Health

Malaria in the 2000s: A Tale of the Dreaded Chloroquine, Fansidar and Quinine-Based Treatment

Malaria is reported as the leading cause of morbidity and mortality in Uganda as per the Ministry of Health analysis.

Approximately, 16 million malaria cases were reported in 2013 and over 10,500 malaria deaths are reported annually according to Ministry of Health statistics.

The World Health Organisation (WHO) noted that in 2018, there were an estimated 228 million cases of malaria worldwide. The World Health Organisation data also shows that the African Region carries a high share of the global malaria burden whereby in 2018 alone, the region had 93% of the malaria cases and 94% of malaria deaths.

Malaria Treatment

Until 2000, Chloroquine (CQ) was the first-line medicine for treatment of uncomplicated malaria in Uganda, and Sulfadoxine/Pyrimethamine (SP) or Amodiaquine (AQ) was the 2nd-line medicine while Quinine (Qn) was the reserve medicine as compiled by the Malaria Research and Treatment teams.

For severe malaria, Quinine was the recommended medicine initially given intravenously until the patient is conscious and able to take medicines orally.

However, in the late 1990s, parasite resistance to CQ, at varying levels in the 8 East African Network for Monitoring Antimalarial Treatment (EANMAT) sentinel sites located in different parts of the country, was documented.

By 2000, the parasitological resistance to CQ had increased significantly, ranging from <5% to >50% in different sites, and clinical failure following CQ treatment in Uganda had increased to about 38% [4], exceeding the WHO recommended threshold of clinical failure of 25%.

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As such, in line with the World Health Organisation recommended threshold for antimalarial drug policy change (clinical failure rate of ≥25%), Uganda embarked on yet another policy change process that culminated in the adoption of artimesinin combination therapies (ACTs) as the first-line treatment for uncomplicated malaria.

Tales of the then malaria treatment experience

The tales of the now grown millennials who experienced the side effects of the Quinine injection which included; ringing in the ears, vomiting, stomach cramps, nervousness, nausea, diarrhea and confusion among others, highlight the urge to prevent catching malaria as one could not imagine ever visiting the hospital after such an encounter.

Nagawa Christine Diana, 28, is a resident of Namungoona. She is a manager at a local clinic and drug shop.

Nagawa is one of the victims who suffered from Malaria in the early 2000s, a period when she was still a child. Her story, like many of the others who have fallen prey to the deadly plasmodium, was a wake-up call to her household to employ possible efforts to prevent the reoccurrence of malaria.

“In 2004, I was 12, living in Mityana, I remember waking up with terrible headache, my temperature was so high and I later got soars in my mouth,” she said.

She said that upon being taken to the near by health centre by her parent, she was diagnosed with malaria.

Christine Nagawa

Treatment

“Malaria management then was either with Quinine, Chloroquine (CQ) or Fansidar. I was treated with quinine and it gave me one hell of a ride,” she said.

“First of all, it was an Intramuscular Injection (IM) injection on the bum. I still get pain from one of the injections given then. The dizziness and blocking of ears from the medication were unforgettable. But I recovered within five days of treatment,” she said.

However, despite recovering, Nagawa and her family were left in shock as malaria had spread to the other family members.

“It was more like an outbreak. Upon healing, my two young brothers and some other children in the neighbourhood got malaria too,” she stressed.

Adopting measures to fight against Malaria

After the mini malaria outbreak in their neighbourhood, Nagawa’s family adopted measures to prevent the spread of malaria. On top of sleeping under the treated mosquito nets, mosquito repellents were also added to the regimen.

“I remember my parents buying mosquito repellents for us then because as children, however much we slept in mosquito nets, we always got the bites from sleeping close to the net,” she said.

Nonetheless, her family benefited from the government’s mosquito nets in the year 2011/12.

Her childhood malaria experience was an alarm to her. As an adult, Nagawa has learnt to prioritize her health.

“Since then, I have never suffered from malaria. This is because I am very cautious now. I sleep in a treated mosquito net daily and I also have my anti malarial drugs like thrice a year,” Nagawa said.

A Malaria Free Uganda

Uganda has the 3rd highest malaria burden in Africa, the disease being the cause of 50% of out-patient cases and 14% of in-patient deaths according to the Malaria Consortium Uganda.

It should be recalled that the Ministry of Health has concluded two waves of distribution of Long Lasting Insecticidal Nets(LLINs) under the ‘Under the Net Campaign’, which will see over 27 million Ugandans get free mosquito nets in a bid to end malaria.

The National Malaria Control Program data shows that the nets provide protection against mosquito bites, transmission of parasites and kill mosquitoes or repel them.

The next wave is scheduled to be conducted in October 2020, covering Kampala and Wakiso areas.

Nagawa recommended that people living around water logged areas should be prioritised, as they are the most affected persons.

“People in slums and those leaving around water bodies should be given top priority because they stay around breeding places for mosquitoes,” she said.

She also said that the government should sensitize the masses more on malaria, teach them the importance of clearing bushes, treating of stagnant water and the relevancy of sleeping under a treated mosquito net.

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