“For almost a week I had not been able to get much work done. My energy levels were low, but I did not think I was particularly ill. Later I developed what I thought was either a flu or an upper respiratory tract infection, so I placed myself on cold medicine and antibiotics. (I know what you are thinking about the antibiotics without a test…). I got a bit better but was still not 100%. Then it struck me to do a malaria test. It turned out to be positive. Since at work I have access to a lab, I actually had the pleasure… or shall I say displeasure to look down the microscope myself to see the trophozoites!1
So I went to the closest pharmacy, where the attendant sized me up and presented me with three antimalarial drugs; all ACTs approved by the Ghanaian Ministry of Health as first-line options for treating uncomplicated malaria.
He advised against one of the three formulations, saying although it worked well, I might feel weak, especially if I did not eat very well before taking it. Of course I knew better, because this was a WHO quality-assured fixed-dose ACT we were talking about here! I had tried it before and it had worked excellently for me! But I was also keenly aware of the unfortunate negative public perception of that particular formulation in Ghana accounting for that misplaced “not a good idea advice” from the pharmacy attendant. It could all be traced to some unforeseen mishaps during our attempt to roll-out a loose-dose version of that formulation as first-line policy in 2004.
Nevertheless I opted for one of the two other MoH-recommended alternate first-line therapies just because I had never tried that particular formulation before, the packaging looked just as good as the others did, I knew the manufacturer, and could afford it. Moreover, the long half-life of the partner drug in that ACT somewhat appealed to me. After I completed the first day of my selected ACT (3 tabs in one go!), I set a reminder on my cloud synchronized cell-phone calendar for the next 2 days to make sure I took them at exactly 4 pm as I had done on the first day. By the end of the second day I saw visible improvement, and was feeling almost back to normal.
Although I have done this several times, it struck me, again, how many folks would…?
- have the opportunity to consider mild malaria based on the symptoms I had even though they had not yet completed the course of antibiotics
- have the luxury of walking into a research lab and actually look down the microscope to see the parasites themselves (for free)
- get to a well-stocked pharmacy and have the opportunity to choose from an array of multiple effective therapies
- make an informed choice and take the meds as directed
- and set an alarm on their phones to make sure dosing was perfect.
Of course, I know that folks do not need to be able to do all that, but it reminded me of how important the work we do is; to make life easier for several millions of people by taking away the barriers to life-saving, morbidity-lowering antimalarial treatment.”
Dr. John Amuasi, MBChB, PhD, is a Senior Research Fellow at the Kumasi Collaborative Centre for Research in Tropical Medicine, KNUST, Kumasi, Ghana. He works with MMV as a consultant to the Access and Product Management team, assisting to remove the barriers patients face in accessing life-saving antimalarials.
1. One of the asexual forms of malaria parasite in the blood of an infected person. It is this blood stage that leads to the clinical symptoms of malaria.