Zoonoses

For the past month I have been writing on various infectious diseases that are affecting our world today.

In my entry today I will continue on our topic of infectious diseases and we are going to look at what are known as zoonoses.

First of all let us start by defining the word Zoonosis (plural- Zoonoses). Zoonosis is any disease or infection that is naturally transmissible from vertebrate animals to humans. Zoonoses are diseases of interest to humans  as humans have for centuries interacted with animals both wild and domesticated. Zoonoses can be transmitted through animal excreta, urine, and animal products.

Over 200 zoonoses have been described so far and atleast 61% of all human pathogens are zoonotic.  The big question is still what causes zoonoses?

Zoonoses are caused by various agents including:

·         Bacteria

·         Parasites

·         Fungi

·         Viruses

·         Unconventional agents

Let us break down some of the zoonotic diseases by their causative agents.

1.    Zoonoses caused by Bacteria

·         Salmonellosis

·         Campylobacteriosis

·         Anthrax

·         Brucellosis

·         Leptospirosis

·         Plague

·         Q-fever

·         Shigellosis

·         Tularaenia

2.    Zoonoses caused by Parasites

·         Cysticercosis/Taeniasis

·         Trematodosis

·         Echinococcosis

·         Toxoplasmosis

·         Trichinellosis

3.    Zoonoses caused by viruses

·         Rabies

·         Avian flu (bird flu) H5N1

·         Crimean- Congo hemorrhagic fever

·         Ebola

·         Rift valley fever

4.    Unconventional agents

·         These are agents that are yet to be defined for example the agent that causes spongiform encephalopathy the same variant that causes variant Cruetzfeldt-Jakob disease (vCJD).

In the coming weeks I will be looking at how zoonoses have affected communities, the efforts that have been put forward to overcome these zoonoses and the way forward.

HIV / AIDS the number 1 infectious disease in the world

What is HIV and AIDS?

Human immune deficiency virus (HIV) the virus that causes AIDS (acute immune deficiency syndrome) has caused havoc all over the world. Over the years the disease has claimed many lives all over the world. Scientists, researchers and medical practitioners are trying different ways to find the cure for the disease.  One major breakthrough in the past decades was the discovery of anti-retroviral drugs that have helped to slow down the replication of the virus thereby prolonging the life of the person carrying the virus.

HIV and AIDS is rated as the number 1 most dangerous infectious disease in the world.

The first case of HIV was discovered in Malawi in 1985. From the 2010 Malawi Demographic and Health Survey (MDHS) it is estimated that there are about 920,000 adults and children living with HIV in Malawi as of 2009.

Malawi and HIV

What are the major factors of HIV transmission in Malawi?

According to the 2010 MDHS these are some of the major factors contributing to HIV transmission in Malawi include:

·         Poverty

·         Low literacy levels

·         High levels of casual  and transactional unprotected sex in the general population particularly among youth between the ages of 15-24

·         Low level of male and female condom use

·         Cultural and religious factors

·         Stigma and discrimination

In an effort to address these factors the National AIDS Commission (NAC) was established in 2001.  In 2003, a National AIDS and HIV policy was launched by the Malawi Government through the office of the president and cabinet (OPC).  The policy was developed a consultative process involving:

·         Civil society organizations

·         Public and private sector

·         Media

·         Persons living with HIV

In 2004, a National AIDS and HIV framework (NAF) was established as a tool to mobilize response to the HIV epidemic. Some of the goals of NAF are;

1.    To prevent the spread of HIV.

2.    To provide access to treatment for people living with HIV.

3.    Mitigate the health and socioeconomic and psychosocial impact of HIV on individuals, families, communities and the nation.

4.    Impact mitigation.

5.    Main streaming, partnerships and capacity building.

6.    Research and development.

7.    Monitoring and evaluation.

8.    Resource mobilization and utilization.

9.    Policy coordination.

10. Programme planning.

I have talked about the government efforts to combat the disease but what about the Malawian population in general? Is there any knowledge of HIV and AIDS and prevention?

