Editor's note: Welcome to the Global Health page. The purpose of this feature is to raise awareness of global health issues with an academic spirit to help improve the quality of care provided to patients. E-mail globalhealthnews@musc.edu.

Malaria is one of the world’s most common and serious tropical diseases.  Half the world’s population is at risk for malaria, which is endemic in more than 100 countries. Children are at particular risk, accounting for most malaria deaths globally.
 
Although preventable and treatable, malaria causes significant morbidity and mortality, especially in resource-poor regions. Sub-Saharan Africa is the hardest hit region in the world, and Ghana is no exception. Malaria is the leading cause of morbidity and mortality in Ghana, especially in children under 5 years old. It constitutes about 40 percent of outpatient hospital attendance and about 13 percent of all recorded deaths in Ghana.
 
Due to the increasing resistance of the parasites to the popular chloroquine and sulfadoxine-pyrimethamine (Fansidar) treatments, there have been changes in the treatment guidelines for malaria. The recent protocol adopted by the Ministry of Health includes the combined therapies of Artesunate (artemisinin) with either lumefantrine or amodiaquine for uncomplicated malaria. Complicated malaria is treated with quinine or parenteral arthemeter/artesunate. Most travelers to Ghana tend to use mefloquine or malarone (atovaquine-proguanil) for preventive treatment.
 
There are ongoing efforts by the government to control malaria, including dealing with sanitation to decrease breeding grounds of mosquitoes, providing insecticide-treated mosquito nets and the provision of affordable medication for treatment.
 
Most of the measures adopted for the control of malaria fall under the Roll Back Malaria (RBM) Program, which is an ongoing malaria vaccine project in Ghana. Hopefully, when a vaccine becomes available, the economic burden of malaria will be greatly reduced.

Herbal medicine plays key role in Ghana

by Frank Osei, M.D.
Pediatric Resident
Ghana offers two main teaching-university hospitals: Korle-Bu Teaching Hospital, located in Accra, and Komfo Anokye Teaching Hospital, located in Kumasi. Other health care options for patients in Ghana can be found in hospitals in each of the 10 regional capitals, as well as through religious and private medical practitioners who operate hospitals and clinics throughout the country where herbal medicine is commonly used. Considering these multiple outlets for medical care, efforts that support continuing medical education include a bachelor’s degree offered by the faculty of pharmacy in the Kwame Krumah University of Science and Technology, Kumasi; as well as a special government-endorsed Herbal Hospital and Research Center, located at Awkwapim-Mampong in the eastern region of Ghana.
 
Until the introduction of the National Health Insurance Scheme (NHIS) in 2003, the “cash and carry” system was used, which required patients to pay for every medical service up front, apart from some emergency services. The financial burden caused by that system, combined with the limited accessibility to health care in certain areas, made it hard for many to receive health services. Currently, the NHIS covers more than 60 percent of the population, allowing more people to have access to health care.

Ghana—Geopolitical
The Republic of Ghana, a former British colony, was the first country located south of the Sahara to attain independence from colonial rule. This effort was led by Dr. Kwame Nkrumah. Ghana extends from the Gulf of Guinea along the west coast of Africa and is bordered by the Atlantic Ocean to the south. With a surface area of 238,837 square kilometers, it is similar in size to Great Britain or the state of Oregon. It has a tropical climate with a rainy season from April to October and is hot and dry the rest of the year.
 
More than 70 languages and dialects are spoken countrywide, the most widespread being Twi, which is spoken by roughly half the population.
 
The predominant religion in Ghana is Christianity.

Clinician’s corner
A 2-year-old male from Sub-Saharan Africa traveled with his mother to spend the holidays in Charleston. On the second day of the visit, the boy developed a fever of 102.5F, vomited twice, and had become prostrated. He passed dark colored urine on the way to the hospital. On examination, he was febrile temp 103.1F, ill looking, had dry mucous membranes, and had a tinge of jaundice. The rest of the examination was normal. UA was positive for blood, but no RBCs. What is the definitive test for the diagnosis of the cause of this illness?
A. CBC           
B. Blood film for Giemsa staining
C. Urine culture  
D. Blood culture
E. Chest X-ray

The answer is B. Blood film for Giemsa staining for the malaria parasite. The diagnosis is established by identification of the organisms on Giemsa-stained smears of peripheral blood. Giemsa stain is said to be superior to either Wright’s or Leishman’s stain. Both thick and thin blood smears should be examined. The thick blood film identifies the degree of parasitisation while the thin film will identify the Plasmodium species causing the infection. P. falciparum is most likely to be identified from blood just after a febrile paroxysm, but timing the smears is less important than obtaining them several times a day. A single negative blood smear finding does not exclude malaria. There may be a need to repeat the smears as frequent as every four to six hours a day. Alternative, non-microscopic methods such as monoclonal antibody and rapid antigen tests are being used more commonly. Polymerase chain reaction testing which is even more sensitive can also be used for diagnosis.

 

Friday, June 26, 2009