WHO study on Malaria

Simplifying drug delivery vastly improves malaria treatment:

Giving malaria patients pre-packaged medicines halved patient waiting times at dispensaries and also halved the costs of the antimalarial medicines in areas participating in a study in Ghana. The simple pre-packaging method also resulted in a 20 percent increase in patients’ compliance with treatment in these districts, the study found.

Describing the study in the latest issue of the (Bulletin of the World Health Organization) the researchers said that pre-packaging anti-malarials should help counter disease resistance to these drugs and could also be applied to the treatment of other diseases.

“The pre-packaging of drugs,” can be expected to result in more patients taking the full treatment regimen, thereby reducing the risk of resistance to the drugs and extending the time before it will be necessary to switch to a more expensive drug for first-line treatment,” the author said the pre-packaging operation, which the authors describe as ‘low-level technology’, requires little or no specialized training and can be done locally and inexpensively.

Studies on pre-packaged anti-malarials conducted in other countries, including Burkina Faso, Nigeria and Uganda in Africa and China in Asia, have confirmed the positive impact of this strategy that was found in the Ghana study and in addition have reported an 80 percent reduction in the use of injections and a 70 percent reduction in wastage of medicines.

In Ghana, during the mid-1990s, the cost of treatment to patients was high, largely because of the dispensing of excessive volumes of chloroquine and the prescribing of chloroquine injections for uncomplicated malaria.

There were long waiting times at dispensaries and poor compliance with recommended treatment regimens.

Ghanian health management officials decided to find out of if matters could be improved by offering patients the anti-malarial drug chloroquine pre-packaged in plastic bags. The packs of chloroquine tablets were divided into three compartments, each containing a daily dose.

The method worked. After 20 weeks, compliance of adults and children was more than 20 percent higher in the three test districts than in three control districts where traditional methods of dispensing drugs continued to be used.

The costs of the anti-malarial drugs and patients’ waiting time were 50 percent less than in the control districts.

The intervention, which tended to improve case and drug management, was well accepted by health staff and did not involve them in additional working time.

The reduction in waiting time at the three dispensaries was achieved because staff were not spending time counting tablets while patients were waiting.

The pre-packaging cut the cost of treatment because fewer tablets were dispensed and there was less wastage.

“Both policy-makers and the general public would welcome any intervention that reduced cost without compromising effectiveness or quality,” the authors say. With regard to longterm malaria control, the most important result of the present study is the demonstration that pre-packaging improves compliance.

Staff at the dispensaries were also enthusiastic about the switch to pre-packaging and suggested the other commonly used drugs should be pre-packaged.

The patients approved the methods because it made it easier for them to remember how to take the prescribed medicine.

The study was conducted by Dr. Kojo Yeboah-Antwi, then District Director of Health Services for Wenchi District, Ghana, and colleagues from the Health Research Unit of the Ghanian Ministry of Health, and the Liverpool School of Tropical Medicine, United Kingdom and received financial support from the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland.

(Sent by Dr. Viraj Peramuna)

Things to know about diabetes

Although diabetes is fast becoming a common disease in Sri Lanka, there is little understanding amongst the majority of the public how the disease is caused, it’s consequences and the management of the disease.

It has been observed that many patients ignore the disease after the initial diagnosis for a number of years, some times even until serious problems develop.

A common phrase used by many is ‘I only have only a little bit of diabetes’, implying that diabetes is treated lightly at least during the initial stages of the disease after diagnosis.

This is largely due to the lack of knowledge on the seriousness of the complications that may arise as a result of undetected and poorly controlled diabetes.

An individual may have diabetes for many years without having any noticeable symptoms and some of the damage due to diabetes may actually be caused during this asymptomatic, silent stages of the disease.

There is evidence (American Diabetes Association-ADA, 1997) that diabetic retinopathy (damage to the fine blood vessels that supply blood to the eye), may begin to develop about seven years before clinical diagnosis of Type 2 diabetes (see section on types of diabetes) is made.

Undiagnosed diabetes is a serious condition. Patients with undiagnosed Type 2 diabetes are at increased risk for developing coronary heart diseases, strokes and peripheral vascular diseases (narrowing of the blood vessels supplying blood to the extremities of the body).

They also have a higher chance of having high fat levels in the blood (hyperlipidaemia), high blood pressure (hypertension) and obesity (being fat). Due to these reasons, the American Diabetes Association has proposed lower blood glucose values for diagnosis and classification of diabetes and pre-diabetic conditions which are very useful.

However, even if a pre-diabetic status is detected, considering the current attitudes towards diabetes in Sri Lanka, it is most likely that the condition will be ignored by many unless the public is made aware of the dangers of undiagnosed diabetes.