To reduce sexual transmission, a model for behavior change was set up; this comprised of three attributes:

1.    Sexual abstinence.

2.    Mutually faithful monogamy between HIV negative partners.

3.    Condom use for people not practicing abstinence.

Despite having the efforts from the government and other stakeholders providing civic education regarding the disease, there are several misconceptions that are held by the communities.

Common misconceptions about HIV and AIDS

To begin with, maybe it’s a good idea to understand what we mean by misconceptions. A misconception can be defined as simply an ideology or belief that does not reflect the true facts OR A view or opinion that is incorrect because based on faulty thinking or understanding.

Here are some of the common misconceptions in Malawi:

1.    A healthy person does not have AIDS.

2.    HIV is transmitted by mosquito bites.

3.    HIV is transmitted through supernatural means.

4.    AIDS is transmitted through sharing food with a person who has HIV or AIDS.

As funny as these may sound, these misconceptions present a problem in the knowledge and understanding of the disease and its transmission.

In this article I am not going to dwell on the methods of transmission of the disease but more on some of the major factors that I mentioned earlier that contribute to the transmission of HIV and AIDS.

A widespread stigma and discrimination against people who are HIV positive has generated fear, anxiety and prejudice against people living with HIV. Despite this, there are still attitudes and practices that people still indulge in which are risky and may propagate the spread of HIV and AIDS.

Here are some of the practices;

Attitudes towards condom use

Some people believe that sex education and condom use for the youth promotes early sexual initiation. In as much there could be some truth in this what is better; let the youth contract HIV and AIDS blindly or educate them so they have a chance to make the right decision regarding their sexuality?

It has also been suggested that condom use between married couples or sexual partners is a challenge. How do you negotiate with your partner for safer sex? According to the 2010 MDHS, it was reported that over 90% of men and women believe that a wife is justified taking some action to protect herself from HIV either by refusing sexual intercourse or by requesting that her husband or partner use a condom. In as much as this is the belief but is this what takes place in reality?

Culture and tradition have always been respected in most communities and societies, as such, there are some underlying issues regarding how a wife should behave towards her husband and or partner which makes it difficult for some women or wives to say no or ask them to use a condom even when they have evidence that their husbands have a sexually transmitted infections (STIs) or have been promiscuous. This has led to spread of STIs including HIV and AIDS.

Multiple sexual partners

As unreal as it may sound but there is a growing tendency where people think that having multiple partners makes you more clever or “cool”. Some have multiple partners because they want to make some extra money but on the other hand for some it is just a habit which could be costly.

There are two types of partnerships that I want to shed some light on with regards to multiple sexual partners. These are concurrent and serial sexual partnerships.

1.    Concurrent sexual partnerships: this is where a person has multiple partners and has sexual intercourse with one partner  between two acts of intercourse with another partner (overlapping partnerships) (UNAIDS 2009).

2.    Serial sexual partnership (serial monogamy): this is the opposite of concurrent partnerships, an individual may have multiple sexual partners without any overlapping partnerships.

Payment for sex

This is also known as transactional sex, where there is exchange of money, gifts or favours for sexual intercourse. This practice is fast growing and a cause of concern especially among the youth. Before it used to be older men enticing young girls with money and gifts but now it is also older women enticing young boys with the same. This practice is really dangerous as there is an unseen sexual networks which are formed as the young girls or boys that are involved with older partners for favours also have other sexual partners (of their own age or other older people) and if one of them is infected with HIV or STIs this is becomes a network for spreading the diseases.

So with this knowledge what can we do to help the youth in our society?

HIV and AIDS related knowledge for the youth

Earlier on I mentioned the need for sexual education for the youth and pointed out some views regarding this in Malawi. When I say youth, I mean individuals between the age of 15-24years. With the initial age for first sexual intercourse being between 15 and 18 years for both boys and girls, it is my view that there is a strong need of sex education and condom use.

The youth need comprehensive knowledge of HIV and AIDS, as this is crucial for their survival and future. So what is considered as comprehensive knowledge in this case?

According to the 2010MDHS report, this is what is considered as comprehensive knowledge;

1.    Knowing that abstinence, condom use and having just one HIV-negative faithful partner can reduce the chances of contracting HIV.

