Nets are best against malaria
Aug 11, 2003
The parasites that cause malaria are becoming more and more resistant to common drugs. This has raised new concerns on how to tame the epidemic that claims up to a million lives annually in sub-Saharan Africa
By John Eremu
The parasites that cause malaria are becoming more and more resistant to common drugs. This has raised new concerns on how to tame the epidemic that claims up to a million lives annually in sub-Saharan Africa.
With a vaccine yet to come and recent discoveries showing that excessive use of common anti-malarials like chloroquine, quinine and mepacrine, have adverse side effects, the use of Insecticide Treated Mosquito Nets (ITNs) remains the only viable control measure in the short run.
Michael Okia, senior entomologist with Malaria Control programme, Ministry of Health, says widespread use of ITNs could avert 30,000 infant deaths a year in Uganda and reduce the under-five mortality by as much as 20%.
At the just concluded international students’ conference on malaria control, Okia said research over the past 20 years had shown that widespread use of ITNs could reduce pressure on health workers and health facilities as sick-child visits would fall by 45%.
At the same time, hospital admissions would drop by 40%, severe childhood anaemia by a similar percentage, severe maternal anaemia by 47% and malaria transmission rate by up to 90%.
Okia said ITNs are a good repellent and do not only kill mosquitoes but also other insects, thereby protecting everybody in the room where the net is used including those not sleeping under it.
“Where over 80% of the people in a community use ITNs, there is such a mass killing effect on mosquitoes that even the 20% not sleeping under the nets are protected,†Okia said.
He, however, cautioned that only recommended chemicals from recognised dealers should be used in impregnating the nets. He said the six recommended chemicals approved by the World Health Organisation (WHO) were Lambdacyhalothrin (Icon) Capsulated Suspension distributed by Twiga Chemical Industries on Seventh Street Industrial Area and Deltamethrin (K-Othrin) Suspension Concentrate (SC) and Deltamethrin 25% tablet (K-O-Tab) from Quality Chemicals Katwe.
The others are Alphacypermethrin (Fendona) SC from Famous Distributors opposite St. Balikuddembe (Owino) market, Cyfluthrin (Solfac) 5% Emulsion Oil in Water (EW) and Etofenprox (Vectron) 10% EW distributed by Kwera Limited on Bombo Road.
But Uganda still has a long way to go in achieving the desired ITN coverage to substantially reduce the mosquito population. The current coverage is less than 5%. However, the current Health Sector Strategic Plan targets reaching a 60% coverage by 2005.
“Innovative and collective efforts by all stakeholders are needed to rapidly and substantially increase this coverage,†Okia said. A family size ITN costs about sh10,000.
The use of ITNs is known to cut down household expenses on health by 45%.
The Ministry of Health estimates that between sh2,000 and 5,000 is spent on treating an episode of malaria depending on the place of residence.
Dr. Marios Obwona, the director of research at Bank of Uganda said the disease costs Uganda US $337m (sh674bn) annually. He added that malaria accounts for 20% of all hospital admissions, 9% to 14% of in-patient deaths and between 20% to 23% of the under-five mortality.
At continental level, malaria is estimated to cost Africa US $12bn annually in lost Gross Domestic Product.
However, Prof. A.M. Odonga, a Consultant Surgeon at the Makerere University Medical School cautioned that ITNs collect a lot of dust if not used in clean environments. He said the dust contains dust mites which are responsible for chronic coughs and may lead to asthma. He said their long-term side effects are not yet known. But Okia said the nets were safe and any side effects were just transient.
Nevertheless, the use of the nets would cut on household expenditure for malaria treatment, freeing the family resources for higher standards of living. Adverse effects of anti-malarials like chloroquine, quinine and mepacrine would also be avoided.
Prof. Medi Kawuma a consultant opthamologist at the Medical School and Dr. C.L. Sezi, a Malariologist at Mulago Hospital say research has shown that the three drugs had toxic effects and could lead to total or partial visual impairment.
Kawuma said ocular toxic effect of chloroquine was on the rise in Uganda. “It is particularly common in relatively small, low-weight patients, particularly those who exceed the standard daily dose of 250 milligram.
Excessive use of chloroquine leads to toxic deposits on the cornea and the macular, leading to blurred vision and inability to distinguish colours. The cornea is that part of the eye through which light passes while the macular is responsible for most acute vision.
Repeated use of quinine, Kawuma said, damages the optic nerve and retinal cells leading to gradual loss of sight and eventual total blindness. He said mepacrine, though not widely used in Uganda, affects the cornea giving rise to bizarre blue halos around objects.
Research by Medicens Sans Frontiers (Doctors without borders) also indicates that chloroquine resistance strain of malaria was as high as 81% in Mbarara and 76% in Kampala.
