Tropical Health Matters

During the past month we have posted few blog entries due to a heavy travel schedule.  That said, we have maintained malaria communication through our three other venues. If you are not aware of these news and update options, please check out and follow these links …

• The malaria Facebook Page is a closed group that you can request to join if you are a Facebook member
• Our Twitter account is updated almost daily
• The malaria listserve provides regular news and abstracts on a regular basis

Part of recent travel includes Rwanda where we are working with the Ministry of Health and the US President’s Malaria Initiative to design and implement a malaria in pregnancy (MIP) survey.  As seen in the attached chart, Rwanda is making great progress in moving toward pre-elimination with string emphasis on community case management and ITN promotion.

Normally in low and/or unstable transmission areas, intermittent preventive treatment for malaria in pregnant women is not practiced. That does not mean that pregnant women are not at risk. The results of the MIP prevalence study will help the Ministry and other partners decide on appropriate ways to protect pregnant women as we move closer to malaria elimination.

Finally as Rwanda makes progress, there is concern about malaria in the neighboring countries.  Efforts like this MIP study can become part of a larger surveillance activity to monitor the potential for imported malaria in the future.

John Costa of Ashdin Publishing has written to let us know about a new open access journal on malaria: Malaria Chemotherapy, Control & Elimination.

John Costa explains that, the new journal, MCCE, has been recently launched by Ashdin Publishing. The journal aims to bridge basic and applied malaria research in tropical and other settings.

MCCE will provide contributors with a forum for publication of research findings, in the form of basic science, clinical studies, case reports, and focused or general reviews of science or policy. MCCE is published using an open access publication model, meaning that all interested readers will be able to access  the journal freely online without the need for a subscription.

Although Editorial Board positions have not yet all been been filled, there is a significant contribution from the London School of Tropical Medicine and Hygiene (LSHTM) and alumni as well as other distinguished workers. The publishers hope to see the journal accepted as an essential forum in the coming years.

Of note, the journal will be affiliated with the Malaria Center at the London School of Hygiene and Tropical Medicine, which houses the largest number of malaria researchers, students and support staff in Europe. The Center is unique in its size and breadth and draws together the diverse research and teaching activities carried out at the School.

By Guest Writer  – Emmanuel Fiagbey, Country Director, Ghana Voices for a Malaria-free Future

The Johns Hopkins University Center for Communication Programs (JHU/CCP) Voices for a Malaria-free Future Project under its flagship program, United Against Malaria, and in collaboration with the National Malaria Control Program and other partners have presented special commemorative ceritificates and T’Shirts to the National Sports Authority here in Accra.

The Certificates signed by the Director General of the National sports Authority Mr. Worlanyo Agra will be presented to all 4,942 participants and their officials. They carry the messages:

“Be a member of the Winning Team- Sleep in treated mosquito nets every night; Take only ACTs any time you have malaria; Encourage pregnant women in your house to seek Antenatal care on time; and Keep Ghana Malaria-free for the next games.”

The over 600 T’Shirts which also carry the above messages will be presented to members of the finalist teams of all the team games including Football, Volleyball, Table tennis, Handball, Netball, Basket ball, and the winners of the first, second and third positions in all the athletics events.

Mr. Emmanuel Fiagbey, Country Director JHU/CCP Voices, in presenting the items called on all sports men and women as well as their officials to remain ambassadors in the fight against malaria. He charged them to continue to behave as models in their communities in ensuring that families make maximum use of their treated mosquito nets and no one uses any other medicine apart from ACTs in treating malaria when they fall sick of the disease.

The Director General of the National Sports Authority, Mr. Worlanyo Agra in receiving the items commended the ever growing partnership between the malaria program community and the National Sports Authority. “We would remain active members of the United Against Malaria partnership and continue to ensure that sporting activities at all levels, national, regional, district and community are used as grounds for educating our people on malaria prevention and correct treatment of the disease.

Whether you are a sports man or woman or not, mosquitoes do not know the difference and the malaria parasite they carry can kill any one of us any time if we fail to sleep in our nets or take the correct medicines”, he emphasized.