2.    Knowing that a healthy looking person can have HIV.

3.    Rejecting the most common misconceptions about HIV transmission.

AIDS continues to cause havoc around the world so let us work together to combat this disease and help others know more about HIV and AIDS.

Malawi and Malaria

Background

Malawi’s population has been growing through the decades and is still growing. The first population census was conducted in 1966, followed by 1977, 1987, 1997 and finally 2008. According to the country’s 5^th population census held in 2008, by the National statistics Office of Malawi (NSO), Malawi has a population of 13,077,160. On the other hand according to the World Health Organisation (WHO), the population projection has been put at 15,263,000  which is a 2,185,840 from the NSO census.

The Malawi Demographic Health Survey (MDHS),is a survey conducted by NSO to provide national estimates of key indicators in Malawi for the country’s 27 districts. The 2010 MDHS is an update of the 1992, 2000 and 2004 surveys and it covers the following key areas:

§  Fertility levels

§  Nuptiality

§  Fertlity preferences

§  Knowledge and use of family planning methods

§  Breast feeding status of mothers and children

§  Use of maternal and child health services

§  Maternal violence

§  Anaemia status of women 15-49 years and in children 6-59 months

§  Anthropometric measures for children 0-5years

§  HIV and AIDS related behaviours

§  HIV prevalence

§  Malaria

In this article I will review the findings of the 2010 MDHS with regard to malaria. I have chosen malaria because there are over six million malaria cases annually in Malawi.

Malaria

The National Malaria Control Program (NMCP) set up a 5 year strategic plan from 2005-2010 based on the Abuja declaration, 2000, which calls for universal areas to HIV/AIDS and malaria services by 2010 for all Africa. The declaration aimed at halving malaria mortality and morbidity by 2010.

The following were the strategic plans:

1)    Case Management; atleast 80% of those suffering from fever due to malaria have access to correct and appropriate medication within 24 hours.

2)    Intermittent preventive treatment (IPT) among pregnant women;

a)    At least 80% of pregnant women have access to malaria prevention by 2010.

b)    At least 80% of pregnant women have access to appropriate treatment by 2010.

3)    Vector control; at least 80% of children under 5 years of age and pregnant women sleep under insecticide treated bed nets(ITNs) and long lasting insecticide treated nets (LLINs) by 2010.

Why is malaria such an important disease?

As mentioned earlier, there are over six million cases of malaria in Malawi every year. But worldwide, malaria causes over 500 million cases and 1-3 million deaths every year, making it the fourth most dangerous infectious disease in the world.

So how is Malawi dealing with such a disease?

For the past two decades, there has been growing research in malaria and other infectious diseases by both local and international organizations. The National malaria control program with funding from the Malawi government and its partners, Global fund, Department for International aid (DFID), United States agency for international development (USAID), World Health Organisation  and other agencies under United nations system, have managed to do country wide malaria projects to achieve the intervention strategies above.

Apart from surveillance, there has been in depth scientific research that has been carried out by the Malawi-Liverpool Wellcome Trust Clinical research program (MLW) formerly called Malaria project and the Blantyre Malaria project (BMP). With funding from the UK and the USA and links with universities in the afore mentioned countries and the University of Malawi College of Medicine and the ministry of health (MOH), in depth research in malaria and other diseases has been the focus of these institutions. There are other international research institutions also working in Malawi but I have mentioned these two because their profound focus in malaria research and training of scientists in advanced malaria research.

With challenges such as;

·         continued rise in the number of reported suspected cases due to lack of diagnostic equipment and training in health facilities,

·         Low coverage of ITNs per household,

·         Low utilization of LLINs,

·        And inadequate surveillance mechanisms to access disease burden as well as challenges in the supply chains of anti malarial medications,

Malaria remains a challenge in Malawi.

But what has been achieved so far?

1.    Mosquito nets

Country wide the primary malaria intervention method is the use of treated and untreated bed nets. Since 2007, over 6 million LLINs have been distributed in Malawi(NMCP,2010).

