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THE NATION TUESDAY, APRIL 28, 2015 THE NATION HEALTH 45 E-mail:- health@thenationonlineng.net During this year’s World Malaria Day, last Saturday, the World Health Organisation (WHO) canvassed the need to address gaps in the prevention, diagnosis and treatment of malaria, writes OYEYEMI GBENGA-MUSTAPHA and WALE ADEPOJU. Can there be end to malaria scourge? THE figures are scary. Malaria, experts say, kills more people than HIV if appropriate treatment is not given. It is for this that the World Health Organisation (WHO) has called for more commitment to the eradication of the disease in Africa in particular. It made the call during this year’s World Malaria Day last Saturday, with the theme, Invest in the future: Defeat malaria, set by the Roll Back Malaria Partnership. The theme reflects the targets set in a draft post-2015 strategy, to be presented to the World Health Assembly next month. The new strategy aims to reduce malaria cases and deaths by 90 percent by 2030. Four countries have been certified free of malaria in the last decade; they are the United Arab Emirates (2007), Morocco (2010), Turkmenistan (2010) and Armenia (2011). The post-2015 strategy sets the goal of eliminating the disease from a further 35 countries by 2030. The event created a chance to highlight the advances that have been made in malaria prevention and control, and to commit to continued investment and action to accelerate progress against this deadly disease. According to WHO, while huge gains in the fight against malaria have been made in recent years, the disease still has a devastating impact on people’s health and livelihoods around the world, particularly in Africa, where it kills almost half a million children under five each year. According to WHO Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, Dr Hiroki Nakatani, effective tools to prevent and treat malaria exist, but more funds are urgently required to make them available to the people who need them and to combat emerging drug and insecticide resistance. “As we celebrate World Malaria Day on April 25, we must recognise the urgent need to expand preventive measures and qualityassured diagnostic testing and treatment to reduce the human suffering caused by malaria,” he said. Head, Malaria Research Programme at the Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Dr Sam Awolola, said malaria is still a health issue. According to the malariologist, the disease is responsible for most deaths in the country, specifically those in the rural areas where access to tests and modern drugs are often available. The researcher said most efficient mosquitoes, which transmit malaria parasites, are common in the country because of geographical location. “Malaria is also responsible for lateness or absenteeism from work and low productivity due to loss of man-hour. Malaria is a disease caused by a parasite called plasmodium falciparum carried by anopheles mosquitoes, it is the most virulent. And it is responsible for about 98 per cent cases of malaria,” he said. Awolola said: “There are several species of plasmodium depending on where people are. We have some that even attack animals. But the one that attacks human is called plasmodium falciparum as found in Nigeria, other Africa countries and the Asia. Nigeria; is endemic to malaria because there is a breeding ground for the Anopheles mosquito to thrive. To prevent malaria attack, he recommended, WHO treatment guidelines. Updated “Guidelines for the Treatment of Malaria” as issued by WHO last week. They include the latest recommendations on preventive treatment for infants, children under five and pregnant women. The updated guidelines should help expand access to recommended treatments. For uncomplicated malaria cases, WHO recommends the use of artemisinin-based combination therapies (ACTs). Globally, 392 million ACT courses were procured by malaria-endemic countries in 2013, up from just 11 million in 2005. However, millions of people are •Mosquito Guidelines on treatment Updated “Guidelines for the Treatment of Malaria” have been released by WHO. They include the latest recommendations on preventive treatment for infants, children under 5 and pregnant women. The updated guidelines should help expand access to recommended treatments. For uncomplicated malaria cases, WHO recommends the use of artemisinin-based combination therapies (ACTs). Globally, 392 million ACT courses were procured by malaria-endemic countries in 2013, up from just 11 million in 2005. However, millions of people are still not treated for malaria, primarily because the communities most affected by the disease have limited access to health care. WHO recommends diagnostic testing for all suspected malaria cases to ensure that malaria drugs are used only for those who have the disease and that—when a test is negative—other causes of fever are investigated. Rapid diagnostic tests (RDTs) are now still not treated for malaria, primarily because the communities most affected by the disease have limited access to health care. WHO recommends diagnostic testing for all suspected malaria cases to ensure that malaria drugs are used only for those who have the disease and that—when a test is negative— other causes of fever are investigated. Rapid diagnostic tests (RDTs) are now widely available and more than 319 million were purchased in 2013 compared to 46 million in 2008. Despite this progress, nearly 40 percent of people with suspected malaria at public health facilities in Africa are not tested. WHO also recommends that the most vulnerable groups in malaria-endemic areas of sub-Saharan Africa—pregnant women, children under five, and infants—receive preventive