Surprise – the latest in the Rupert Murdoch scandal concerns malaria.  Yesterday Metro Online headlined a story: “Cheryl Cole’s ‘phone hacked while she was suffering from malaria.'”  The claims are still at the level of rumors, and thus investigators are still “looking into claims that her voicemails were hacked while she was hospitalised.”

A year ago when Ms Cole’s bout with malaria hit the news, The News of the World was mentioned as a source. One online posting noted that Ms Cole, “is believed to have lost half a stone during her battle with malaria. A source told the News of the World that the Girls Aloud beauty is now just over 7 stone. The insider told the newspaper that medics have said that it could be six months before Cole is allowed to perform her strenuous dance routines.”

Similarly another website reported last year that, “A source told the News of the World: “We nearly lost her and the battle is far from over. She is so weak and this horrible illness has taken complete hold of her. ‘It got so bad she was literally only hours from death’s door. Thank goodness she was diagnosed in time.'”

Now a year later MTV UK published that, “Cheryl’s lawyers are investigating claims by a former News of the World journalist, who stated that the Geordie’s voicemails were listened to “while she underwent treatment for malaria.”

Fortunately most use of mobile phone technology these days helps promote malaria control and elimination. In Nigeria for example, mobile phone SMS has been used to track bednet distribution.  A UNICEF spokesperson who is involved in promoting such innovations explained that …

In Africa, we are finding there are systemic failures in public health and supply in terms of getting reliable information quickly from the field. Ninety percent of the developing world has access to a cell phone, so we’re experimenting with the use of instant messaging to make a difference. We’re finding that we can train people in villages to be data collectors and help us by using cell phones to text information to central authorities; we and governments can then respond faster to specific needs. In some places, it takes months just to get a piece of paper from the field. Mobile phones and SMS technology can help surmount that hurdle.

Recently the Business Standard reported that, “The University of Glasgow has received a grant from the Bill & Melinda Gates Foundation to further help in the diagnosis of malaria. The $100,000 award would go towards developing a device which uses mobile-phone derived technology to detect and separate red blood cells infected with malaria parasites.”

A study by Caroline Asiimwe and colleagues in Uganda has shown SMS improves the timeliness in reporting of specific, time-sensitive information on RDT positivity rates and ACT stockouts at modest cost, while by-passing current bottlenecks in the flow of data. Likewise in Tanzania “A multinational computer, technology and IT consulting company, IBM, in partnership with Novartis and Vodafone, together with Roll Back Malaria and Tanzania’s Ministry of Health and Social Welfare have reaped from the technology dubbed ‘SMS for Life’. The system tracks movement and the supply of anti-malaria drugs in sub-Saharan Africa.”

People have argued that technology itself is ethically neutral – it is how people use it that has ethical ramifications. In the case of malaria hopefully we will see more uses that help save lives instead of illegally spying on and disrupting them.

Most people have seen “clouds” of words on web postings that highlight the main terms or key words of relevance to that page or entry. A program called Wordle can tranform webpages or documents into such clouds. Below is a Wordle-created cloud of recent postings on Malaria Matters. Such programs might help us communicate key words and concepts in a colorful form.

Enjoy.

In wondering whether Nigeria’s health system is non-existent, Seyi Abimbola suggested that, “It is safe to assume that every country has a health system, no matter how dysfunctional.”  Seyi also addresses the potential role of patent medicine vendors whose neighborhood shops have become ‘trusted’ institutions.  But let’s take this one step further beyond the shop.

The other evening after food, I was sitting with friends out on an Abuja back street having drinks when a man came buy with a straw tray on his head selling medicines.  These ‘drug hawkers’ specialize in what the Yoruba term pa’se po, a combination of pills and capsules, often sold in a small clear nylon bag that taken at once should relieve one of a particular ailment. Some actually say this mix that literally ‘combines or brings together the work of all’ can be formulated to treat all kinds of diseases in one. Colorful mixes of analgesics, antibiotics and even valium have been common.

One person at a nearby table began to explain his aches and pains and was given a mix of pain killers and vitamins.  I called the guy over and asked what he had for malaria and was given the mix pictured here – sulphadoxine-pyrimethamine, paracetamol and big multi-vitamin caplet.  These two mixes cost only 100 Naira (about 67 US cents) each.  Like many, this man had mixtures for both chronic and infectious illnesses.