2.    Indoor residual spraying

Indoor residual spraying is another intervention method that is yet to be implemented throughout the country but has been tried in one district and has proved to yield good results.

3.    Intermittent presumptive treatment (IPT)

This is a system where pregnant women are given anti malaria treatment during the second and third trimesters of their pregnancy. This is important because malaria infection can cause anaemia in the foetus, low birth weight, and spontaneous abortion.

Over a decade now the ministry of health has implemented IPT.

4.    Research interventions

Research on severe malaria through postmortem studies on children who have died from cerebral malaria have been conducted for over 10 years to find out the characteristics of the malaria parasite that results in severe disease.

Studies looking at drug resistance trends in Malawi have also been carried out to determine how effective the malaria drugs that are in circulation are in killing the malaria parasite and also to determine when the parasite develops resistance to these drugs. This research has helped in the changing of malaria first line drugs from chloroquine, to Fansidar and now LA.

Malaria remains a big challenge in Malawi and more work in surveillance, treatment interventions and research are needed to combat the disease.

Influenza (Chimfine)

Influenza yomwe imadziwika kwambiri ndi dzina loti flu ndi matenda omwe amagwira mbalame komanso anthu. Matendawa anagwedeza dziko lonse mu chaka cha 2009 pamene kunagwa mlili wa chimfine cha mbalame(bird flu). Chimfine cha mbalame chinaopsya zedi chifukwa mbalame zodwala chimfinechi zi mapatsira anthu. Anthu omwe anatenga chimfinechi anadwala kwambiri ndipo ena anamwalira kumene.

Tsopano tisasokoneze influenza ndi matenda a chimfine omwe timadwala nthawi ndi nthawi omwe pa chizungu amati common cold ndipo ine ndi watcha chimfine cha wamba. Chimfine cha wamba chi ndi chija timakhala tikuyetsemula komanso kukha mamina. Chimfinechi chimatifoola ndipo chilakolako cha chakudya chimatheratu.  Chimfinechi timatha kudwala nthawi ina iliyonse koma chimachhuluka nyengo ya mvula ndi yozizira.

Tsopano kubwerera ku mutu wa lero, influenza  imasiyana ndi chimfine cha wamba  chifukwa influenza ndiyoopsya ndipo ikhoza kupha wodwalayo ngati salandira chithandizo.

 Zizindikiro

Zizindikiro za influenza zimafananira ndi zizindikiro za chimfine cha wamba. Munthu wodwala influenza amamva mpepo, kupweteka kokhala ngati kupalapala kwa pakhosi,    kupweteka kwa minyewa, kupweteka kwa mutu, chifuwa, ndi kufooka.

Kufala kwa matendawa

Matendawa amafala kudzera mu mpweya pamene munthu ayetsemula kapena kutsokomola. Influenza yo chokera kwa mbalame imafala kudzera mu zitosi komanso kudzera mu mamina a mbalame zomwe zikudwala matendawa. Munthu akhozanso kutenga matendawa pogwira malo omwe pagwera mamina, monga zitseko, pa tebulo ndi zina zotero.

Kupewa

·       Njira yoyambilira yozitetezera ku influenza ndi kulandira katemera yemwe amakonzedwa chaka chili chonse kulingana ndi mtundu wa chimfine omwe wavuta nthawi imeneyi.

·       Tikhoza kupewanso matendawa potseka pakamwa ndi mphuno ndi ka nsalu kominira pomwe tiyetsemula kuti tipewe kufalitsa tizilombo tofalitsa matendawa mu mpweya.

·       Nthawi zonse pewani kugwira m'maso, mphuno ndi pa kamwa, chifukwa tizilombo toyambitsa matendawa timatha kulowa mthupi kudzera njira imeneyi.

·       Ngati mwadwala influenza kapena chimfine cha wamba, khalani kunyumba ma ola 24 (24hrs) kuyambira nthawi yomwe kutentha kwa mthupi kwasiya.

Munthu wodwala influenza amatha kuchira mu sabata imodzi kapena awiri chiyambireni kudwala matendawa, koma ana ndi anthu achikulire, komanso omwe ali ndi matenda ena chimfinechi chikhoza kusokoneza mthupi ndi kuyambitsa chibayo kapena imfa.

