Moving towards a malaria free Lanka

By Carol Aloysius

Once regarded as one of the most feared scourges in the island, when literally thousands of people died from this disease during the colonial regime and later in the early1960s, Sri Lanka is surely and rapidly moving towards a Zero Malaria nation.

Thanks to the efforts of the Health Ministry and the anti Malaria Campaign, whose vision is to eliminate indigenous spread of the two most common forms of malaria in the country, namely P. Falciparum by the year 2012 and P.Vivax by the year 2014, there has been a dramatic reduction in the disease in the past decade from over 210,000 cases in the year 2000 to just 23 cases in 2012.

As Health Minister Maithripala Sirisena observed in his message for World Malaria Day on April 18, the AMC has much to celebrate in its centennial celebrations this year, since the number of positive cases in 2012 is the lowest since 1963.Yet although the burden of malaria has come down significantly for Sri Lanka, with only sporadic cases reported from some parts of the country and occasional outbreaks in certain malaria risk areas, Health authorities are fully aware they cannot afford to rest on their laurels.

Like any other disease which has seen such significant reductions in this country, due to interventions on the part of the Health Ministry, Malaria too can re-emerge, especially with migration of persons living in endemic areas such as the Dry Zone which covers a vast regions including the Anuradhapura district, Moneragala district and Uva province, to non endemic areas.

Education, Awareness programs, constant examination of blood specimens of high risk populations by trained medical officers, and drugs to prevent malaria, are as important as public co-operation in spraying their indoor walls with insecticides, using mosquito repellents and mosquito nets and reporting to their nearest MOH office at the onset of the disease.

The Sunday Observer spoke to Director, Anti Malaria Campaign Dr S. L. Deniyage, to find out what the campaign was doing to achieve its target of eliminating indigenous malaria in the country, maintaining zero mortality rates from malaria, and most importantly preventing re-introduction of malaria into the country.

We also asked him how the disease was caused, and how it could be treated and prevented.

Excerpts…

Q: How is malaria caused?

A: It is caused by a single celled microscopic blood parasite called plasmodium. The types of parasite common in Sri Lanka are (1) p.vivax and (2) falciparum. The former does not cause serious complications like the latter type which is causes serious illness with several grave complications. There are two other types of the malarial virus which are found in other parts of the world and not in Sri Lanka.

Q: Where is malaria found mostly in Sri Lanka?

A: In the Dry Zone where it is endemic. But it can also spread to non endemic areas.

Q: How?

A: When visitors living in non endemic areas get infected and return to their homes carrying the infection in their bodies, thereby infecting others.

Q: How is it transmitted?

A: From person to person by the bite of an infected female Anopheles mosquito.

Q: What are the typical symptoms of Malaria?

A: The patient may first feel intensely cold and chilly. This is followed by a bout of shivering (rigors) which can sometimes be violent. Gradually the temperature starts rising and the shivering stops when the temperature rises.

Q: Any other symptoms?

A: At the height of the fever, the patient may experience severe headaches, giddiness, vomiting and sometimes delirium. This is followed by a sudden fall in the temperature accompanied by profuse sweating.

Q: Are the symptoms the same for both types of malaria?

A: Falciparum malaria may present as cerebral (brain malaria) with high fever, severe headaches, fits, abnormal behaviour and changes in the level of consciousness. It may also present as fever with severe anaemia, jaundice and diarrhoea.

Q: Is it a very serious illness?

A: Yes. It causes grave complications and carries a high death rate, unless treated immediately. In both types of malaria, you may also detect an enlarged spleen at the latter stages.

Q: How is it diagnosed?

A: Diagnosis is confirmed by examining finger prick blood films for the malarial parasite.

Q: Do all government hospitals have the facilities for doing these blood tests?

A: Yes. All government health institutions have these facilities. Officers of the National Anti Malaria campaign are posted to many health institutions in malarial areas. Help in examining blood samples and dispensing appropriate drugs in addition to their duties to control the disease.

Q: How?

A: By spraying chemicals and destroying larvae in the well lit large water bodies such as rivers, lakes, canals where you get pools of water. We also use biological methods as well such as fish to destroy the mosquitoes.

