In this exclusive interview with METROWATCH’s Ogochukwu Isioma, Dr. Udoh James Akpan, a renowned researcher and change management consultant with extensive expertise in malaria and sickle cell disorder, shares his insights and expertise on the prevention, treatment, and management of these diseases, highlighting the critical role of effective health communication in promoting public awareness and understanding.
Excerpts:
May we meet you?
My name is Dr. Udoh James Akpan. I am a researcher with the University of KwaZulu-Natal in Durban, South Africa. I am also a change management consultant, and have worked in Nigeria and South Africa.
What are the common symptoms and complications of malaria, and how can it be prevented or effectively treated?
Let us firstly understand what Malaria is? Malaria is caused by a parasite that spreads to humans through the bites of infected female Anophe les mosquitoes. It is a life-threatening disease primarily found in tropical countries. It is both preventable and curable. However, without prompt diagnosis and effective treatment, a case of uncomplicated malaria can progress to a severe form of the disease, which is often fatal without treatment.
Malaria is not contagious and cannot spread from one person to another; the disease is transmitted through the bites of female Anopheles mosquitoes. Five species of parasites can cause malaria in humans and 2 of these species – Plasmodium falciparum and Plasmodium vivax – pose the greatest threat. There are over 400 different species of Anopheles mosquitoes and around 40, known as vector species, can transmit the disease.
Risk of infection is higher in some areas than others depending on multiple factors, including the type of local mosquitoes. It may also vary according to the season, the risk being highest during the rainy season in tropical countries.
Malaria patients can experience a range of symptoms — from none to mild, to severe. Typically, symptoms include tiredness, flu and fever-like illness, chills, muscle aches, and headaches. Severe cases of malaria can cause organ failure and even death. But malaria is curable if diagnosed quickly and treated correctly.
What role does health communication play in preventing the spread of malaria?
Health Communication is the study and practise of communicating promotional health information such as health campaigns, health education and between doctors, nurses and patient. The purpose of disseminating health information is to influence personal.
Health communication therefore is strategic in preventing people from having malaria since it would run a campaign of health and hygiene of the public to improve their health literacy. With a good health literacy, the public will make improved health choices
What are the latest developments in malaria research and treatment?
Early diagnosis and treatment of malaria reduces disease, prevents deaths and contributes to reducing transmission. The World Health Organization recommends that all suspected cases of malaria be confirmed using parasite-based diagnostic testing (through either microscopy or a rapid diagnostic test).
Malaria is a serious infection and always requires treatment with medicine.
Multiple medicines are used to prevent and treat malaria. Doctors will choose one or more based on:
– the type of malaria
– whether a malaria parasite is resistant to a medicine
– the weight or age of the person infected with malaria
– whether the person is pregnant.
These are the most common medicines for malaria:
– Artemisinin-based combination therapy medicines are the most effective treatment for P. falciparum malaria.
– Chloroquine is recommended for treatment of infection with the P. vivax parasite only in places where it is still sensitive to this medicine.
– Primaquine should be added to the main treatment to prevent relapses of infection with the P. vivax and P. ovale parasites.
Most medicines used are in pill form. Some people may need to go to a health centre or hospital for injectable medicines.
What is sickle cell disorder, and how is it inherited?
Sickle cell disorder is an inherited blood disorder marked by defective hemoglobin. It means that it runs in the family. It inhibits the ability of hemoglobin in red blood cells to carry oxygen. Sickle cells tend to stick together, blocking small blood vessels causing painful and damaging complications
To be born with sickle cell disorder or disease, a child has to inherit a copy of the sickle cell gene from both parents. This usually happens when both parents are carriers of the sickle cell gene, also known as having the sickle cell trait. An example is that parents with AS and AS trait may produce a child with SS.
What are the common symptoms and complications of sickle cell disorder?
Symptoms of sickle cell anemia usually appear around 6 months of age. They vary from person to person and may change over time.
Symptoms can include:
– Anemia. Sickle cells break apart easily and die. Typical red blood cells usually live for about 120 days before they need to be replaced. But sickle cells usually die in 10 to 20 days, leaving a shortage of red blood cells. This is known as anemia. Without enough red blood cells, the body can’t get enough oxygen. This causes fatigue.
