This blog is part of a series of articles produced by student, faculty and staff participants in the Global Health Initiative International Experience in Ghana in early January, 2012.
Mosquitoes and I share a very long history. Growing up in Mumbai, India, I had learned to live with their presence always buzzing around. Every day I would spend about 10-15 minutes killing all the mosquitoes in the vicinity of my desk and bed and I had gotten pretty good at it. Well, they are easier to kill than the common house-fly. I also realize that the entomologists in my group will be frowning at me for rambling about killing insects. But there was no other choice, practically speaking. Even an hour’s play on the grounds nearby would result in swarms of these pests surrounding your face and hair. In fact, every friend of mine would have their own independent swarm with almost no evidence of crossing over of bugs from one swarm to another.
During my undergraduate, I had the chance to study them further through a review project on what really attracts mosquitoes. Without going into much detail on the findings of those studies, it can be definitely said that there has been so much research on these bugs and it continues to attract a lot of attention mostly from a negative perspective due to their role as vectors for the malaria parasite. Malaria has a strong presence even in India. In fact, the local government in the city of Mumbai maintains detailed records on mosquito populations in every part of the city and does regular fumigation with kids running behind the guy with the white smoke machine.
Prior to embarking on our trip to Ghana, we knew that malaria was rampant in sub-Saharan Africa. In fact, most of us had even started our prophylaxis medication before leaving. During our trip, we realized that malaria is, in fact, currently the biggest problem in the country in terms of infectious diseases. 40% of all out-patient visits in hospitals and clinics are malaria-related. In fact, any malaria-like symptoms in patients are always given anti-malaria medication even before confirming the presence of the parasite. This might be a problem in the long run wherein there might be issues of drug-resistance. Already, chloroquine is ineffective in most parts of West Africa since the parasite has developed resistance against the drug.
The diagnosis for malaria is done via two methods. One is the popular and antiquated Giemsa staining technique followed by microscopic visual observation. The second method is the new Rapid Screening Test kit (RST) that enables quick detection via the use of monoclonal antibodies specific for the parasite antigen. However, there are a couple of issues with the RST. One is that it does not provide any measure of the degree of the disease and hence must be followed with the visual observation anyway. The other minor problem is the specificity for only one kind of malaria parasite.
There are 3 recommended medications for malaria as specified in the picture for Ghana (This poster was put up at a rural clinic in Bhrimsu, Central Region) – Artesunate-Amodiaquine, Artemether-Lumefrantine or Dihydroartemisinin Piperaquine. Travelers in this region are advised Doxycycline, Mefloquine or Malarone as prophylaxis. Vaccines for malaria are still in the research stage.
Considering that good treatment options are available for most people in Ghana against malaria (malaria is covered under the national insurance scheme with medication being free), the current situation is that even though most out-patient visits and hospital admissions are related to malaria, fatalies are rare. The current diagnostic method (Giemsa staining technique) being used is the same as in the USA. However, the USA does not have a problem with malaria. The need of the hour for Ghana is to have efficient, quick methods for screening the parasite that can also allow for the measurement of the degree of the disease. The degree is assessed at 3 levels based on the counts of the parasite seen in a particular slide of the blood sample (‘+’ – 1-10, ‘++’ – 10-100, ‘+++’ – >100).
If the same information could be available through a new RST, it would enable two major advantages. One would be that rural areas especially in the far-off regions of Ghana would greatly benefit from this quick method and the other is that it would allow for anti-malarial dosage to be given appropriately only after clinical diagnosis of the parasite. Our lab director in the urban clinic at Cape Coast agreed that such a modification of the existing RST would drastically quicken the rate of diagnosis for his lab at least. This particular lab had electricity cuts when we first visited them thereby causing issues with their diagnostic procedures. A new RST would also enable quick diagnosis without worrying about power cuts. Of course, prevention is still the best way for most of the population. ITNs (Insecticide treated nets) are still recommended for the local population through public posters. Malaria can be controlled and treated as can be seen currently in Ghana. With minor improvements in diagnosis, treatment methods and overall efficiency can be increased manifold to the greater benefit of the local Ghanaian people.
For more information on malaria: http://dpd.cdc.gov/dpdx/HTML/Malaria.htm