This hawker was a bit more sophistocated than most in that he sold the medicines still in their blister pack, and the malaria medicine, though no longer approved as a treatment in Nigeria, at least was not expired.  Of course when he walks around the neighbourhoods during the day, the tray on his head is explosed to the sun!

Nigeria has long fought a battle against illegal sales of medicines, which often include fake or expired drugs. For example in 2007 the Federal Government “called for sanctions to be to put in place against persons who engage in unauthorised distribution, sale and dispensing of medicine or controlled substances.” While this article bemoaned the fact that, “Nigeria is one of the few developing countries in the world where medicines of all categories are sold in open market stalls, roadside kiosks, peddled in buses and hawked in basket along the streets,” the press from other countries also carry such stories as seen below from The Gambia …

“… it is still a common practice for some people who have taken the sales of these drugs as a livelihood. This is no doubt a dreadful act and should be discouraged. It is sad to not e that the people who are hawking these drugs don’t even know the essence of the drugs, their indication, dosage, side effects or even their contra-indications. They just carry them in a transparent plastic bag and move with them from place to place particularly around the ferry crossing terminals.”

Efforts to bring down the cost of appropriate and approved malaria medicines such as those by the Clinton Foundation and the Global Fund’s new Affordable Medicines Facility for malaria, may not compete with the convenience and price of the drug hawkers. More regulation in a non-existent system will not do the trick. Maybe a more clever market-oriented consumer education approach would help? Let’s hawk ideas not expired medicines.

Health literacy was a term coined to express people’s knowledge of useable health information.  Although the word ‘literacy’ is obviously about reading, just an numeracy is about one’s ability to comprehend and perform mathematical functions, it has been used because no one has come up with a comparable single word like ‘healtheracy’.

The implications of this concept introduces a prejudice into the coversation about health.  Especially in developing societies the word literate shines with positivity, while saying someone is illiterate is a term of abuse.  Are we therefore implying, even if we don’t say it, that people who lack our ideas of ‘health literacy’ are health illiterates?

Health knowledge is a culutral commodity.  Orthodox scientific knowledge about health is one cultural manifestation of what people know about what makes us healthy and what makes us unwell.  If not carefully used though, one can come across as saying that this scientific knowledge is the ‘correct’ way of viewing the world, and everyone else is ‘illiterate’ or wrong.  The term clearly can have neo-colonialist connotations.

Communities have local knowledge about the cause, effects, treatment and prevention of common ailments that have survival benefits and also some negative consequences. Scientific knowledge is also not without negative consequences since it is an evolving process – like knowledge in any cultural setting. What may seem scientifically correct today may be found to be misleading or dangerous tomorrow.  While we give science the benefit of the doubt when crafting our health literacy campaigns, we are not so charitable with local knowledge.

Neglecting local knowledge in the name of health literacy is a one way conversation.  Behavior change will never occur without dialogue where both parties learn from each other.  By engaging in a dialogue that shows respect for different point of view we can arrive at a solution that not only promotes health, but does so in ways that are culturally acceptable.

Guest Posting by Bremen Leak, Voices for a Malaria-Free Future, Bamako Office Johns Hopkins University – Center for Communication Programs

The 2010 FIFA World Cup South Africa may be over, but Africa is still fanatic about football.

That’s why the United Against Malaria partnership—forged ahead of the World Cup to raise awareness about malaria through football—continues to fill stadia and airwaves across the continent with critical messages about malaria prevention and treatment. Today it’s the humanitarian face of the CECAFA (short for the Counsel of Eastern and Central African Football Associations), organizer of Africa’s oldest football tournament and the year’s biggest football competition since the World Cup.

A 12-team tournament lasting 16 days, the CECAFA Challenge Cup has drawn as many as 60,000 fans per game since its started on Nov. 27 in Dar es Salaam, Tanzania. These fans are primarily men, considered the decision-makers and breadwinners of Tanzania.

To reach this key demographic, Voices for a Malaria-Free Future, through Johns Hopkins Bloomberg School of Public Health—a founding partner of UAM, has joined forces with CECAFA and local beverage maker Tusker to bring attention to the region’s deadly malaria statistics, one football game at a time.