treatment to reduce the risk of malaria infection. Preventive treatments are highly cost-effective, with the potential to save tens of thousands of lives each year. Coverage with such treatments, however, remains low and needs to be significantly scaled up. The need to address gaps in preventive treatment for malaria is also being highlighted by the Roll Back Malaria (RBM) Partnership, which has issued a global call to action to increase national coverage with preventive treatment in pregnancy. The malariologist said the best initiative in malaria management is prevention which is better than cure, “and the best method is to sleep under LLINs or get your house treated with indoor residual spray (IRS); they are very effective and should be used according to instructions,” he said. widely available and more than 319 million were purchased in 2013 compared to 46 million in 2008. Despite this progress, nearly 40 percent of people with suspected malaria at public health facilities in Africa are not tested. WHO also recommends that the most vulnerable groups in malaria-endemic areas of sub-Saharan Africa—pregnant women, children under 5, and infants—receive preventive treatment to reduce the risk of malaria infection. Preventive treatments are highly cost-effective, with the potential to save tens of thousands of lives each year. Coverage with such treatments, however, remains low and needs to be significantly scaled up. The need to urgently address gaps in preventive treatment for malaria is also being highlighted by the Roll Back Malaria (RBM) Partnership, which has issued a global call to action to increase national coverage with preventive treatment in pregnancy. Source: www.who.int Dr Awolola said Nigerians should embrace the right use of long lasting insecticide treated nets (LLITNs), “insecticide-treated bed nets are the most cost-effective way to prevent its transmission. People should sleep under nets, we found out that many stopped using nets because they claimed they feel too hot underneath but this should not deter them. Our study revealed that people lifestyles could be part of the challenges of not using nets, for instance, the Fulani herd men still sleep in the open air in the north. Nigerians ought to use long lasting insecticide nets, spray the wall of their home with chemicals or use aerosol in the houses. Malaria can be prevented by applying insecticide to the inside walls of individual homes. Mosquitoes that land on treated walls are killed, preventing the transmission of malaria. Early treatment with anti-malaria drugs, such as Artemisinin-based combination therapies (ACTs) can effectively cure malaria.” Awolola said artemisinim-based combination therapy (ACT) for effective treatment of malaria, according to WHO recommendation should be adopted. He said chloroquine, which was popular in the 80s and 90s as malaria therapy, has failed. This, he said, is because there are parasites that have become resistant to it because of its wrong dosage. “It is still a very effective drug but most people take substandard dosage while some do not follow the required regimen which made the parasites develop resistance to it. This is why we changed from chloroquine and other monotherapies to ACTs. ACT is a combination of two different drugs of two varying modes of action therefore it is very effective against the parasites. In Cambodia and other parts of Asia, they have also resulted to ACTs. That does not mean there is no resistance to ACT. What we try to do at NMIR is to be vigilant. This effort is called pharmacovigilance. We monitor the use of chloroquine in the field, and the parasites with reaction to chloroquine, we’ve researched into how the drug has been effective over the parasites over the years. In whatever we do in the treatment, research or malaria, we stick to WHO recommendations,” he said. He identified a challenge. “Mosquitoes nowadays are adapting to the environment as they are also getting resistant to insecticides. This is becoming a big problem in our environment. At present, it is a key area of research in the country. We are researching into this with the help of WHO, we want to identify why the problem of resistance. We are doing that to support the National Malaria Control Programme (NMCP),” he said. He urged the government to fund malaria more, adding that providing nets or drugs alone cannot solve the problem but rather the environment where mosquitoes breed should be taken care of. “There should be environmental management and protection. Also, there should be reengineering. The way people build their houses are wrong and it encourages mosquitoes breeding. People should ensure there is environmental sanitation and avoid those practices which encourage mosquitoes, such as putting eaves in houses built, especially in the villages where we have the most burden of the disease and about 60 per cent of the country population,” he said. The researcher said the country is not yet ripe to use vaccine against malaria as the best method is what is presently being done. “Moreover, people should use the prevention prescribed and those having the disease should be promptly diagnosed and receive treatment. They must be tested to be sure they are carrying the parasite before they are given the drug, if not, it will mean they are misusing the drug, which may cause some problems later in life,” he said. Firm, NGO partner on malaria prevention By Oyeyemi Gbenga-Mustapha IN commemoration of this year’s World Malaria Day, ExxonMobil has partnered with Youth Empowerment and Development Initiative (YEDI) to combat the disease, with a tournament tagged: Kick against malaria football tournament. The tournament, now in its third year, was held at Q.I.C