Compiled and coordinated by Edward
WHO study on Malaria
Simplifying drug delivery vastly improves malaria
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
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
The Malaria injector
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
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
The reduction in waiting time at the three dispensaries was achieved
because staff were not spending time counting tablets while patients
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
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
The fastest and easiest way to check your sugar level
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
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
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
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
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.
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
Glycogen is the storage form of carbohydrates in the human body.
Chocolate and heart disease
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
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
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
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
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
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?
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
* Trouble with speech or having difficulty in talking, like you may
struggle with finding words, slur your speech or find yourself unable to
* 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
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:
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.