Malaria is many ways like the hippopotamus, depending on what one thinks is the cause of the disease.
There is hardly anybody in Ghana who has not suffered from the disease, yet knowing about what causes it remains elusive to many who live in the rural areas.Although, there is widespread knowledge that mosquitoes cause malaria, many African societies have traditional perceptions about the causes and management of the disease.
It is, therefore, not surprising that everybody in Africa can treat malaria. Right from the household level, where self-medication is common, to witchdoctors and herbalists, who prepare concoctions to treat malaria. Some people believe in Ghana that they suffer from malaria because they exert themselves too much while working under the hot sun. To others, eating sweet and oily foods, poor environmental sanitation and consumption of unripe fruits can cause malaria.
But Ghana is not alone. In Banjul for example, some rural dwellers believe that if you drink lots of sour milk during the raining season you would get malaria.
In some parts of Togo, it is believed that one suffers from malaria eating too much palm oil.
The deep cultural belief in witchcraft has also greatly impacted on the prevention and treatment of malaria across Africa. It is not surprising therefore that the treatment for disease greatly varies, particularly in the rural areas where interventions are greatly influenced by the perceptions about the disease. These include drinking coconut juice, applying regular enema, drinking liquid from boiled pineapple peels and neem tree leaves.
The truth about the causes, diagnosis and treatment of malaria across the continent is largely surrounded by myths and conceptions just like the hippopotamus, which lives largely submerged by water with only the ears sticking out.
Perceptions and myths about the causes and treatment of malaria, which has hindered the effective management of the disease, largely within the communities, could be likened to the hippopotamus, which has a large part of its body submerged in water.
"Malaria is unique because its roots lie in human communities," says Dr Margaret Gyapong, a Malaria Expert at the Dodowa Health Research Center in the Greater Accra region of Ghana.
Early work on malaria, she said focused on vector control without reference to human behavior and belief system. "Too often behavioral and socio-cultural aspects were an afterthought. Lack of attention to these aspects is reason for failure of early attempts at malaria control", she notes.
Dr. Gyapong points out that said perceptions about the causes of the disease has influenced the decisions individuals make in seeking treatment for the disease.
She laments that as a result of such myths, decisions to seek treatment for malaria at health facilities are often the last resort. The relatively few patients, who have contact with the health services, represent the ears of the hippopotamus," Dr. Gyapong said.
Studies have shown that usually, victims of malaria seek medical examination and treatment from health facilities when the initial attempts have failed resulting in late presentation. Very often treatment of malaria in Ghana occurs at home with only a few of such home based treatments being correct and complete. Clearly, there is an urgent need for health education to deal with the perception about the disease. Health education is needed at this point to help the communities to appreciate the need for better management of the condition.
Malaria, no doubts, is a common but complex disease. There have been studies to determine the proportion of fevers actually due to malaria. However fever remains the most recognized symptom of malaria. This situation sometimes leads to that practice of presumptive diagnosis and treatment on the part of both health professionals and people within the communities.
For those within the communities, presumptive diagnosis and treatment reduces cost in time and money for the patient or guardian, who may find it difficult to attend a formal health outlet. Prof. Kwadwo Koram of the Nugochi Memorial Institute for Medical Research, however, said there were drawbacks in presumptive diagnosis because of over-exposure of population to risk of drug toxicity.
He said there was also the "likelihood of inaccurate dosing, including the use of sub-therapeutic treatments that may favour the evolution or spread of drug-resistance".
Studies on health –seeking behavior, perceptions of malaria, treatments, and decision-making for health care at the household, community and health facility levels, are crucial to malaria control. Malaria is an important social, economic and developmental problem affecting individuals, families and communities. The best chance for combating the disease is a collaborative approach.
Over the last few years though, malaria control has led to studies on perceptions about he disease. Some of these studies have recently informed policy development.
For instance, one intervention by the Ghana Health Service (GHS) is to bring malaria treatment closer to the communities, especially to help save the lives of children through the promotion of early and appropriate home management of malaria
This is because the majority of children who die from malaria do so within 48 hours of onset of illness. The early use of effective anti-malaria medicines at home, therefore, can help reduce the burden of the disease.
The GHS was distributing choloroquine at the community level through trained people. However, with the introduction of the new malaria drug, artesunate amodiaquine,
it is time to "kill" the African Hippopotamus malaria!
Studies are being conducted to see if this drug, complex in administrating, could be distributed in the communities. Malaria control is everyone should contribute. It requires the partnership of community members and the involvement of those engaged in health care delivery.
Indeed malaria is of major concern to households. It can be detrimental to livelihoods and if not protected these costs can push households towards poverty. In Ghana, the disease is the leading cause of workdays lost due to illness. The condition, with the general malaise it brings on, reduces output by increasing absenteeism from work and school.
WHO records indicate that there are 300 to 500 million clinical cases a year and up to 2.7 million deaths occurs globally. Certainly malaria is not only a public health problem but also a developmental problem that must be addressed.
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