Primary School, Usung Inyang, in Akwa Ibom State. According to ExxonMobil, sustained efforts by corporations, individuals and organisations on Malaria awareness, prevention and control are yielding results as Malaria mortality rate in the WHO African region has fallen by 54 percent and by 47percent globally since 2000. And since that year (2000), ExxonMobil has become a leading private investor in Malaria, with an investment of over $120 million that has seen the distribution of 13,186,369 bed nets, 1,922,031 doses of anti-malarial drugs and 1,054,165 rapid diagnostic kits. This intervention which has reached more than 105 million people in Africa and Asia has trained of 355,484 healthcare workers and counsellors, as early diagnosis and treatment reduce the disease, prevent deaths and reduce transmission. Since 2013, ExxonMobil has sponsored Youth Empowerment and Development Initiative (YEDI) with the Kick Against Malaria Football Tournament to provide Malaria Testing and Treatment, Free Health Services, Insecticide- Treated Net Distribution, and much more to communities in Nigeria.
46 HEALTH THE NATION TUESDAY, APRIL 28, 2015 Funding research ‘ll promote medicine, say experts PECIALISTS in medicine have called for more funding for research and devel- Sopment to advance medicine in Nigeria. According to an embryologist Prof Oladapo Ashiru, more awareness and support for medical education are required to move the country’s healthcare forward. Ashiru spoke at the 14 th Annual Scientific Conference of the Society of Experimental and Clinical Anatomists of Nigeria (SECAN), MALARIA prevention can save Nigeria billions of Naira as curing the disease is more expensive than preventing it. Efforts have been made by various groups to prevent the disease. For instance, the Society for Family Health (SFH), has encouraged the use of mosquito nets by distributing same freely (Long Lasting Insecticidal Nets freely). According to Safurat Eromosele of SFH, “LLINs are factory-treated mosquito nets that are safe, easy to use, and come in a variety of sizes and colours to address individual needs. Some LLINs are effective for up to four years and will last a minimum of 20 washes – they require no re-treatment during this time, making them five to 10 times more effective than conventional re-treatable mosquito nets.LLINs are an inexpensive and easy way to prevent malaria and thus reduce its burden on the health and economic well-being of Nigerians. SFH uses its extensive marketing and distribution channels to move LLINs all across Nigeria so that they are available to everyone, particularly women and children.” She said when prevention fails, treatment of malaria is critical. “In seeking treatment for malaria, some mothers are given the wrong drugs for their children, while others find treatment options confusing and difficult to complete the dosage. In 2003, SFH and other stakeholders developed an innovative approach to “pre-package” malaria treatment for easy use by mothers and families to rapidly and correctly treat malaria. SFH’s treatment programmes to combat malaria are focused on promoting and distributing an innovative and effective drug for malaria, called Artemisinin-based Combination Therapy (ACT). This is an easy way to use pre-packaged drug combination that ensures effective By Wale Adepoju ‘Malaria prevention can save billions’ Lagos. It had as theme: Current trends in biomedical research; the subtheme was: the anatomist: catalyst for medical education. He said funding research, especially in anatomy will move health care forward because “anatomists serve as a mechanism for promoting medical education.” The reproductive expert said there is need for advances in anatomical teaching and research to By Oyeyemi Gbenga-Mustapha treatment of malaria for children and adults as well. Now, SFH promotes ACT treatment using the pre-packaged method and distributes this product throughout Nigeria, especially in remote and rural communities. In 2014 alone, about 8.2 million doses of ACTs were distributed in the country. “SFH is actively engaged in behavioural change communication activities through mass media and community-based interpersonal communication activities to facilitate the adoption of positive behaviours by individuals and communities. These interpersonal communication activities available mostly in hard to reach communities, help to ensure that individuals are equipped with the right information and attitudes to prevent and treat malaria. SFH also works closely with the Federal Ministry of Health on technical matters, education, training, and coordinating on policy and research to move the nation forward on both prevention and treatment issues in the battle against malaria,” she stated. On other efforts to control the scourge, she said, “SFH has four projects that address malaria – the Global Fund Malaria Project, the Expanded Social Marketing Project in Nigeria (ESMPIN), the Rapid Access Expansion (RAcE) Programme and the Africa Health Markets for Equity (AHME) Programme. ACTwatch collects data to inform evidence-based malaria control policies and programmes. Regardless of the giant strides made so far, more needs to be done to defeat this fight against malaria in Nigeria. This could be achieved by intensifying our efforts and exploring innovative approaches to tackle the disease. Behaviour change communication to increase use of malaria prevention is important in this regard.” First malaria vaccine out soon HE world’s first malaria vaccine, made by TGlaxoSmithKline (GSK.L), could be approved by international regulators for use in Africa from October after final trial data showed it offered partial protection for up to four years. The shot, called RTS,S and designed