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Rapid Responses: Rapid Responses published:
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enviroment - o prevention of breeding of vector
- george chew (25 April 2009)
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Fighting Malaria: Isn't the best approach through Environmental Hygiene and Public Health?
- Felix ID Konotey-Ahulu (26 April 2009)
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Public health measures can and do work
- Yolande M. Agble (28 April 2009)
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Support health centres to become self-reliant in malaria treatment – not dependent on ever changing “financial mechanisms”
- Keith Lindsey, Hans-Martin Hirt (28 July 2009)
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george chew, retired, past consultant in Upper Region of Ghana retired
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The artemisinin combination therapy is another commercial based measure imposed on a suffering population A much more basic need is the education on the prevention of breeding of the vector in the environment: elimination of poor drainage, stagnant pools of water, and other public health environmental measures are crucial. During the dry season in the sub-sahara regions there is a reduction of malaria as breeding sites are reduced, Competing interests: None declared |
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Felix ID Konotey-Ahulu, Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana Consultant Physician Genetic Counsellor Sickle/Haemoglobinopathies 10 Harley Street, London W1G 9PF
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Fighting Malaria: Isn’t the best approach through Environmental Hygiene and Public Health? “Fighting malaria” Peter Moszynski (April 25, page 974) says “is part of the United Nations’ sixth millennium development goal” [1], and he quotes Director of the Global Fund for AIDS, Tuberculosis and Malaria Dr Michel Kazatchkine: “There is no reason any child should die from malaria anymore” because we have “impregnated bed nets” and “effective drugs to treat those who fall ill” [2] WHERE IS PUBLIC HEALTH THEN? Not a word from these experts do we get about Environmental Hygiene or Public Health which curtailed malaria considerably not only in the Colonial Days of the Gold Coast/Ghana [3] but also in present day Singapore, Cuba, and Trinidad [4] with the same hot and humid climate as Ghana. I was recently surprised to see vast areas of standing water in equally hot and humid Orlando in Florida where they farm gold fish to devour mosquito larvae, hence ‘No Malaria’. FRENETIC THERAPEUTICS Has this frenetic malarial therapeutics with apparent exclusion of Public Health as practised in politically disciplined Singapore, Florida, Cuba and Trinidad more to do with the interests of the pharmaceutical companies than with the health of the natives? [5 6 7]. Uproar at complications (especially neurological ones) of Artemisinin Combination Therapy in school children in Ghana was so vehement that “the Director- General of the Health Services with the Minister of Health had to appear together to answer furious questions” [4], when the Director of Public Health of the Ghana Health Service explained the ‘new policy’ dictated from abroad [4] and apologized for the complications of ACT [8]. Ghanaians are now voting with their feet [3 9 10], and turning to the natural products one of which is shown in the BMJ photograph accompanying Peter Moszynski’s article, labeled “WHO delegates visit a farm in Tanzania where Artemisia annua plants are being grown” (page 974) QUESTION OF TRUST Why will the natives rather use leaves of Artemisia annua and Azadirachta indica (Neem sold as ‘Dongo Yarro’ on the market) for malarial fever than obey “Official Policy” with its recommendation to use Artemisinin Combined Therapy? ANSWER: They are beginning to mistrust ‘Official Policy’. If the so-called “Monotherapy” works for the natives, they spare no thought for “future drug resistance”. If ordinary bed nets work for them, as they worked for most of us in our days in boarding school in the Gold Coast, why should they obey ‘Official Policy’ and subject themselves to the Pyrethrum used to impregnate the bed nets? [11] Not to mention the real possibility of the mosquitoes becoming “immune to insecticides” through frequent contact with these medicated nets? MILLENNIUM DEVELOPMENT GOALS As regards Millennium DEVELOPMENT Goals I pointed out that “The West will only give you tablets and vaccines, and will even prevent your goods from being sold on the European market” but “we natives seize on the word ‘development’ and think about agriculture, covering of open drains, and pipe borne water” [12] How many of these Global Fund experts advising us in the Tropics have had the guts to tell our leaders: “If you do not cover your open drains within 12 months, do not come to us begging for funds to fight malaria!”