Monday, December 20, 2010

Malaria could be eliminated by 2015

Malaria –World Malaria Report 2010 (15.12.10)
By Esther Nakkazi
In many countries, the total number of malaria deaths and hospital admissions have been more than halved in a decade as a result of increased control interventions particularly the provision of insecticide-treated mosquito nets.
According to the World Malaria Report 2010, released by the World Health Organisation (WHO) last week, malaria-related deaths have fallen from 985,000 in 2000 to 781,000 in 2009 the largest absolute decreases observed in Africa.
Ban Ki-moon, the UN Secretary General, said it is possible that when a broad range of partners join forces malaria deaths could be eliminated by 2015.
The affiliation between committed African leaders, financial support from donor countries providing more than $5 billion in new money since 2008 and the Roll Back Malaria partnership has already brought success.
“If we heed to the lessons highlighted in this report we can achieve our goal of ending malaria deaths by 2015, accelerate progress toward the MDGs and usher in a better future for all,” said Ban Ki-Moon.
According to the World Malaria report, in eleven African countries including Rwanda in east Africa, the malaria burden dropped by more than 50 percent in 2000 to 2009.
For Kenya, Tanzania and Uganda there was a wide scale implementation of malaria control activities to more than 50 percent of the populations at high risk over this same time period. Most of these populations where able to access Insecticide Treated mosquito Nets (ITNs).
Already, enough nets have been delivered to sub-Saharan Africa to protect nearly 580 million and more than 75 million people have received protection from Indoor Residual Spraying (IRS).
Now the World Health Organisation has promised an additional 54 million nets to be delivered to sub-Saharan by early 2011, totaling 350 million, bringing the goal of universal coverage declared by UN Secretary-General Ban Ki-moon in 2008 within reach.
This achievement represents the largest scale-up of a malaria control intervention in Africa ’s history.
The WHO Director-General, Dr Margaret Chan, said the results set out in the report are the best seen in decades after so many years of deterioration and stagnation in the malaria situation.
"The phenomenal expansion in access to malaria control interventions is translating directly into lives saved, as the WHO World Malaria Report 2010 clearly indicates. By maintaining these essential gains, we can end malaria deaths by 2015," said Ray Chambers, the UN Secretary-General's Special Envoy for Malaria.
In the east African region, other countries could emulate Zanzibar and Rwanda’s persistence and maintenance of successful malaria control campaigns and programmes.
According to the report, Rwanda has significantly scaled up malaria control interventions including distribution of 6.4 million mosquito nets over the last three years.
Most of these Long Lasting Insecticide-treated mosquito nets (LLINs) were distributed during a measles vaccination campaign to children below 5 years, and each of them were given as well as all households to avoid further malaria cases and deaths.
Inpatient malaria cases and deaths in Rwanda have now fallen by more than 50 percent from 2000 to 2009 says the report.

However, Rwanda noted an upsurge in cases of malaria beginning in 2009 but a new mosquito net campaign was launched in April 2010 to replace older nets, which then reduced malaria cases and deaths.
By 2009, the number of malaria admissions and deaths in Zanzibar were 81 percent lower than those recorded in 2000, says the report.
Zanzibar’s malaria success is largely attributed to free for all anti-malarial drugs (ACTs) in all public health facilities since September 2003 and universal coverage of nets to the 1.3 million islanders.
Annually, indoor residual spraying is carried out to cover nearly all households and there is improved diagnosis of malaria cases as Rapid Diagnostic Tests (RDTs) began to be more widely used from 2005.
In the rest of Africa, by 2009 more than a third of suspected malaria cases were confirmed with a diagnostic test, an increase from less than 5 percent by 2000.
Now the WHO recommends that all suspected malaria cases undergo diagnostic confirmation prior to treatment. Already, a number of African countries including Uganda have been able to scale up malaria diagnostic testing at a national level.
“Not only has this resulted in saving the unnecessary use of hundreds of thousands of courses of ACTs annually, but has also allowed for the implementation of timely and accurate surveillance for malaria,” said Dr Chan.
Research shows that using RDTs improves the quality of care for individual patients, cuts down the overuse of drugs, protects their therapeutic life, and allows for timely and accurate malaria surveillance.
However, the report cautions that these gains are fragile and all supporting partners should keep in the loop or the opportunity could be lost.
For instance insecticide-treated bed nets remain effective for three years and their supply must be replenished while the development of parasite resistance to antimalarial drugs and mosquito resistance to insecticides are perennial threats.


Wednesday, December 1, 2010

Use of herbal remedies in HIV treatment still causes stigma

By Esther Nakkazi

When the cock crows and birds fly out of their nests early morning, the African herbalists rise with the sun to go to the forests.