Once diagnosed, such persons should receive effective counselling, on the importance of introducing the necessary dietary and lifestyle changes with a view to weight reduction or weight management as the first line of defence against developing diabetes later in life.

What is diabetes?

In order to be able to control diabetes effectively, one needs to understand what diabetes is and what happens to the food in the body, specially the starchy and the sugary foods that are the major sources of carbohydrates in our food.

Just like a car needs energy to run, our body also needs energy to perform various tasks. A car can burn different sources of fuel (petrol, diesel or gas) to obtain energy. Similarly, the human body can derive energy from carbohydrate, protein or fat that is found in our food. Carbohydrate is the preferred source of energy for the human body.

Once a meal is eaten, food is digested or broken down into smaller particles. Carbohydrates are converted into sugar, glucose being the most predominant form and absorbed into the blood stream. From the blood stream, glucose enters the body cells with the help of the Insulin.

Once the glucose enters the cells it is oxidised or burnt in the cells to provide energy that is necessary for various kinds of bodily functions.

Some glucose is stored in the liver and muscle as glycogen. The body can store only a small amount of glucose as glycogen. Excess glucose will be stored in the body as fat. If your diet contains more energy than necessary (carbohydrate, protein, fat or alcohol), the body will store the excess energy as fat. Excess deposition of fat leads to over weight and obesity (fatness).

Obesity is a risk factor for developing diabetes, coronary heart diseases, high blood pressure and certain types of cancer and many other health complications.

When you eat a meal containing carbohydrates, there will be an increase in the blood sugar level quite rapidly. In a non-diabetic person, an increase in blood sugar above normal levels will stimulate the pancreas (an organ in the body) to produce and release more insulin into the blood stream thus enabling the body to clear the excess glucose from the blood stream by helping it to enter the cells. In healthy individuals the blood glucose returns to normal levels within about two hours after a meal. This does to happen in a diabetic person and there is a build up of glucose in the blood leading to diabetes.

Carbohydrates

The major nutrient found in the staple foods such as rice, wheat, potato, yams and others. Commercially available glucose and the commonly used table sugar (sucrose) are also carbohydrates.

The sweet taste of fruit is due to the fructose which is also a carbohydrate. In addition to what is mentioned here, there are also other types of carbohydrates. When starchy foods are eaten they are converted to glucose in the body which provides energy.

Insulin and Pancreas

Insulin is a hormone secreted by certain kind of cells (islets of langerhans) found in the pancreas. Insulin has many different functions in the body but its main function is to help blood glucose to enter the body cells,

Glycogen

Glycogen is the storage form of carbohydrates in the human body.

Dr. Damayanthi Piyadasa Perera

PhD (London), Consultant

Nutritionist and Dietitian, National Diabetes Centre, Rajagiriya.

Chocolate and heart disease

Dr. D. P. Atukorale

Chocolate is a confection made from cocoa beans and is used to make candy and beverages. Fermented beans are roasted and ground, then mixed with cocoa butter, sugar and milk powder. Cocoa butter is rich in fat and it contains proteins (25 per cent), fat (30 percent) and carbohydrate (45 percent).

Drinking chocolate, is a blend of cocoa powder, sugar and dried milk powder. Milk chocolate is produced by mixing finely ground cocoa powder with some cocoa butter, sugar and dried milk. The process of making chocolate was perfected in Switzerland around 1836.

Free radicals, oxidants and antioxidants

Dark chocolate and preparations containing cocoa powder are rich in bio-flavonoids which have antioxidant action. Before speaking about various bio-flavonoids, I would like to mention a few words on free radicals, oxidants and antioxidants.

Free radicals: Electrons in an atom occupy regions in space known as orbitals. Each orbital can hold a maximum of two electrons spinning in opposite directions.

A free radical is defined as any species capable of independent existence, that contains one or more unpaired electrons, an unpaired electron being one that is alone in an orbital. Free radicals are more reactive than non-radical species.

Free radicals form in our cells and tissues as a part of normal cell activity. During the process of injury to tissues and hypoxia to tissues as in myocardial infarction and stroke, free radicals such as superoxide radicals, which are made by adding an extra electron to oxygen molecule, play an important role.

We cannot completely stop free radical formation, but we can minimize the damage.

Free radicals play a crucial role in the patho-physiology of broad spectrum of cardiovascular disease, congestive heart failure, valvular heart disease, (cardiomyopathy) and (atherosclerosis).

Oxidants: The term oxidant is used to include not only free radicals such as superoxide and hydroxyl radicals, but also non-radicals such as hydrogenperoxide (H2O2) and hypochlorous acid (HOCL) which are powerful oxidizing agents formed during tissue reactions.