? Or “Why don’t you send health teams to Singapore to find out how they do things?” While the World Health Organization projects herself as the friend of the African, some other international advisers do not want Malaria to be controlled. CONTROL OF MALARIA IS BAD NEWS FOR SOME PEOPLE I can prove this. While chairing a Consultation in Zurich in March 1973 on GENETICS AND THE QUALITY OF LIFE [13], Dr Robert Edwards had to use all his British diplomatic wisdom to diffuse an explosive situation caused by one of the participants turning to the only 2 Africans present (Professor Alexander Boyo and myself) and furiously accused us of (sic!) “upsetting the course of Darwinian Evolution by seeking to eradicate malaria in Africa through chemoprophylaxis and other means” [14]. Alexander Boyo, himself a malariologist and pathologist, was livid. If Boyo was not black you could have quantified the degree of anger by the redness of his face matching that of our Caucasian participant. There are many in the world today who want the Anopheline mosquito to flourish in Africa. They call themselves Friends of the Environment, and Custodians of the future Planet. They rejoice that AIDS is depopulating Africa faster than anywhere else. Many of these are world Experts who rush into the Continent brandishing “Official Policy” on how to treat this and that condition. Ghana’s geographical area is identical to that of United Kingdom whose population is around 70 million. Ghana’s is 20 million, but the Experts rushing in with reams of ‘Official Policy’ say that Ghana is overpopulated, and we are doomed to starve. They are also interested in giving advice about how to avert a malaria disaster on our continent, leading me to pose this question in The Lancet: “But would averting a malaria disaster not upset the population control lobby?” [3] PERSONAL TESTIMONY Over the decades, especially working in Africa, I have moved from an unhealthy dependence on Therapeutics, to an unrivalled respect for Preventive Medicine and Public Health. Keeping a Diary of all patients admitted on my wards in Ghana, I came to realize annually that upwards of 80% of all acute admissions on my wards were for preventable diseases. Even for a hereditary ailment like sickle cell disease, the commonest precipitating cause of bone pain crises was malaria [15]. What saddens me as I get older is that Experts sent to us in Africa ostensibly to help “Roll back Malaria” prefer to talk Therapeutics to pulling us up sharply on environmental sanitation. Not many of them think, and talk, like Professor Jane Zuckerman who reminded us recently: “Get rid of vectors, and malaria tends to disappear” [16]. But as I pointed out before [6 17], not all the fault is from abroad through the “Official Policy” Directives. I described in detail the role that CORRUPTION plays nationally in compromising the health of us Africans [6 17]. And if we will get into the habit of travelling, and seeing how other people survive on less natural resources than we have, we will discover how Israel, for one example, grows bananas and avocado pears (and much else) in the desert, and how they harvest water from morning dew. For us Africans just to sit there, swallowing without question any ‘Official Policy’ handed down to us from abroad, is to play right into the hands of those who would rather see Darwinian Evolution “protected” than have our towns, streets, and homes free of mosquitoes. Felix I D Konotey-Ahulu MD(Lond) FRCP(Lond) FRCP(Glasg) DTMH Kwegyir Aggrey Distinguished Professor of Human Genetics, University of Cape Coast, Ghana and Consultant Physician Genetic Counsellor in Sickle & Other Haemoglobinopathies, London W1G 9PF [felix@konotey-ahulu.com] 1 Moszynski P. New funding mechanism is launched to expand access to artemisinin based combination drugs. BMJ 2009; 338:b1627 (April 25, pages 974-75) 2 Moszynski P. New funding mechanism is launched to combat malaria http://www.bmj.com/cgi/content/full/338/apr20_2/b1627 BMJ 2009 April 20 3 Konotey-Ahulu FID. Averting a malaria disaster. Lancet 1999; 354: 258 (17 July) 4 Konotey-Ahulu FID. Imported malaria in the UK: Unde venis? & Quo vadis? BMJ 16 July 2008 Rapid Response http://www.bmj.com/cgi/eletters/337/jul03_2/a135#198874 5 Konotey-Ahulu FID. Do international donors genuinely desire to help solve Africa’s health problems? BMJ 19 March 2008 Rapid Response http://www.bmj.com/cgi/eletters/336/7643/518#192285 6 Konotey-Ahulu FID. Who should best pharmacovigilate in developing countries? BMJ 14 September 2007 Rapid Response http://www.bmj.com/cgi/eletters/335/7618/462#176455 7 Konotey-Ahulu FID. Doctors must not be lapdogs to drug firms: even more relevant to The Third World. BMJ 12 Nov 2006 Rapid Response http://www.bmj.com/cgi/eletters/333/7576/1027#149040 8 Amofah G. Furore over Artesunate-Amodiaquine. Daily Graphic, Accra, Ghana 15 May 2006, page 23. 9 Konotey-Ahulu FID. Fever in Africa and WHO recommendation. Lancet 1997; 350: 1549 10 Konotey-Ahulu FID. Probing anecdotes in traditional African therapeutics. African Journal of Health Sciences 1994; 1: 55-56. 