The doctors warned that the disease was becoming resistant to fansidar and quinine, leaving ITNs as the best solution before a vaccine is found.
The parasites that cause malaria are becoming more and more resistant to common drugs. This has raised new concerns on how to tame the epidemic that claims up to a million lives annually in sub-Saharan Africa.
With a vaccine yet to come and recent discoveries showing that excessive use of common anti-malarials like chloroquine, quinine and mepacrine, have adverse side effects, the use of Insecticide Treated Mosquito Nets (ITNs) remains the only viable control measure in the short run.
Michael Okia, senior entomologist with Malaria Control programme, Ministry of Health, says widespread use of ITNs could avert 30,000 infant deaths a year in Uganda and reduce the under-five mortality by as much as 20%.
At the just concluded international students’ conference on malaria control, Okia said research over the past 20 years had shown that widespread use of ITNs could reduce pressure on health workers and health facilities as sick-child visits would fall by 45%.
At the same time, hospital admissions would drop by 40%, severe childhood anaemia by a similar percentage, severe maternal anaemia by 47% and malaria transmission rate by up to 90%.
Okia said ITNs are a good repellent and do not only kill mosquitoes but also other insects, thereby protecting everybody in the room where the net is used including those not sleeping under it.
“Where over 80% of the people in a community use ITNs, there is such a mass killing effect on mosquitoes that even the 20% not sleeping under the nets are protected,†Okia said.
He, however, cautioned that only recommended chemicals from recognised dealers should be used in impregnating the nets. He said the six recommended chemicals approved by the World Health Organisation (WHO) were Lambdacyhalothrin (Icon) Capsulated Suspension distributed by Twiga Chemical Industries on Seventh Street Industrial Area and Deltamethrin (K-Othrin) Suspension Concentrate (SC) and Deltamethrin 25% tablet (K-O-Tab) from Quality Chemicals Katwe.
The others are Alphacypermethrin (Fendona) SC from Famous Distributors opposite St. Balikuddembe (Owino) market, Cyfluthrin (Solfac) 5% Emulsion Oil in Water (EW) and Etofenprox (Vectron) 10% EW distributed by Kwera Limited on Bombo Road.
But Uganda still has a long way to go in achieving the desired ITN coverage to substantially reduce the mosquito population. The current coverage is less than 5%. However, the current Health Sector Strategic Plan targets reaching a 60% coverage by 2005.
“Innovative and collective efforts by all stakeholders are needed to rapidly and substantially increase this coverage,†Okia said. A family size ITN costs about sh10,000.
The use of ITNs is known to cut down household expenses on health by 45%.
The Ministry of Health estimates that between sh2,000 and 5,000 is spent on treating an episode of malaria depending on the place of residence.
Dr. Marios Obwona, the director of research at Bank of Uganda said the disease costs Uganda US $337m (sh674bn) annually. He added that malaria accounts for 20% of all hospital admissions, 9% to 14% of in-patient deaths and between 20% to 23% of the under-five mortality.
At continental level, malaria is estimated to cost Africa US $12bn annually in lost Gross Domestic Product.
However, Prof. A.M. Odonga, a Consultant Surgeon at the Makerere University Medical School cautioned that ITNs collect a lot of dust if not used in clean environments. He said the dust contains dust mites which are responsible for chronic coughs and may lead to asthma. He said their long-term side effects are not yet known. But Okia said the nets were safe and any side effects were just transient.
Nevertheless, the use of the nets would cut on household expenditure for malaria treatment, freeing the family resources for higher standards of living. Adverse effects of anti-malarials like chloroquine, quinine and mepacrine would also be avoided.
Prof. Medi Kawuma a consultant opthamologist at the Medical School and Dr. C.L. Sezi, a Malariologist at Mulago Hospital say research has shown that the three drugs had toxic effects and could lead to total or partial visual impairment.
Kawuma said ocular toxic effect of chloroquine was on the rise in Uganda. “It is particularly common in relatively small, low-weight patients, particularly those who exceed the standard daily dose of 250 milligram.
Excessive use of chloroquine leads to toxic deposits on the cornea and the macular, leading to blurred vision and inability to distinguish colours. The cornea is that part of the eye through which light passes while the macular is responsible for most acute vision.
Repeated use of quinine, Kawuma said, damages the optic nerve and retinal cells leading to gradual loss of sight and eventual total blindness. He said mepacrine, though not widely used in Uganda, affects the cornea giving rise to bizarre blue halos around objects.
Research by Medicens Sans Frontiers (Doctors without borders) also indicates that chloroquine resistance strain of malaria was as high as 81% in Mbarara and 76% in Kampala.
The doctors warned that the disease was becoming resistant to fansidar and quinine, leaving ITNs as the best solution before a vaccine is found.