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Malaria N° 7 - Subject N° 3

W.A. Chinery

In a consideration of the impact of drug-use on the MALARIA situation in GHANA, it was suggested that the recalcitrant MALARIA epidemic of 1987 was due to a complex of interrelated ecological factors including existing very low incidence of parasite resistance and insensitively to drugs combined with undertreatment and a waning immunity due to several causes ut infra. That some of the putative resistance and insensitivity cases were successfully treated with standard doses of drugs of low potency or both.

The observed decline in parasite rate in Accra over the past 4 to 5 decades is due to rapid urbanisation with its attendant pollution of breeding waters and therefore reduced vector frequency, increasing individual and household prophylactic measures (anti-parasite and anti-mosquito measures) as well as anti-larval measures at the municipal level over several decades. This is likely to lead to an appreciable decline in specific antibody levels in the population which was underscored in a suburb of Accra. It is believed that this situation of low parasite rates and low specific antibody levels is developing in other urban centres in the country. Immunity shortens parasite life-span, enhances effect of antimalarials and masks the appearance of chloroquine resistance. The causes of the above recalcitrance include existence of very low incidence of parasite resistance in population, non compliance with the course of treatment, importation of drugs of doubtful potency or without active ingredients. To this is added reduced bio-availability of drugs in the blood due to several causes including self-medication, difficulty in administering the absolutely correct dosage which may vary with each individual and unwillingness to disturb the patient’s immunity.

It suggested that relevant long term research on the observed ecological factors which may predispose the community to episodes of recalcitrant MALARIA be carried out in order to institute appropriate intervention strategies which will include a comprehensive and detailed laboratory test for P.falciparum parasitaemia, monitoring P. falciparum drug resistance and insensitivity, stoppage of prophylactic chloroquine administration, relevant health education of the community and hospital laboratory-based research on the host e.g., HLA type and the parasite e.g., parasite genetics; socio-sero-parasitological studies in different bioclimatic zones in the country to provide a comprehensive information for use in effecting a sound drug-use policy.

KEY WORDS: Drug use, Malaria scenario, Relevant epidemiology, Intervention strategies, Ghana

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