11 The Globe and Mail Toronto. Tough flight for mosquito nets: “If they are safe for babies and mothers in Africa, why are they not safe enough in Canada for a week?” 18 August 2006 12 Konotey-Ahulu FID. MDG’s, Countdown to 2015, and “concern” for Africa. Lancet 2008; 372: pages 369-370. 13 World Council of Churches. Genetics and The Quality of Life: Study Encounter Vol X, No 1 1974. Report of a Consultation. Church and Society, Christian Medical Commission, World Council of Churches, Zurich, June 1973, Switzerland. 14 Konotey-Ahulu FID. Malaria and Sickle Cell: “Protection?” Or “No Protection?” – Confusion reigns. BMJ 13 Oct 2008 Rapid Response http://www.bmj.com/cgi/eletters/337/oct01_3/a1875#203067 15 Konotey-Ahulu FID. Malaria and sickle cell disease. BMJ 1971; 2: 710-711. 16 Zuckerman Jane N. Imported Malaria. EDITORIAL BMJ 2008; 337: a135 17 Konotey-Ahulu FID. Epidemiology of Malaria (5). The Why? Question. Ghanaian Times Feb 18 2006, page 6. Competing interests: None declared. Competing interests: None declared |
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Yolande M. Agble, Rtd. Public Health advisor (schools) NA
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As a Trinidadian who spent the first 21 years of my life in that country never having had an attack of malaria or even knowing anyone who did, I am committed to the public health measures which I saw being employed in my native country which made this possible. In Ghana, I personally know of a number of friends and relatives who suffered very serious side effects after a course of the new ACT, and which did not guarantee any long term immunity from a subsequent attack within a short time either. Good old fashioned public health programmes, which could be implemented with effective supervision at every level of the health care chain, should form the basis of the health care programme of any government serious about eradicating/minimising the incidence of malaria among its populace. One of my memories of this programme was the fact that the sanitary inspector, who was easily recognisable by his uniform, had the authority to impose fines on residents who did not comply with basic preventive measures. These were inexpensive and simple to undertake. There was a large workforce in this disease prevention programme which likely helped to keep unemployment to a minimum. Another thing, isn't it about time, as we approach the end of the first decade of the 21st millenium, that African governments took responsibilty (total) for the health of their people? I am at a loss to know why these decisions are still under the purview of WHO and other groups. There can be no denying that drug companies which stand to gain from the perpetual incidence of malaria in Africa and elsewhere would not want to lose their golden egg goose. This is how the system works and has worked for decades, why change it, some will ask? A good reason- because it is not at all in the interest of African and other peoples in poor countries. Yolande M. Agble Competing interests: None declared |
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Keith Lindsey, Deputy Coordinator, anamed Berglenstr. 10, 71364 Winnenden, Germany, Hans-Martin Hirt
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The effectiveness of artemisinin in treating malaria is well proven. Artemisinin is extracted from Artemisia annua, a plant that contains several anti-malarial components. Anamed (Action for Natural Medicine) has nearly 1000 partners working in about 70 tropical countries who give overwhelming feedback that indicates that not only is tea made from the dried leaves of Artemisia annua just as effective as artemisinin in treating malaria, but also that, compared with conventional anti- malarials, the recrudescence rate is much lower. This provides us with an amazing opportunity. That is, at minimal cost we could provide seeds and training to the staff of government and church health centres in the cultivation, harvesting and storage of artemisia, and in its administration as tea to malaria patients. What would that mean? Simply that even in the most remote places, and in those areas affected by civil disturbance where absolutely no modern pharmaceuticals are available even if in that country they are theoretically available at no cost, the local health centre could have its own supply of an effective anti-malaria drug. We do not deny that voices have been raised in opposition to the use of artemisia tea. All possible concerns have already been fairly considered (1). Through this column, therefore, we invite the Global Fund to host another facility, that of providing seeds of Artemisia annua and the necessary training to another group of 11 countries. A comparison of the results, particularly 5 years hence when the proposed subsidies for the ACT drugs may well have been withdrawn once again, would be more than interesting. Hans-Martin Hirt PhD
(1) http://www.anamed.net/English_Home/anamed_artemisia_programme/Circular_letter_ -_May_2006/circular_letter_-_may_2006.html Competing interests: None declared |
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