There, they pick fresh leaves, peel the new bark off trees and dig plant roots from the soft ground before the sun hardens it. They then apply the knowledge most of them acquired from their ancestors.

Traditional herbalists are custodians of knowledge on herbal concoctions that are used by millions of Africans to survive. In Uganda, they are big contributors to HIV treatment as high costs and shortages of modern drugs remains imminent.

The World Health Organization estimates that up to 80 percent of people in the developing world still rely on herbal remedies for their health care.  It has thus adopted a deliberate policy of encouraging the development and utilization of traditional medicine in HIV treatment and care.

In Uganda, it is estimated that 70 percent of Ugandans infected with HIV go back to nature and consult traditional herbalists for treatment as various symptoms present. But herbalists feel there is still a lot of stigma with the use of herbs in HIV/Aids although it remains a sustainable way in HIV treatment.

“When a client goes for HIV treatment they do not mention their use of traditional medicine. Yet the drug interaction between herbs and anti-retroviral drugs could be dangerous,” said Ms. Primrose Kyeyune, a technical advisor, Traditional and Modern Health Practitioners Together Against AIDS (THETA)

Experts say the attitude towards traditional medicine use is bad because people do not want to be associated with it.

Stigma Still High Among Users of  Herbal Remedies for HIV

“People stigmatize herbal medicine but they buy it every day and prefer herbal products to modern medicines,” said Kyeyune.

According to THETA officials stigma can only be reduced through training and counseling of both the herbalists and the HIV patients. Started in 1992, THETA is a Uganda non-government organization that has been working with traditional healers in Uganda especially in HIV/AIDS prevention and care.

With THETA trainings most herbalists have changed their ways of administering herbs in HIV treatment and care. Many now can identify the dangerous HIV symptoms and refer patients to health facilities to test for HIV. They have also been trained to do record keeping, maintain minimum standards of hygiene and offer counseling.

“Originally herbalists used to claim that they heal HIV but with our training, they now have knowledge that it is not curable,” said Grace Nanyonga, the information officer at THETA.

THETA has trained the herbalists to understand the HIV cycle, which has ensured that most of them know that they can only treat symptoms but cannot heal HIV.

Working as a team the herbalists have now come up with herbs for HIV that can boost the immune system, relieve Herpes Zoster, diarrhea, skin diseases and oral thrush, all opportunistic infections of Aids.

Some of the herbs have been investigated at the research Laboratory in Wandegeya, a Kampala suburb and found to have active substances that are therapeutically useful.

Training for Herbalists

Ssenga Bernadette Nabatanzi a herbalist says since she joined THETA and trained under the Regional Aids Training Network (RATN) her way of treating patients has changed.

“I am now able to keep records of my clients- like the date, age, physical and telephone contacts, next of kin, type of disease or symptoms, and the medicine, which I have administered.”

“In practice, I cannot cut patients with the same razor blade anymore and the patients do not accept because they know their rights. They no more can take herbs which we spit on,” said Nabatanzi a reproductive health specialist.

Nabatanzi says with limited time and long lines of patients, most doctors using modern medicines do not have the time to counsel patients and gain their trust. However, herbalists who are usually permanent residents of the community, are always available and have a lot of time to administer in-depth counseling.

THETA has integrated HIV/Aids information into counseling relating HIV to culture, which enables the patients to feel better. In counseling HIV patients, the herbalists are encouraged to prepare, persuade, and request those who have symptoms to go and check for HIV.

“Usually when they test and find that they are HIV positive they come back and consult me. They confide in me because most herbalists become their confidants and counselors,” said Nabatanzi who also advises on a good diet.

For their services, the herbalists or counselors accept cash payments in installments or in-kind - beans, goats, chicken. The herbalists have also been taught about minimum standards of hygiene- toilets, clean drinking water, well lit and ventilated clinics to not get infected with tuberculosis.

“I am well respected in the society, and the community prefers coming to my clinic,” said Suleiman Nkuutu a herbalist.

But as the communities continue to seek herbalists’ services and trust them, these continue to charge exorbitant fees and with no law to regulate them some administer fake herbs.

THETA also has a problem with those that get so rich as most of them eventually become untrainable, rigid, secretive- they fear that their concoctions will be stolen- so they work at night.

Still, medical practitioners medics treat herbalists with a lot of suspicion and disregard. However, THETA official says that with continued training the gap is getting closed as they start appreciating each other’s role. THETA officials say they can work with all those that fall in the WHO definition of traditional herbalists including those who sacrifice children.

“We would wish to have the witches who sacrifice children on board so that we educate them to stop the practice. If the government can support us we can come together and train all of them,” said Ms. Kyeyune.