Influenza ndi nthenda ya chisanu ndi chitatu (8) yopatsirana yoopsya kwambiri pa dziko lonse.

Kamwazi (Typhoid Fever)

Typhoid fever (kamwazi) ndi matenda omwe a Malawi ambiri akuwadziwa. Matendawa, omwe nthawi zina anthu amasokoneza ndi malungo chifukwa chofanana zizindikiro, timayambitsa ndi tizirombo totchedwa bakiteria.

Matenda a kamwazi amayambitsa kutsegula m’mimba ndi ziwengo, kamba ka mtundu wa bakiteria womwe umayambitsa matendawa wa Salmonella typhi (S. typhi).

Nanga matendawa amayamba bwanji ndipo tingawapewe bwanji?

 Ka chilombo ka S. typhi  kamafala kudzela mu zakudya, zakumwa komanso madzi amene mwapezeka tizilomboti. Ngati mwadya kapena kumwa madzi omwe muli tizilombo toyambitsa kamwazi, tizilomboti timalowa mthupi mwanu kudzera mu matumbo. Kenako tizilomboti timachoka mu matumbo ndikulowa mu magazi momwe timafala ku ziwalo zosiyana siyana.

Kuopsya kwa matendawa ndi koti anthu ena amatha kukhala ndi matendawa mthupi mwao koma osadwala. Anthu oterewa amatchewa “afalitsi” (pa chizungu amati ma carriers), anthuwa amanka na falitsa matendawa asakudziwa. Anthuwa amafalitsa matendawa kudzera mu chimbudzi chawo, ndipo akhoza kufalitsa matendawa kwa zaka zambiri.

Zizindikiro za matendawa

Chizikiro choyamba ndi kutentha kwa mthupi, kuphwanya mthupi ndi kupweteka kwa m’mimba, ndi kutegula m’mimba.

Anthu ena amakhala ndi ziwengo zomwe zimaoneka ngati madontho ofira pa mimba ndi pa chifuwa.

Matendawa ndi oopsya choncho ndi chofunikira kuti ngati mwaona zizindikilozi, mupite ku chitala mwa msanga kuti mukalandire chithandizo.

Musayiwale kuti kamwazi ndi nthenda ya chisanu ndi chinayi (9) yoopsa pa dziko lonse lapansi pa matenda opatsirana.

Kodi Mukudziwa?

Sabata lapitali takhala tikukambirana za matenda opatsirana ndipo ndinaperkapo ndondomeko ya matenda khumi opatsirana omwe ali oopsya kwambiri pa dziko lapansi.

Lero tikambepo za nthenda yomwe ili ya chi khumi pa matenda oopsya kwambiri opatsirana pa dziko lapansi. Nthendayitu ndi ya nthomba yomwe pa chizungu imatchedwa smallpox.

Aliyense amane anabadwa kuyambira zaka za mbuyomo kulekezera 1978 wa chi Malawi ali ndi chipsyera chokhala ngati dzuwa pa mkono wao wa kumanja. Anthu ena nkumadabwa kuti kodi chipsyera chimenechi chinachokera kuti?

Chipsyerachitu ndi cha katemera wa matenda aja a nthomba omwe pa chizungu amatchedwa. Nthomba ndi imodzi mwa matenda oopsya kwambiri opatsirana pa dziko lapannsi. Nthendayi ili pa nambala 10 pa nthenda zoopsya kwambiri zopatsirana.  Ngakhale nthendayi inatha mumaiko ambiri, adakalipo maiko angapo omwe katemerayu adakaperekedwabe.

Nthendayi  imayambitsa ndi vairasi yotchedwa variola. Pachimake pa nthendayi mwa anthu zana limodzi (100) opezeka ndi matendawa anthu ochepera khumu okha ndi omwe amatha ku chira ku nthendayi.

Nkhani yosangalatsa ndi yakuti nthenda ya nthomba inagonjetsedwa ndipo inatha padziko lonse. Munthu omaliza kupezeka ndi matendawa adapezeka mu mwezi wa okotobala mu chaka cha 1977.

