Treat Malaria Today and Eradicate the Disease Today: A model for Disease Eradication Strategy for Endemic Regions. Remigius Okea, (MD, MPH) ScM.D: American Academy of Primary Care Research, American Hope Institute and Colleges, ScienceMedicine Research Institute. Print

Name :  Remigius Okea

Date  :  02-Jun-2013

Remigius Okea

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Problem:

There has been a lack of organized strategy to unify the treatment of malaria and many tropical diseases, and a lack of continuous effort to re-educate the physicians and health providers with the latest advances in the field of tropical medicine in Nigeria and Africa. More importantly there has been a lack of conceptual framework for the treatment-eradication of malaria or other tropical diseases. Statistical and demographic data are lacking even in many institutional settings. This has created over-dependency on WHO and similar organizations that have a primary objective, many times, divergent to the immediate need of individual countries or states.    

 

Method;

The first consideration in formulating a treatment strategy is to define the objectives and the intent of the strategic guideline based on the expected outcome. Thus the two main objectives of a malaria treatment strategy are:

(1) To reduce morbidity and mortality from malaria

(2) To eradicate malaria on the long term.

To achieve these, the concept of Malaria Individual Eradication (MIE) is proposed. The MIE concept is built on the premise that every confirmed case of malaria offers us an opportunity to target eradication of the disease by focusing on that individual case, treating immediate infection, preventing relapse, preventing recrudescence, and above all stopping re-infection. This can be summarized as Treat Relapse Recrudescence and Re-infection (TR3). 

 

The MIE program is a wining concept for the eradication of malaria. Armed with existing and new tools, MIE education for doctors and health care providers shall be taught in medical schools and CME/CPD courses. MIE is redesigning treatment guidelines for malaria with the aim to eradicate the disease rather than stop at the point of care that have hitherto been the practice. A MIE center is proposed for every teaching and general hospital, and for all local government headquarters to track malaria incidence, support referred patients and homes with indoor DDT sprays and outdoor, breeding site spray with bio-degradable EK solution. AAPCR shall provide the training for specialized health care workers on the use of DDT and EK solution, and support electronic data and records. Governments at the local, state and federal levels are called to support and partner with AAPCR to catapult the program to quick success. Public education and advertisement on malaria prevention shall be vigorous.

 

Guideline features:

All treatments should be with combination anti-malarials. Monotherapy is discouraged. All treatments should contain Artemisinin or its derivatives in combination with one or more other antimalarials for at least the initial 3 days. Treatment duration should be 7 days. Once decision to treat is made, complete course of treatment should be given whether diagnosis of malaria is confirmed or not, and whether the patient is symptomatic or not. Treat all G6PD negative patients with Primaquine at the appropriate dose. These measures are meant to reduce drug resistance and target individual eradication. (also see WHO guidelines).

Preventing same individual from malaria disease a second time should be integrated into the guideline. This is done using targeted indoor residual spraying (IRS) with DDT and or community wide IRS and encouraging the use of EK solution to kill mosquitoes in the surrounding breeding sites.

 

Ongoing research with new techniques to limit the development of resistance to anti-malaria drugs and to achieve selective pharmacology and drug targets using nano-technology is the future in the war against malaria and remains to focus of AAPCR.

 

Conclusion:

We can begin to eradicate malaria today by focusing on the individual cases in the MIE strategy that advocates treat relapse recrudescence and re-infection (TR3) with laid out guidelines. Incorporated into this is the use of indoor residual spraying (IRS) with DDT and outdoor breeding site elimination with EK solution. Continuous research into new techniques to reduce resistance to anti-malaria medicines and to improve selective pharmaco-toxicity toward plasmodium using nano-technology should be ongoing. The AAPCR MIE centers is proposed to achieve these objectives.