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Plans underway to eliminate Malaria in 6 endemic districts

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Health Minister Dr Alfred Madigele has urged Batswana to make proper use of available malaria interventions to reduce the rate of infections and death by Malaria.

Addressing the nation on radio during the World Malaria Day themed; ‘Zero Malaria Starts with Me’ Dr Madigele said malaria was still a disease of significant public health importance in Botswana, with high morbidity and infection rates, and that although deaths, due to the disease have reduced considerably, there was still a long way to go.

The theme, he said seeks to empower individuals across the world to make a personal commitment to saving million more lives, and help communities and economies to thrive by ending malaria.
“This global movement seeks to re-energise the fight to eliminate the disease, which still threatens half of the global population and kills one child every two minutes”.

The African region is the worst hit by the killer disease in the world. In the World Malaria Report 2018, WHO estimates that we still have more than 4.4 million cases in the region and sub-Saharan Africa accounted for 93% (404,550) of the global malaria deaths.

Botswana has made incredible progress towards malaria elimination in the last decade, but Dr Madigele said sustaining gains will take extra effort until the job is finished and malaria has been eliminated.

“We have managed to reduce the incidence of malaria from 28.7/1000 population in 2001 to 0.24/1000 population by 2018. While efforts are on course to conduct active and passive case detection, notify, investigate, list and map all cases and deaths, resource limitation becomes a big challenge in the area of malaria surveillance and rapid response to contain secondary cases and outbreaks.
Nevertheless, we have also managed to introduce modern technology for rapid notification of cases and mapping of malaria transmission areas,” he shared.

He indicated that available interventions had proven to work and urged the public to support the National Malaria Elimination Programme (NMEP)’s strategies of using the Long-Lasting Insecticide Treated Nets (LLINs), Indoor Residual Spraying, and Intermittent Preventive Treatment of pregnant women (IPTp) to prevent being infected.

Others, he said, include vector control intervention designed to destroy the mosquito larvae conducted in three districts of Tutume, Bobirwa and Boteti. The country has also introduced a radical anti-malaria therapy for effective treatment of malaria.

To address the challenge of low community response, participation, ownership and ultimately low uptake of malaria elimination interventions, Dr Madigele said the NMEP with the support from the Global Fund adopted the Communities Acting Together to Eliminate Malaria (CATTEM) in 2018.

“This is an approach that seeks to involve community leadership and other community structures to drive malaria elimination in their communities; resonating well with this year’s theme that drives for personalisation of malaria elimination by all,” he said. The approach is being implemented in the 6 endemic Districts with plans to expand to the whole country.

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ON LIVING WITH A BLOOD DISEASE

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Bubbly James Nkomo still exudes oodles of a positive spirit and is not deterred by a genetic blood condition that predisposes him to frequent bleeding. He has since found a way to live life fully with haemophilia, a condition he was diagnosed with when he was only one year old.

Born in Maitengwe, Nkomo remembers outgrowing his mother’s and grandmother’s laps to explore the exciting world around him. “Crawling was painful; my knee joints ached endlessly and navigating outside was worse. I always had bruises that bled longer than usual and also took longer to heal,” says Nkomo. The swellings were worse and would take ages to heal; little Nkomo was discouraged from playing with his peers. Not long after, further medical investigations led to a diagnosis of haemophilia.

His mother and grandmother were told by the doctor to ensure that he did not engage in play that predisposed him to injuries, since the ability of his blood to clot was severely reduced, causing him to bleed severely even from slight injury. However, these medical warnings only made a growing Nkomo less popular among his friends. “Playing the ‘soft’ games was not fun at all. I was always isolated because if I got injured, my grandmother would reprimand my friends,” he says, recalling that this only led him to rebel against his family.

“I wandered beyond our homestead and got involved in the dangerous games to prove that I was a worthy playmate. However, I would go home with swollen ankles and lots of bruises that gave way to painful nights,” he says.And the play got dangerous. When Nkomo was eight years old, together with adrenaline-filled peers, they would hang on the back of a pick-up to quell their desire for adventure.

“As we were enjoying our free ride, the driver noticed us and took emergency breaks to discourage us. I hit my chin against one of the metallic guards of the vehicle, leading to uncontrolled bleeding of my gums,” he says. His friends deserted him and when he got home, he paid the price for defying authority. “I could not be treated at the local clinic and was referred to the Princess Marina Hospital where I got a series of stitches and was admitted for one month to ensure the wounds were well-healed,” says Nkomo.

He had to learn to take up more favourable pastimes like swimming that gave him even more gratification than an aggressive game of football. “Haemophilia is a painful disease yet learning how to cope provides an almost normal lifestyle,” says Nkomo, a human resource practitioner. At 34 years of age, married and father to six-year-old Tiffany, Nkomo has also taken up the role of being mentor and big brother to his male cousin who also has the same genetic condition.

Nkomo cites the need to create nationwide awareness on the condition in order to improve the quality of life for individuals living with it and for families unaware of how to cope with it.
“Once you know what you are dealing with, a normal life is possible,” he says. Haemophilia is a rare disorder in which the blood clot does not clot normally because it lacks sufficient blood clotting proteins.

A patient with haemophilia may bleed for a longer time after an injury than he/she would, if the blood clotted normally. This internal bleeding can damage organs and tissues, and may be life-threatening. Some symptoms of haemophilia include, excessive bleeding from cuts or injuries or after surgery or dental work, prolonged menses in women, many large and deep bruises.

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Haemophilia on the rise in Botswana

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Medical Director at Global HOPE Botswana, Dr. Jeremy Slone

Medical Director at Global HOPE Botswana, Dr. Jeremy Slone has warned against the increasing risk of haemophilia in the country.

He was speaking on the sidelines of an awareness camp held at Princess Marina Hospital (PMH) recently about the diagnosis, treatment methods and forms of rehabilitation available.
The camp also focused on the importance of fitness and physical activity and changing the lifestyle of haemophilia patients, as well as the role of parents and how they can participate in achieving the required lifestyle and fitness for their children that suffer from bleeding disorders and haemophilia.

Haemophilia is a lifelong blood clotting disorder that affects one in every 1,000 males around the world. Blood fails to clot normally because of a deficiency or an abnormality of one of the clotting factors, which can cause bleeding, especially in the muscles, joints, or internal organs.The two most common types are hemophilia A and B.

“A person with haemophilia does not bleed more profusely or faster than normal, but bleeding may last longer,” Dr Slone explained. With over 50 registered cases of men suffering from haemophilia, Dr Slone said the number is definitely high.

He said it was unfortunate that some of them do not receive enough or adequate treatment, or none at all. This is largely because patients are often unwilling or unable to give accurate family histories because the stigma associated with haemophilia encourages them to conceal the disorder. Without treatment, Dr Slone said the condition could cause crippling pain, severe joint damage, disability and even early death.

Although there is no cure for haemophilia, there are effective treatments available, and with adequate care, haemophilia patients can live to an advanced age.
The treatment, according to Dorcus Ramphaleng, a nurse and haemophilia care expert at PMH, largely depends on giving patients enough self-confidence that they can perform their daily activities to help them improve their fitness, strengthen their muscles, and reduce the deterioration of muscle function, giving them more freedom to go about their own lives without help and do more exercises.

She said children with haemophilia should not be afraid to engage in sports. “They should improve their fitness and the health of their bones, avoid obesity and improve their quality of life.”

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