for children in Africa, would be the first licensed human vaccine against a parasitic disease and could help prevent millions of cases of malaria, which currently kills more than 600,000 people a year. Experts have long hoped scientists would be able to develop an effective malaria vaccine, and researchers at the British drugmaker GSK have been working on RTS,S for 30 years. Hopes that this shot would be the final answer to wiping out malaria were dampened when trial data released in 2011 and 2012 showed it only reduced episodes of malaria in babies aged 6-12 weeks by 27 percent, and by around 46 percent in children aged 5- 17 months. But the final stage follow-up data published in the Lancet journal on Friday showed vaccinated children continued to be protected four years on, albeit at a declining rate — an important factor given the prevalence of the disease — and rates of protection were stronger with a booster shot. “Despite the falling efficacy over time, there is still a clear benefit from RTS,S,” said Brian Greenwood, a professor at the London School of Hygiene & Tropical Medicine who worked on the study. He said an average of 1,363 cases of clinical malaria were prevented over four years for every 1,000 children vaccinated, or 1,774 cases with a booster shot — the children would normally be expected to have had several cases of infection over that period. In babies, over three years of followup, an average 558 cases were prevented for every 1,000 vaccinated; and 983 cases in those who got a booster. “Given that there were an estimated 198 million malaria cases in 2013, this level of efficacy potentially translates into millions of cases of malaria in children being prevented,” Greenwood said. • Source: www.Reuters.com take Nigeria to the next level. This, he said, would lead to improved understanding of human system, and as such ensure longevity and better treatment outcome. Professor of Anatomy at the Lagos University Teaching Hospital (LUTH), Abayomi Okanlawon said the Federal Government needs to provide more funding for research. He said the discovery of new medicine and therapies require careful scientific experimentation, development and evaluation. Okanlawon said research is a prerequisite for medical advances, adding: “It ensures that • From left: Second prize winner, Mrs Oby Ibeh Okpareke; Managing Director, SKG Pharma Ltd, Akpa; Manager of Jonaco Pharmacy, Mr Chizoba Oleuku; General Manager, Sales and Customer Care, Mrs Patricia Iloba and MD, Eternity Concepts Ltd, Mr Chidi Akabuogu at the event. SKG Pharma launches products PHARMACEUTICAL company SKG Pharma Limited has promised continued product development to meet customers’ yearnings for effective products, its Managing Director, Okey Akpa, has said. Akpa spoke during the SKG’s Trade Partners Conference and Awards in Lagos. According to him, the conference was to appreciate the trade partners who have been adding value to the company by interfacing between SKG Pharma and the final consumer of the products. The company also used the opportunity to launch some new products, such as SKG Rexifen, which is a 400mg, Ibuprofen capsule By Oyeyemi Gbenga-Mustapha health services support improved delivery, access and cost.” He called for public-private partnership (PPP) to promote biomedical research and as such ensure medical education. The anatomist advised the government to set up research centres across the country to develop the healthcare industry. “The Nigerian Universities Commission (NUC) has been promoting responsible and qualitative research to develop medicine,” he said. The future, he said, is for biomedical research to seek fundamental knowledge about the nature and behavior of living systems, adding that the knowledge will be applied to enhance human health, lengthen life and prevent illness and disability. SECAN President, Prof Hakeem Fawehinmi said anatomy as a discipline has faced a crisis of identity and purpose, adding that this has raised educational concerns. He said the approach to teaching of anatomy and medicine as a whole is shifting from its traditional methods to self-directed problem based or the integrated system oriented learning. “It is, therefore, taking advantage of E- teaching and learning,” Fawehinmi added. product, SKG Galways 100mg vitamin C drops for newborns to 12 years plus, SKG Novadex Paracetamol 100mg BP drops for newborns to 11 months old babies with the advantage of being sugar free and SKG Novavite Multivitamin15ml drops for newborns to 12 months old babies plus, fortifies babies immune system against ailments and infections. The event was attended by trade partners all over the country. There were regional and national awards to honour high performing trade partners. These awards were complemented with mouth-watering gifts. The grand award winner, Jonaco Pharmacy based in Onitsha, through its Manager Chizoba Oleuku, thanked SKG Pharma for helping him grow his business. “SKG looks out for its distributors and makes sure they grow along with the company, no one is left behind and I intend to remain in the SKG family” Mr. Oleuku said as he lifted his golden trophy beaming with smile. The second position went to Simba Pharmaceuticals represented by Mrs. Oby Ibeh Okpareke while the third position’s trophy was lifted by Mr. Chidi Akabougu of Eternity Concept. • From right: President, Pharmaceutical Society of Nigeria (PSN), Mr Olumide Akintayo; Vice President, Nigeria Academy of Pharmacy (NAP), Sir Ifeanyi Atueyi and Representative of Registrar, Pharmacists Council of Nigeria (PCN), Amaka Okafor, at the Pharmacy Education Summit of Nigeria Academy of Pharmacy (NAP) in Lagos. PHOTO: ABIODUN WILLIAMS
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