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REDUCING MALARIA DEATHS AMONG
CHILDREN IN RURAL GHANA —ARTESUNATE-AMODIAQUINE HOME
MANAGEMENT APPROACH
GNA Feature by KWABIA OWUSU-MENSAH
Kumasi, March 21, GNA – Malaria has been identified as the
most common but deadly disease in the world. Every day
thousands of people, especially pregnant women and children
under five years die from malaria.
It is estimated that between 1.1 million and 2.7 million
people die of malaria every year. About 3.2 million people
in 107 countries are said to live in malaria endemic areas
while an estimated 350 million to 500 million clinical
malaria episodes occurred annually in the world.
The pathetic situation is that, over 90 per cent of this
occurs in Sub-Saharan Africa and 70 per cent of the dead are
children under five years.
Africa has the greatest burden of malaria cases and deaths
in the world with malaria-related maternal anaemia in
pregnancy; low birth weight and premature delivery estimated
to cause 75,000 to 200,000 infant deaths per year in Africa
South of the Sahara.
In 2004 malaria caused 18 per cent of deaths of children
under five in Sub-Saharan Africa.
In Ghana, malaria is endemic everywhere and it is one of the
leading causes of morbidity and mortality, especially among
pregnant women and children under five.
Over the past 10 years there have been two million to three
million cases of malaria each year, representing 45 per cent
of out-patients cases and 33 per cent to 36 per cent of
in-patient cases with 36 per cent to 40 per cent OPD malaria
cases are in children under five.
It is estimated that, in Ghana, every hour four persons die
out of malaria. Two of the four are children under five.
This means about 35,040 deaths are caused by malaria every
year in Ghana. Out of this, 17,520, representing about 25
per cent are children under five years.
Mosquito bites have been identified as the main cause of
malaria.
Over the years governments all over the world have tried in
vain to prevent the breeding of mosquitoes and the
subsequent transmission of malaria. This had been attributed
to the inability of the people, especially those in the
Sub-Saharan Africa, to change their attitudes and lifestyles
towards the environment.
Choked gutters, stagnant waters, bushy surroundings, heaps
of refuse among other things are common sights in cities and
towns everyday. This has made malaria prevention and control
very difficult.
Various drugs and therapies have been developed over the
years by doctors and researchers to control and manage
malaria infections but the menace persists.
In Ghana for instance, Chloroquine had over the years been
used to treat uncomplicated malaria. However, the steady
resistance of the malaria parasite to the drug and the
reported side effects, such as itching of the body after
taking the drug compelled the Ministry of Health to
research, develop and introduce new drug,
Artesunate-Amodiaquine, which was a combination of two
drugs, to be taken on a course.
After few years of its introduction, the drug also came
under severe criticism following complaints of the severity
of the side effects.
It was in the midst of these confusions that the Department
of Community Health of the School of Medical Sciences of the
Kwame Nkrumah University of Science and Technology (KNUST),
Kumasi, decided to undertake a research to determine the
efficacy and effectiveness of the Artesunate-Amodiaquine in
the treatment of malaria in children under five in rural
communities.
The objective of the Home Management of Childhood Malaria
(HMM) using Artesunate-Amodiaquine pre-packs was to assess
the feasibility; acceptability; safety and cost of using the
drug for home management of malaria in young people in the
research areas.
It had been conducted in the Gomoa, Wa and the Ejisu-Juaben
Districts.
In the Ejisu-Juaben District, the research was conducted in
35 rural communities in the Juaben and Bomfa Sub-Districts
where access to formal health services were limited. It was
started in January 2005 and ended in August 2006.
Unit-dose blister packs (pre-packs) of
Artesunate-Amodiaquine were given to respectable and
gainfully employed individuals in the communities, popularly
called Community Drugs Distributors (CDDs) to be distributed
to mothers or caregivers to administer to children aged six
months to 60 months who had uncomplicated malaria.
The research findings, which was disseminated at a workshop
attended by District Directors of Health Services in
Ashanti; Chiefs; Assembly Members; Health Workers and
Community Health Volunteers as well as other community
leaders revealed that, 72 per cent of mothers gave their
children, who had fever pre-packed Artesunate-Amodiaquine,
with three quarters of them using the drugs appropriately
and completing the three-day course.
Ninety Nine per cent of mothers in the research communities
found the treatment highly effective for childhood malaria.
According to the findings, less than two per cent of the
children treated with the drug reported side effects in the
form of itching, vomiting and weakness.
The Report indicated that 72 per cent of mothers could tell
the correct prescription as given by the CDDs, while 70 per
cent of mothers complied fully with instructions given by
the CDDs.
Sixty per cent of the respondents sought early treatment for
children with fever within 24 hours of onset of symptoms of
malaria, while the CDDs provided the correct prescription in
99 per cent of cases of fever treated.
According to Dr E. Nii Laryea Browne, Head of the Department
of Community Health of KNUST and Leader of the Research
Team, the findings of the Study provided firm and conclusive
evidence that pre-packed Artesunate-Amodiaquine was a safe,
acceptable and effective drug for home management of Malaria
in home and near-home settings in rural communities with
poor or limited access to formal health services.
He indicated that, doubts about the use of the drug in home
management of malaria had been erased from the communities
while the method had helped to reduce the travelling time
and cost in accessing health care delivery since it was
easily available on demand and also non-discriminatory.
It is important to note that, malaria, as indicated earlier
continues to be the number one killer of children and
pregnant women in the country and every effort by scientists
and researchers, which promotes quick response and effective
treatment methods must be accepted and adopted into the
national health care delivery system.
It is in the light of this that the appeal by Dr Browne to
all stakeholders in the Health Sector, especially that of
young children, to accept and adopt the research findings
nationwide is worth supporting.
There is the need for all stakeholders to mobilize the
relevant political will and financial resources to ensure
the rapid scaling up of the home management of malaria
strategy across all rural communities in Ghana, using
pre-packed Artesunate-Amodiaquine in order to reduce malaria
deaths among children in the country.
District Assemblies, District Health Management Teams,
Opinion Leaders and Traditional Authorities should accept
this all important challenge of dealing with the malaria
menace in collaboration with the district-wide mutual health
insurance schemes.
This is because the method of treatment is cheaper and would
help to reduce the cost of medical care in the communities
and thereby reduce the burden of mutual health insurance
schemes paying huge medical bills of subscribers to service
providers.
As pointed out by Dr Browne, HMM strategy should be combined
with the existing malaria control strategies and executed in
the context of community integrated management of childhood
illness.
The use of Artesunate-Amodiaquine for home management of
presumptive malaria in rural Ghana, as revealed by the
research findings, is feasible, acceptable and safe and
should, therefore, be embraced by all to help to reduce
malaria related deaths, especially among children in the
country.
GNA
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