Antioxidants: Antioxidants are substances such as alpha-tocopherol (Vit E), betacarotene (pro-vitamin A) and Vit C which are believed to prevent damage to cells and tissues by oxidants mentioned earlier in diseases such as cancer and (ishcaemic) heart disease.

Antioxidants can prevent diseases such as cancer and heart disease. Certain enzymes such as SOB (Superoxide-bismuthase) present in human tissues remove free radicals such as superoxide and hydroxyl radical and convert these radicals to hydrogen peroxide which in turn are removed by other enzymes.

All plants are rich in antioxidants such as Vit C and betacarotene, Grains are much in Vit E.

Antioxidants and heart disease

There are two main types of cholesterol, LDL the so-called bad cholesterol and HDL the good cholesterol. Most of the people believe that LDL cholesterol is atherogenic. It is not so. LDL cholesterol is relatively harmless. When LDL is oxidized by oxidants, the oxidized LDL cholesterol becomes atherogenic leading to heart disease, stroke and peripheral vascular disease.

The antioxidants such as Vit E, carotenoids, Vit C, flavonoids (which are polyphenolic antioxidants present in vegetables, fruits, wine, tea, coffee and cocoa) inhibit oxidation of LDL and also reduce the clotting tendency of blood.

If the oxidation process of fats were to go on with nothing to stop, it will eventually destroy body cells completely. Fortunately many antioxidants protect our cells and tissues from the ravages of fat oxidation.

To be continued next week

Am I having a stroke?

Do you know the common symptoms of stroke? Learn what they look and feel like so that you’ll know when to get emergency help.

The window of opportunity to successfully treat a stroke is short - about three hours, so awareness of stroke symptoms is important. Maybe you think you can spot stroke symptoms in someone else, but would you know if a stroke was happening to you?

Symptoms

Mark Alberts, MD, Professor of Neurology at the Northwestern University Feinberg School of Medicine and Director of the Stroke Program at Northwestern Memorial Hospital in Chicago, lists these common stroke signs.

* Trouble with speech or having difficulty in talking, like you may struggle with finding words, slur your speech or find yourself unable to speak

* Trouble understanding what other people are saying to you.

* Feeling weak or numb on one side of your body, especially if it strikes you suddenly (you can’t move your face, one leg, or one hand).

* Having trouble with coordination on one side of the body, especially when it happens all of a sudden.

* Seeing double or having trouble focusing on objects or people.

* An excruciating headache that comes out of nowhere.

* Headache is a stroke symptom that many people may not know about, but it’s a serious warning sign. You may dismiss a headache as an everyday occurrence, but a stroke headache is one that hits you hard and fast, and with no apparent cause. And while migraine headaches have been linked to increased stroke risk, this doesn’t feel like your average migraine either.

Dr. Alberts describes it as the “sudden onset of the worst headache of your life. Call your nearest emergency hotline number and get to the hospital if you notice any of these symptoms. Don’t waste any time by contacting your doctor instead,” Dr. Alberts said.

What it feels like

Lily U. Burns of Boston suffered an ischemic stroke two and a half years ago at the age of 33. Her boyfriend was with her at the time, and what he heard and saw was some mumbling, a drooping of her mouth, and her inability to respond.

Diana Rodriguez, Medically reviewed by Pat F. Bass III, MD, MPH

To be continued next week

Laughter the best medicine:

Donkey serenade

God created the donkey and told the animal you will work tirelessly from dawn to dusk for man. Carrying heavy bags on your back. You will eat grass. You’ll have no intelligence and ive for 50 years.

The donkey replied: “My lord 50 years is too much for me, give me only 20 years. God said alright.

God next created the dog and told the animal. You’ll look after man and his house. You’ll be his best friend, and eat whatever he gives you, and you’ll live for 25 years.

Oh lord the dog replied 25 years is too much for me, make it only 10 years, and it was granted.

God next created the Monkey and told the animal, you’ll jump from tree to tree eat fruits and do silly things, and you’ll be amusing too and you’ll live for 20 years.

The Monkey replied. Oh no God make it only 10 years for me, and that too was granted.

Finally God created Man and told him. I am making you the only rational being on earth. You’ll use your intelligence to control other animals, and you’ll dominate the world and live for 20 years.

Oh, God please listen to me, the Man said. “20 years is not enough for me. Can’t you give me the 30 years 20 years and the 10 years that the donkey the dog and the Monkey dropped from their life? The God said:

“Ok you’ll have them, and since then Man on earth lives the first 20 years like a Man, then he gets married and lives the next 30 years like a donkey working and carrying the load of married life and then when his children get married and leave the family, the next 20 years from dogs like a dog looking after the house and eating whatever is given to him, and then when he gets old and retires spend the next 10 years like a Monkey jumping from one child’s house to another, doing silly things to amuse the grand children.

Taken from HeathFact and Myth.