Parasitology

A skin-worm sickness which has broken out in the Mafikeng area has been identified, the provincial health department said on Wednesday. The condition is Cutaneous Myiasis, a skin condition caused by Cordylobia Anthropophaga (tumbu fly, mango fly, putsi fly).

People whose blood contains infectious malaria parasites attract more mosquitoes, say researchers.

A six-dose course of the combination of two drugs - artemether and lumefantrine (coartum or Riamet)- is a highly effective treatment for malaria in the areas of Africa where resistance to frequently used malaria drugs is common, according to two randomised controlled studies published in the April 22nd issue of The Lancet.

South Africa has achieved a dramatic reduction in malaria cases using a new class of drugs, artemisinin derivatives that are extracted from a Chinese plant. But the US Agency for International Development (USAID) is discouraging other African countries from using the drugs, claiming they are too expensive, hard to take and inadvisable for pregnant women and infants. Malaria experts have reacted angrily, accusing USAID of reneging on World Health Organisation (WHO) policy that recommends countries switch to artemisinin-based combination therapy (ACT) when resistance to first-line drugs such as chloroquine or sulfadoxine-pyrimethamine (S/P) becomes too high. With more than 2 000 African children dying of malaria each day and resistance to S/P exceeding 40% in many African countries, doctors are clamouring for the new treatment. According to Médecins Sans Frontières (MSF), the new drugs are fast-acting and much more effective than first-line drugs, and don't cause significant side effects or the build-up of resistance. As the first country in Africa to adopt ACT, SA's experience has borne this out and is similar to that of Southeast Asia. In 2000, KwaZulu Natal switched to ACT when resistance to S/P was found to be 62%. According to Karen Barnes of SA's National Malaria Advisory Group, malaria cases and deaths fell by 78% and 87% respectively in the year since ACT's introduction. (An enhanced insecticide-spraying programme contributed to the improvement.) The group has recommended that government extend ACT to Mpumalanga and Limpopo, where S/P is still 85% effective, as soon as possible. As SA does not rely on donor support for malaria control, USAID's stance will not affect it. However, donor-dependant African countries could suffer if other donor agencies follow USAID's influential lead. Commentators fear the motivation behind USAID's position is that it doesn't want to shoulder the additional cost. Classic malaria drugs cost about US20c/dose compared with US1,30/dose for ACT (amodiaquine plus artesunate, an artemesinin derivative). At these prices, says a recent MSF study, it would cost an extra $19m/year to introduce ACT to Burundi, Kenya, Rwanda, Tanzania and Uganda combined. MSF argues that the increased cost will be recouped many times over by reducing the medical and socio-economic burden associated with existing ineffective treatment programmes. Barnes agrees. She rejects the notion that poor people will struggle more than the rich to comply with the simple three-day ACT drug regimen or that all artemisinin derivatives need to be taken with food. SA protocols do not prescribe ACT for pregnant women and infants, but this is insufficient reason to not extend the drug to the rest of the population, she argues. (Source:Financial Mail, 7 June 2002)