In Tanzania, for example, malaria claims some 80,000 lives each year—almost one in ten of all malaria-related deaths in Africa. In the long run, those deaths rob football clubs of talent, vitality, and World Cup victory, which is why CECAFA’s chair, Leodegar Tenga, announced last week that CECAFA and UAM “shall be partners forever, until we eradicate malaria.” As a result, five additional CECAFA football federations have since joined the campaign.

The official support of CECAFA and the tireless efforts of Tenga have helped UAM continue to educate fans, inform the media, and engage business and political leaders. As the opening ceremony began, Tanzanian President Jakaya Kikwete joined Tenga on the field to greet the UAM ball boys during the opening ceremony.

Throughout the tournament, UAM banners will fly on the field and in the parking lot. Players, ball boys, team escorts, and officials will wear UAM T-shirts or uniforms. And all printed programs will feature simple messages labeled “winning moves to beat malaria, protect your family, stay healthy, and save money.” These include sleeping under a long-lasting insecticide-treated net every night, visiting a health center for malaria testing and treatment when sick, and encouraging pregnant women to seek antenatal care.

More information on UAM and CECAFA may be found online at www.unitedagainstmalaria.org and www.cecafa.net

By Arsénio Manhice, Mozambique

Journalists can contribute to reduce the burden of malaria if they assume their role and spread continually information about how to prevent and threat malaria, particularly in South Africa, announced Dr. Aziza Mwisongo, Indepth Effectiveness and Safety of Anti-malarial Drugs in Africa (INESS) Project Manager speaking to Journalists. Dr. Aziza Mwsisongo was speaking in a three-day media sensitization workshop on INESS held in Dar-es-salaam, Tanzania, from 18th to 20th March 2010.

In the meeting, the Journalists noted that with concerted efforts from all stakeholders such as Scientists, Journalists, Governments and Non-governmental Organisations malaria can become a disease of the past.

This comes in a communiqué of the workshop promoted under the Indepth Network project in collaboration with the African Media and Malaria Research Network (AMMREN).

During the meeting, the Journalists noted that ten years after, the Declaration adopted by African leaders in Abuja, Nigeria, in 2000, is not moving ahead. In their Declaration, the leaders agreed, besides other goals, that by 2010 80% of children under-five and pregnant women will sleep in ITNs, 80% children under five with fever will have prompt access to care, 25% of childhood fevers will be correctly managed using IMCI.

“These targets have not been met. However, with concerted efforts from all stakeholders, malaria will become a disease of the past”, announced Journalists at the end of the workshop.

However, the journalists from Burkina Faso, Gabon, The Gambia, Ghana, Kenya, Malawi, Mozambique, Nigeria, Senegal and Tanzania applaud the efforts being made by INDEPTH Network and Malaria Clinical Trials Alliance (MCTA) for setting up various investigative sites in Africa to fight malaria.

At the moment, INESS is already carrying out studies in Tanzania and Ghana and will be expanding to other African countries such as Mozambique and Burkina Faso.

To reach the goals, the roll of the media is strategic as emphasized Dr. Gabriel Upunda, the Guest of Honor of the workshop on his opening speech. “The world needs your efforts. The health of the children and pregnant women suffering around Africa only can change if you keep spreading accurate information about malaria”, he said.

According him, more has done to roll back malaria using anti-malarial drugs but he believe that Africa need to do more. “I will not congratulate you because of this network. This is not because you are not implementing good activities. It’s because you still need to use your tools to contribute to reduce malaria”, he explained.

On her remarks, Mrs. Charity Binka, Executive Secretary of Ammren assumed that the networks is ready to give its contribute to fight malaria. Ammren was launched by journalists who has knowledge of malaria and keep on reporting about this disease. “I want to call you all to keep the good job you are doing. Do not ever forget why you are Ammren members. Since we launched the Network in 2006, we have done a lot, but we can do better”, she concluded.

During the workshop, the Journalists visited the Bungu dispensary, Mchukwi Mission Hospital and Ifakara Health Institute (Kwiriri) where they found children and pregnant women suffering because of malaria. Some mothers demanded for ITNs.

That was an opportunity, as well, to know more about INESS.