of the condition.
Malaria, no doubt, is a common but complex disease. Although
there have been studies to determine the proportion of
fevers actually due to malaria. Fever remains the most
recognized symptom of malaria. This situation sometimes
leads to the practice of presumptive diagnosis and treatment
on the part of both health professionals and people within
the communities.
Mismanagement of malaria cases at the health facility occurs
through presumptive diagnosis because one clinical feature
of the disease is that it is a non-specific illness.
According to Prof. Kojo Koram, Head of Epidemiology at NMIMR,
the disease could be mistaken for almost everything.
Once a patient presents a fever, the practice is sometimes
to treat the patient for malaria on clinical suspicion with
no laboratory confirmation.
This is especially so when a practitioner is faced with
patients waiting in long queues.
Although, presumptive diagnosis may have its bad side, Prof.
Koram said there were some benefits from this practice
because prompt therapy may hopefully reduce risk of
progression to severe malaria, which could be fatal
especially in children.
For those within the communities, presumptive diagnosis and
treatment reduces cost in time and money for the patient or
guardians, who may find it difficult to attend a formal
health outlet.
Prof. Koram, however, said there were drawbacks in
presumptive diagnosis because of over-exposure of population
to risk of drug toxicity.
He said there was also the "likelihood of inaccurate dosing,
including the use of sub-therapeutic treatments that may
favour the evolution or spread of drug-resistance".
Studies on health-seeking behaviour, perceptions of malaria,
treatments, and decision-making for health care at the
household, community and health facility levels, are crucial
to malaria control.
Malaria is an important social, economic and developmental
problem affecting individuals, families and communities. The
best chance for combating the disease is a collaborative
approach.
Over the last few years though, malaria control has led to
studies on perceptions about the disease. Some of these
studies have recently informed policy development.
For instance, one intervention by the Ghana Health Service (GHS)
is to bring malaria treatment closer to the communities,
especially to help to save the lives of children through the
promotion of early and appropriate home management of
malaria.
This is because the majority of children who die from
malaria do so within 48 hours of onset of illness. The early
use of effective anti-malaria medicines at home, therefore,
can help reduce the burden of the disease.
The GHS was distributing chloroquine at community level
through trained people. However, with the introduction of
the new malaria drug, artesunate amodiaquine, studies are
being conducted to see if this drug, complex in
administrating, could be distributed in the communities.
Malaria control is everybody's business and everyone should
contribute. It requires the partnership of community members
and the involvement of those engaged in health care
delivery.
Malaria is of major concern to households. "Malaria can be
detrimental to livelihoods and if not protected these costs
can push households towards poverty," Dr Gyapong warned.
In Ghana, the disease is the leading cause of workdays lost
due to illness. The condition, with the general malaise it
brings on, reduces output by increasing absenteeism from
work and school.
The World Malaria Report for 2005 indicates that there were
300 to 500 million clinical cases a year and up to 2.7
million deaths occurs globally.
Malaria is therefore not only a public health problem but
also a developmental problem that needs to be addressed by
all.
GNA
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