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Cerebral Malaria- Shortage of drugs increases infectionsPublish Date: Sep 06, 2009
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By Rebecca Harshbarger

IN the past six months, Uganda has seen an increase in cerebral malaria cases, which experts at the Malaria Consortium, an international organisation that controls the disease at all levels, are attributing to a shortage of malaria drugs throughout the country.

The Consortium blames the shortage of drugs on poor planning and the stalling of the Global Fund disbursement that was effected early last year.

However, when approached, the health ministry officials declined to comment.
According to Daniel Kyabiirize, an epidemiologist at the Malaria Consortium, Uganda has over 300,000 cases of malaria a year, and 25% progress to cerebral malaria.

Cerebral malaria is a complication of a type of malaria parasite called plasmodium falciparium. It is a more advanced and dangerous form of malaria. It causes neurological disorders and can also lead to death.

This condition occurs when malaria goes untreated. Patients experience symptoms between 10 and 35 days after the mosquito bite. The parasites multiply in the body’s blood cells and block the blood’s pathway.

This leads to a shortage of oxygen and nutrients in the brain, causing neurological disorders and death.

Symptoms
Symptoms include high fever, severe headache, drowsiness, unconsciousness, seizures, delirium and confusion.

One in nine patients who survive cerebral malaria develops epilepsy.
Although 50% of epilepsy cases have had no malaria, the disease is linked to cerebral malaria, especially among children.

“Because of the brain involvement with cerebral malaria, patients sometimes get convulsions or seizures,” says David Basangwa, a psychologist at Butabika Hospital. In most cases, epileptic patients seek the help of traditional healers, believing that the disease has spiritual causes.

Though medication that helps reduce seizures is prescribed in health centres, it has side effects like drowsiness which interferes with other medications.

Dr. Richard Idro, a paediatrician at Mulago Hospital, says cerebral malaria causes serious neurological problems, such as cerebral palsy, learning problems, hyperactivity, as well as blindness and hearing problems.

Who is at risk?
Children, visitors from non-malaria endemic areas, women in their first pregnancies, and people who live in Kabale and the highlands are susceptible.

During the first six months of a child’s life, a baby retains antibodies from its mother, who has some resistance to malaria.

But these soon wear off. The child is unprotected and can easily develop malaria infections until they develop immunity.

A major challenge that Uganda faces is the shortage of neurologists to handle the consequences of severe malaria.
Most specialists are based in Mulago, and Mbarara hospitals or the Kampala-based Butabika hospital.

“This has led to a current increase in mental illness and disease,” says Kyabirize.

Curbing the condition
Treatment aught to be within 24 hours of experiencing fever.
The Ministry of Health recommends treated mosquito nets to prevent malaria infection.

Spraying of chemicals in homes has also helped reduce the rates of malaria infection. Get rid of latent containers of water where mosquitoes might breed.


Cases of the disease in Uganda
25% of cases are cerebral, a dangerous form of malaria

Of the 300,000 malaria cases a year, 75,000 are cerebral

Dangers of cerebral malaria
Death:15-20% of children die
Epilepsy
Blindness, deafness
Neurological disorders
Learning problems

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