Every one is at risk of getting malaria. However, children below the age of five years and pregnant women are more vulnerable due to their biological nature. Children at that age have not yet developed enough capacity to fight diseases and pregnant women capacity to fight diseases is usually reduced during pregnancy period.
ACTs is short for Artemesinin Combination Therapy. It is the simultaneous use of two or more anti-malarial drugs that act on critical form of malaria parasite (known as blood schizonts) in the human body. However, either of the two drugs must contain artemisinin or its derivative. The strength of the drug comes from independent modes of action and and their ability to attack biochemical targets in the parasite.
Artemisinin and its derivatives (artesunate, artemether, artemotil and dihydroartemesinin) produce rapid resolution of malaria symptoms as well as clearance of parasites in the blood. ACTs are more effective and protect partner drugs development of resistance.
Before Kenya adopted AL for first line treatment, a number of other combinations were tried to show their effectiveness. Based on these clinical trials done on AL in some parts of Kenya, it was found that they achieved cure rate above 95%. This was corroborated with trials in other countries such as South Africa, Tanzania and Burundi.
AL being a 3-day-6-dose fixed combination and available in pre-packaged age-weight based, packs was found to be the most appropriate. No resistance to either of the component drugs has been observed in Kenya so far.
The approved ACT-AL is currently available in Government and mission hospitals, health centres and dispensaries for free. The cost for provision of this drug is met by the Government of Kenya with help from the Global fund for the fight against AIDs, TB, Malaria and other development partners.
The community strategy current AL is available for community through community health workers.
Pregnant women are at risk of getting malaria because pregnancy tends to reduce their bodies capability to fight diseases as well as affect foetus development. This may affect most children born through mothers who had frequent malaria attacks. For instance, have low birth weight and chance of survival will be minimal. Furthermore, it may cause abortion.
There are different ways of preventing malaria during pregnancy. Some of the preventions are:
Use of long lasting Insecticidal (LLINs)nets properly and continually.
Use of a recommended drug for Intermittent Preventive Treatment during pregnancy (IPTp). This is a safe drug for presumptive treatment of all pregnant women particularly in areas of high malaria transmission. In Kenya, the drug of choice for IPTp is sulphurdoxine pyremethamine (SP) at least three doses.The 1st dose being between 16 – 28 weeks of pregnancy, 2nd at 28 – 32 weeks and 3rd above 34 weeks of pregnancy.
Insecticides have little excito-repellency, thus mosquitoes will be seen flying in the house but that does not mean the chemical is not effective.
Once that surface has been sprayed, it does not mean that the mosquitoes will not enter and fly into the house, however, they must come into contact with the insecticide on the wall. If there are breeding sites around, then more adult mosquitoes will emerge.
IRS does not act as an Aerosol and lacks knock-down effect.
Deltamethrin has been widely used in agriculture and veterinary and may introduce resistance among other mosquito types that are not necessarily vectors for malaria.
Different wall surfaces such as mud, wood, brick and painted surface will have different absorption capacities. However, it is recommended that 200m2 be covered by one sachet of insecticides. The residual period of the synthetic insecticides is also affected by the wall surfaces with alkaline pH, which has been observed in different parts.
DDT is a persistent organic compound. This means that the compound can stay in the environment long after its initial application as an insecticide, that is, up to 12 years. During this time, DDT and its breakdown products may enter the food chain and accumulate in fatty tissues (bioaccumulation). Harmful effects in the wildlife population have been linked to DDT including the thinning of eggshells in birds exposed to the compound.
There are also fears that DDT may have a long-term impact on human health. Although there is currently no direct link between DDT and any negative human health effect, there is growing evidence that it may disrupt reproductive and endocrine function. Opponents of DDT use for vector control argue that its use should be curtailed on these grounds.
Advocates of the continuing use of DDT as an insecticide for disease vector control base their argument on various factors; the unacceptably high levels of mortality and morbidity caused by malaria, the proven effectiveness of DDT in significantly reducing malaria transmission, the relatively low cost of DDT interventions, and the lack of any sustainable alternative in many endemic countries. They argue that the negative environmental and other effects associated with DDT use in the past reflect the massive uptake and bioaccumulation arising from the high.