Q: How else do you protect the individuals including children living inside houses of malaria endemic areas?

A: We encourage them to use mosquito nets such as the special Long Lasting Impregnated nets (LLIN) which are distributed free to most homes.

Q: What advice do you have to give the public?

A: We advise all those visiting endemic areas to protect themselves by taking the prescribed drugs to fight malaria on the advice of their doctor, before they leave and during their stay. We also expect them to report to their physician the moment they show symptoms of the disease on their return.

Heart can affect how we feel fear - Study

Fear may be felt in the heart as well as the head, according to a study that has found a link between the cycles of a beating heart and the likelihood of someone taking fright.

Tests on healthy volunteers found that they were more likely to feel a sense of fear at the moment when their hearts are contracting and pumping blood around their bodies, compared with the point when the heartbeat is relaxed.

Scientists say the results suggest that the heart is able to influence how the brain responds to a fearful event, depending on which point it is at in its regular cycle of contraction and relaxation.

Sarah Garfinkel, a researcher at the Brighton and Sussex Medical School, said: “We demonstrate for the first time that the way in which we process fear is different dependent on when we see fearful images in relation to our heart.”

The study, to be presented at the British Neuroscience Association Festival in London, tested the fear response of 20 healthy volunteers as they were shown images of fearful faces while connected to heart monitors.

“Our results show that if we see a fearful face during systole - when the heart is pumping - then we judge this fearful face as more intense than if we see the very same fearful face during diastole - when the heart is relaxed,” Dr Garfinkel said. “From previous research, we know that if we present images very fast then we have trouble detecting them, but if an image is particularly emotional then it can ‘pop’ out and be seen.

“We demonstrated that fearful faces are better detected at systole, when they are perceived as more fearful, relative to diastole. Thus our hearts can also affect what we see and what we don’t see - and guide whether we see fear.”

To investigate the phenomenon further the scientists used a brain scanner to show how an almond-shaped region of the brain called the amygdala, which is sometimes called the “seat of emotion”, influences how the heart changes a person’s perception of fear.

“We have identified an important mechanism by which the heart and brain ‘speak’ to each other to change our emotions and reduce fear. We hope to explore the therapeutic implications in people with high anxiety,” Dr Garfinkel said. “We hope that by increasing our understanding about how fear is processed and ways that it could be reduced, we may be able to develop more successful treatments for [anxiety disorders], and also for those, such as war veterans, who may be suffering from post-traumatic stress disorder.”

The Independent

Alarming increase in global dengue infection

The global burden of dengue infection is more than triple current estimates from the World Health Organisation, according to a multinational study published in the journal Nature .

The research has created the first detailed and up-to-date map of dengue distribution worldwide, enabling researchers to estimate the total numbers of people affected by the virus globally, regionally and nationally. The findings will help to guide efforts in vaccine, drug and vector control strategies.

Dengue, also known as ‘break-bone fever’, is a viral infection that is transmitted between humans by mosquitoes. In some people, it causes life-threatening illness.

There are currently no licensed vaccines or specific treatments for dengue, and substantial efforts to control the mosquitoes that transmit the disease have not stopped its rapid emergence and global spread. Until now, little was known about the current distribution of the risk of dengue virus infection and its public health burden around the world.

Dr Samir Bhatt, who led the modelling for the study, says: “Our aim was to take all of the evidence that is currently available on the distribution of dengue worldwide and combine it with the latest in mapping and mathematical modelling to produce the most refined risk maps and burden estimates. We then hope to use this knowledge to help predict the future burden of the disease.”

The findings reveal that dengue is ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and urbanisation. The team estimate that there are 390 million dengue infections across the globe each year, of which 96 million reach any level of clinical or sub-clinical severity. This is more than triple the WHO's most recent estimates of 50-100 million infections per year. Professor Simon Hay explains: “We found that climate and population spread were important factors for predicting the current risk of dengue around the world.