Tizilombo toyambitsa matendawa timabisala mu misempha ya khungu komanso mkamwa ndi pakhosi.  Momwe ti mapangitsa matuza omwe amadzala amaonekera kumanso komanso thupi lonse. Munthu akachira ku matendawa amakhala ndi zipsyera kumaso ndi mthupi, ena amachitika khungu kamba ka tizilomboti kupezeka mmaso, ena amapuwala ziwalo zosiyana siyana.

Mu chaka cha 1979 bungwe la World Health Organization (WHO) linalengeza kugonjetsa kwa matendawa.

Kupewa Matenda Opatsirana

Matenda opatsirana ndi matenda ena, ndi gwero la imfa zambiri, kulumala, komanso umphawi kwa zikwi zikwi za anthu pa dziko lapansi.

Ngakhale njira zilipo zopewera matendawa, komanso kupezeka kwa mankhwala osiyana siyana ochiza ena mwa matendawa, vutoli lidakalipobe.

Chifukwa chain vutoli la matendawa lidakalipobe?

Yankho kapena nditi mayankho alipo angapo, ena mwa iwo ndi awa;

    1. Anthu ambiri sadziwa kuti matendawa tikhoza ku wapewa

2. Anthu ambiri sakudziwa njira zopewera matendawa

3. Kusowa kwa mankhwala omwe amathandiza ku chepetsa komanso kuchiza matendawa

4. Kuchepa kwa maphunziro, choncho anthu ambiri satha kuwerenga ndi kulemba ndipo sangathe kuwerenga za njira zopewera kapena kupeza chithandizo ku matendawa.

5. Ku kwera mtengo kwa mankhwala komanso zipatala zolipira komwe anthu angathe kupeza ena mwa mankhwala oti angawathandize ku matendawa

6. Umphawi womwe umapangitsa anthu kukhala m’malo komanso kumwa madzi ndi kudya zakudya zoti si za ukhondo

Nanga tingathandizane bwanji kuti tichepetse kapena kupewa kumene matenda opatsiranawa?

Chifukwa cha kuopsya kwa matenda opatsirana, maiko osiyana siyana pa dziko lonse anagwirizana pa mfundo yotchedwa “Millenium Development goals” omwe pa Chichewa tinganti “Mfundo za chitukuko muchilimika cha mileniyamu”. Imodzi mwa mfundo zomwe anagwirizana ndi :

Kuthetsa komanso kutembenuza njira za kufala kwa matenda opatsirana pofika chaka cha 2015.

Kodi maiko wa akwaniritsa bwanji mfundo imeneyi?

Ilitu ndi funso lomwe dziko lili lonse liyenera kuyankha. Maiko osiyana siyana akonza njira zomwe akutsata kuti athane ndi vuto la matenda opatsiranawa. Zina mwa njirazi ndi;

1) Kuonetsetsa kuti anthu aphunzitsidwe njira zopewera matenda opatsirana

2) Kuonetsetsa kuti anthu akulandira mankhwala oyenerera ochepetsa komanso ku chiza matendawa

3) Kuonesetsa kuti anthu ali ndi madzi a ukhondo komanso akuphunzitsidwa njira zosiyana siyana za ukhondo.

Chikhazikitsileni mfundo za chitukukuko mu chilimika cha mileniyamu mu chaka cha 2000, zina mwa zinthu zomwe maiko akwaniritsa ndi;

· Kuchepetsa kwa imfa chifukwa cha matenda a chikuku ndi pafupi fupi 92% mu Africa ndi Madera a ku mvuma kwa Nyanja ya Mediterenian (East Medeterenian)

· Kukwaniritsa ku chiza matenda a TB mu Madera ambiri a ku Mwera cha ku mvuma kwa Asia (South East Asia)


· Pafupifupi kuthetsa matenda a Polio ndi matenda ena opatsirana kudzera mu tinyongolotsi (worm diseases)

Izi ndi zina mwazitsanzo za njira zomwe maiko akuyesetsa kukhazikitsa mu kulimbana ndi matenda opatsirana.