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Ghana: Avoid Self-Medication for Malaria
By Bernice Bessey A Clinical Pharmacist and malaria focal person at the Ghana Police Hospital, Mrs. Ellen Sam, has warned Ghanaians, especially expectant mothers, against self-medication for malaria, since its impact could result in the fatal dissolving of a 1st trimester pregnancy. She said even though pregnancy increases risk of high frequency and severe malaria, Artemisinin Combination Therapies (ACTs) are not used in 1st trimester of pregnancy, but can be used in the 2nd and 3rd trimesters, adding that Quinine tablets are used in the 1st trimester. She explained that under the Ghana Drug Policy, the three malaria drugs - Artesunate-Amodiaquine (AA), Artemether-Lumefantrine (AL) and Dihydroartemisinin-Piperaquine (DHA) - should not be used in the 1st trimester of pregnancy (0-3 months). The Clinical Pharmacist made this known at a three workshop, organised recently in Accra by Africa Media and Malaria Research Network (AMMREN) and Malaria Care Project. "All three drugs are oral formulations (tablets) and not injections. Doses are based on weight," she added. The Anti Malaria Drug Policy of Ghana insists the combination therapy shall be used, and no more monotherapy, due to the resistance of the plasmodium parasite, but the artemisinin-based combination therapy is the drug of choice at the moment, and is available for malaria treatment globally. Malaria prevalence in Ghana She noted that statistics had shown that the Greater Accra Region is experiencing a low percentage of 4% prevalence, as against a high percentage of 51% in Upper West, Upper East, 44%, Northern 48%, Brong Ahafo 37%, Ashanti 22%, Volta 17%, Eastern 22%, Central 32%, and Western 36%. Malaria prevalence in Ghana was evidenced in 2012, with 38.93% of outpatient department cases being attributed to malaria. Severe malaria is a medical emergency Common complications of malaria include Cerebral Malaria (coma, unconsciousness), Severe Anaemia (low blood levels), Severe Dehydration (profuse vomiting, inability to feed) and Hypoglycaemia (low blood sugar) It is, therefore, important that such cases are given prompt referral to the appropriate hospitals for patients to be injected with Artesunate or Artemether. "Severe malaria must never be managed at home. Death can occur within hours," she warned. Poor adherence She said many patients are unable to finish their dosage within the three day regimen, due to the component in the ACTs which acts rapidly to clear about 80% of the parasites within 24 hours, and makes patients feel better after day two. She added that some patients also find difficulty in following the dosage regimen, since some of the drugs, especially artemether-lumefantrine, must be taken with fatty meals, and as most patients experience nausea during malaria would not want a fatty meal. Mrs. Ellen Sam further warned the public of counterfeit and substandard medicines on the markets, which can lead to disease progression and the development of resistance, charging: "We must join efforts to fight counterfeit and substandard medicines to give patients the assurance that any drugs given them are efficacious." She also appealed for the use of T3 (Test, Treat and Track) for the effective treatment and eradication of malaria.
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