With globalisation and the constant march of urbanisation, we anticipate that there could be dramatic shifts in the distribution of the disease in the future: the virus may be introduced to areas that previously were not at risk, and those that are currently affected may experience increases in the number of infections.

“We hope that the research will initiate a wider discussion about the significant global impact of this disease.”

Of the 96 million apparent infections, Asia bore 70 percent of the burden. India alone accounted for around one-third of all infections.

The results indicate that with 16 million infections, Africa's burden is almost equivalent to that of the Americas and is significantly larger than previously appreciated.

The authors suggest that the hidden African dengue burden could be a result of the disease being masked by symptomatically similar illnesses, under-reporting and highly variable treatment-seeking behaviour.

Prof Jeremy Farrar, Director of the Wellcome Trust Vietnam Research Program and Oxford University Clinical Research Unit Hospital for Tropical Diseases in Vietnam, explains that the map and estimates produced by Hay's group set the benchmark for the disease: “This is the first systematic robust estimate of the extent of dengue.

The evidence that we've gathered here will help to maximise the value and cost-effectiveness of public health and clinical efforts, by indicating where limited resources can be targeted for maximum possible impact.With endemic transmission in Asia and the Americas, recent outbreaks in Portugal, the ever-increasing incidence in Africa, and the challenges of making an effective dengue vaccine or controlling the vector, Prof Farrar stresses: “This really does represent a crucial period in the global spread of dengue.”Jimmy Whitworth, Head of International Activities at the Wellcome Trust, said: “Over time, this comprehensive map of global disease burden will also help to demonstrate which control measures are making the biggest difference in reducing the number of people suffering from dengue infection.

MNT

Use reflexology to complement drugs in pain treatment - Survey

Reflexology may be as effective as painkillers, according to a new scientific survey.

Researchers at the University of Portsmouth have found that people felt about 40 percent less pain, and were able to stand pain for about 45 percent longer, when they used reflexology as a method of pain relief.

Dr Carol Samuel, who is a trained reflexologist and who carried out the experimental procedures, said it was the first time this therapy had been scientifically tested as a treatment for acute pain.

She said the results suggested that reflexology could be used to complement conventional drug therapy in the treatment of conditions associated with pain such as osteoarthritis, backache and cancers.Participants attended two sessions, in which they were asked to submerge their hand in ice water.

In one of the sessions they were given reflexology before they submerged their hand, and in the other session they believed they were receiving pain relief from a Tens machine, which was not actually switched on.

The researchers found that when the participants received reflexology prior to the session they were able to keep their hand in the ice water for longer before they felt pain, and that they could also tolerate the pain for a longer period of time.

Dr Samuel said: “As we predicted, reflexology decreased pain sensations.

“It is likely that reflexology works in a similar manner to acupuncture by causing the brain to release chemicals that lessen pain signals.”

Dr Ivor Ebenezer, co-author of the study, said: “We are pleased with these results. Although this is a small study, we hope it will be the basis for future research into the use of reflexology.”

Reflexology is a complementary medical approach, which works alongside orthodox medicine, in which pressure may be applied to any body area but is commonly used on either the feet or hands.

In this study reflexology was applied to the feet. Dr Ebenezer, from the Department of Pharmacy and Biomedical Sciences, and Dr Samuel used a small study of 15 people to determine whether reflexology would be more effective than no pain relief at all.

Dr Ebenezer said: “Complementary and alternative therapies come in for a lot of criticism, and many have never been properly tested scientifically.

“One of the common criticisms by the scientific community is that these therapies are often not tested under properly controlled conditions.

“When a new drug is tested its effects are compared with a sugar pill.

“If the drug produces a similar response to the sugar pill, then it is likely that the drug's effect on the medical condition is due to a placebo effect.

“In order to avoid such criticism in this study, we compared the effects of reflexology to a sham Tens control that the participants believed produced pain relief.

“This is the equivalent of a sugar pill in drug trials.” Dr Samuel said: “This is an early study, and more work will need to be done to find out about the way reflexology works.

“However, it looks like it may be used to complement conventional drug therapy in the treatment of conditions that are associated with pain, such as osteoarthritis, backache and cancers.”

- PA