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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
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.
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
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.
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?
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