Transcript Malaria - University of Kansas Medical Center

Malaria in Gulu, Uganda
2014.
By: Sarah Francke
University of Kansas SON
Uganda
 Population: 35,918,915
o Age structure- 0 to
14yrs: 48.7%
o Median age- 15.5yrs.
o Mother’s mean age at
first birth- 18.9yrs.
o Total fertility rate- 5.97
children born/woman.
o Urbanization- 15.6% of
total population.
https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html
http://www.nationsonline.org/map_small/uganda_africa.jpg
Gulu
 Population- 154,300.
 Region- Northern Uganda.
o Remote area of the country.
o War-torn region.
o High levels of civil unrest.
 Sub region- Acholi sub-region.
 Main tribal inhabitants- Acholi (80%).
 Life expectancy- 56.8yrs.
 Available hospital serviceo St. Mary's Hospital Lacor
o Gulu Regional Referral Hospital
o Gulu Independent Hospital
http://www.ubos.org/
http://daneenleidig.blogspot.com/2009/09/where-is-gulu-uganda.html
St. Mary’s Lacor Hospital
 482 bed-hospital with 3 peripheral health centers.
 Cares for 300,000+ patients each year.
 Over half all patients served the last years were
children and pregnant women.
 One quarter of all children fail to reach age five due
to poverty-related illnesses such as: malaria.
http://www.lacorhospital.org/
International Experience
Objectives
1. To study the disease process and describe the epidemiology
of malaria
2. To identify the most at-risk populations for malarial
infections and fatalities.
3. To identify the signs and symptoms of malarial infections.
4. To study the treatment options and identify strategies of care
for malaria.
5. To evaluate the availability of prevention options and discuss
community and system strategies to address malaria.
6. Identify barriers to treatment of malaria.
Malaria
 Parasitic infection of
erythrocytes in the
bloodstream.
 Carried and transmitted
by the female
anopheline mosquito.
 Transmitted in 108
countries inhabited by 3
billion people in total.
White, N., Pukrittayakamee, S., Hien, T., Faiz, M., Mokuolu, O., & Dondorp, A. (2014). Malaria. Lancet, 383(9918), 723-735.
Populations at Risk
 Residents of impoverished areaso Lack of availability of bed nets.
o Lack of treatment of residential
structures with insecticide.
 Neonates- highest risk for
morbidity and mortality are
those ranging from 0 to 28 days
of life.
 Children in the poorest families
have a 50% higher risk of dying
from a malarial infection.
Rumisha, S. F. (2014). Relationship between child survival and malaria transmission: an analysis of the malaria
transmission intensity and mortality burden across Africa (MTIMBA) project data in Rufiji demographic surveillance
system, Tanzania. Malaria Journal, 13(1), 124-147.
Symptomatology
 Incubation, symptomless
period of 12-14 days.
 Early symptoms:
Headache, joint aches,
fever, nausea, vomiting,
and general malaise.
 End-stage symptoms:
Severe anemia, palpable
spleen (r/t erythrocyte
sequestration), tremors,
brain damage, and death.
White, N., Pukrittayakamee, S., Hien, T., Faiz, M., Mokuolu, O., & Dondorp, A. (2014). Malaria. Lancet, 383(9918), 723-735.
Early Diagnoses
 Rapid Diagnostic Blood
Test (RTD) used for adult
diagnosis.
 Blood smear used for infant
diagnosis.
 Reduced number of deaths
when antimalarial
medication regimen is
started within 24 hours of
presentation of a fever.
Okwundu CI, (2013). Home- or community-based programmes for treating malaria. Cochrane database of systematic
reviews, 1-21.
Treatment
 Three treatments of IV Quinine
every 8 hours.
o Dilute with Dextrose 5% in
water.
o Requires hospitalization and
observation.
 Oral Quinine three times daily
for seven days.
o Patient may be discharged with
medication or required to
remain hospitalized based on
status.
Okwundu CI, (2013). Home- or community-based programmes for treating malaria. Cochrane database of systematic reviews, 1-21.
Interventions
 Individual Interventions:
o Avoid the outdoors at and after twilight.
o Cover windows with screens.
o Close doors early.
o Sleep under insecticide-treated net.
 Community Interventions:
o Treat homes with insecticide.
o Ensure availability of medications.
o Distribute insecticide treated nets.
 System-Level Interventions:
o Malaria screenings upon early symptom
appearance (available but costly).
Von Seidlein, Lorenz, & Bejon, Philip (2013). Malaria vaccines: past, present and future. Archives of disease in childhood,
98(12), 981-985.
Barriers to Treatment
 Proximity of health care facilitieso Treatment will be delayed if the patient has to
walk/ride a long distance to reach care.
 Lack of resourceso If bed nets and window screens are not available then
they cannot be used for prevention.
 Financial burdenso Supplies for prevention and medication treatment
costs money that most people do not have.
Clements, Archie (2013). Further shrinking the malaria map: how can geospatial science help to achieve malaria
elimination? The Lancet Infectious Diseases, 13(8), 709-718.
Suggestions
 System-level push for screening, education, disease
isolation, or funding for research.
 Distribution and or sale of bed nets at more
locations.
 Ensured availability of low-cost malaria treatment
drugs at all health centers.
Profound Clinical
Experience
 Community Health Center at Pabbo,
Uganda
o 1,500 patients served per month in the
OPD.
 Patients speak a variety of 30 tribal
languages.
o 17 staff members run the health center
with nursing and midwifery students
assistance.
 22 beds are available for admitted
patients.
o Student nurses collect health history,
examine, diagnose, and prescribe
medications.
 Free ambulance transportation is
available for referrals to Lacor
main hospital for patients needing
more care.
Profound Cultural
Experience
 Tribal dancingo Different tribes have unique individual dances
o Certain dances are shared by larger groups –
 Dances for Gulu
 Dances for Uganda
o Dances serve specific purposes –




Boy – Girl courtship
Welcoming
Marriage
Death
Concluding Points
 Gulu, Uganda is an area with rich
history and tradition with hopefilled inhabitants.
 Lack of resources make the Acholi
people a highly vulnerable
population.
 Malaria is a highly preventable
disease when appropriate means are
available.
 With enhanced system-level
interventions there is hope for a
brighter future.
References
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https://www.cia.gov/library/publications/the-world-factbook/geos/ug.html
Clements, Archie (2013). Further shrinking the malaria map: how can geospatial
science help to achieve malaria elimination? The Lancet Infectious Diseases, 13(8), 709718.
http://www.lacorhospital.org/
Okwundu CI, (2013). Home- or community-based programmes for treating
malaria. Cochrane database of systematic reviews, 1-21.
Rumisha, S. F. (2014). Relationship between child survival and malaria
transmission: an analysis of the malaria transmission intensity and mortality
burden across Africa (MTIMBA) project data in Rufiji demographic surveillance
system, Tanzania. Malaria Journal, 13(1), 124-147.
http://www.ubos.org/
Von Seidlein, Lorenz, & Bejon, Philip (2013). Malaria vaccines: past, present and
future. Archives of disease in childhood, 98(12), 981-985.
White, N., Pukrittayakamee, S., Hien, T., Faiz, M., Mokuolu, O., & Dondorp, A.
(2014). Malaria. Lancet, 383(9918), 723-735.