– Episodes of pain. Periodic episodes of extreme pain, called pain crises, are a major symptom of sickle cell anemia. Pain develops when sickle-shaped red blood cells block blood flow through tiny blood vessels to the chest, abdomen and joints. The pain varies in intensity and can last for a few hours to a few days. Some people have only a few pain crises a year. Others have a dozen or more a year. A severe pain crisis requires a hospital stay.Some people with sickle cell anemia also have chronic pain from bone and joint damage, ulcers, and other causes.
Swelling of hands and feet. Sickle-shaped red blood cells block blood circulation in the hands and feet, which can cause them to swell.
– Frequent infections. The spleen is important for protecting against infections. Sickle cells can damage the spleen, raising the risk of developing infections. Babies and children with sickle cell anemia commonly receive vaccinations and antibiotics to prevent potentially life-threatening infections, such as pneumonia.
– Delayed growth or puberty. Red blood cells provide the body with the oxygen and nutrients needed for growth. A shortage of healthy red blood cells can slow growth in babies and children and delay puberty in teenagers.
– Vision problems. Tiny blood vessels that supply blood to the eyes can become plugged with sickle cells. This can damage the portion of the eye that processes visual images, called the retina, and lead to vision problems.
How can sickle cell disorder be managed, and what are the latest treatment options?
Thank you for that wonderful question. Management of sickle cell anemia is usually aimed at avoiding pain episodes, relieving symptoms and preventing complications. Treatments might include medicines and blood transfusions. For some children and teenagers, a stem cell transplant might cure the disease. Gene therapies also are being developed that may offer cures for people with sickle cell disease.
Surgical and other procedures:
– Blood transfusions: Red blood cell transfusions are used to treat and prevent complications, such as stroke, in people with sickle cell disease. In this procedure red blood cells are removed from a supply of donated blood, then given through a vein to a person with sickle cell anemia. This increases the number of red blood cells that are not affected by sickle cell anemia. This helps reduce symptoms and complications. Risks include an immune response to the donor blood, which can make it hard to find future donors. Infection and excess iron buildup in the body are other risks. Because excess iron can damage your heart, liver and other organs, you might need treatment to reduce iron levels if you undergo regular transfusions.
– Stem cell transplant: This also is known as a bone marrow transplant. The procedure involves replacing bone marrow affected by sickle cell anemia with bone marrow from a donor. The procedure usually uses a matched donor, such as a sibling, who doesn’t have sickle cell anemia. A stem cell transplant can cure sickle cell anemia. Stem cell transplant is recommended only for people, usually children, who have significant symptoms and complications of sickle cell anemia. The risks associated with the procedure are high and include death.
– Stem cell gene addition therapy: In this treatment option, the person’s own stem cells are removed, and a gene to produce typical hemoglobin is injected. The stem cells are then given back to the person in a process known as autologous transplant. This option may be a cure for people with sickle cell disease who do not have a well-matched donor.
– Gene editing therapy: This Food and Drug Administration (FDA)-approved treatment works by making changes to the DNA in a person’s stem cells. Stem cells are removed from the body, and the sickle gene is changed, also called edited, to help restore the cells’ ability to make healthy red blood cells. The treated stem cells are then returned to the body through the blood. This is called an infusion. People who are successfully treated with gene editing therapy no longer have symptoms of sickle cell disease. This treatment is FDA-approved for people 12 years old and older. Long-term effects of this new treatment are not yet known and will continue to be studied.
What role does health communication play in raising awareness and promoting understanding of sickle cell disorder?
As long as the genes exist in human, it is imperative that focus is shifted more to prevention than management. To achieve prevention, public health managers will need to mobilise the Social Behavioural Change Communication approach so that individuals will be aware of the consequences before having children together. Social Behavioural Change Communication is the strategic use of communication approaches to promote changes in knowledge, attitudes, norms, beliefs and behaviour. The media, both mainstream and social media, religious centres and schools are locations and platforms where Social Behavioural Change Communication can be used in this health education so as to reduce the prevalent rates. This will greatly reduce the infrastructural and economic burden on health care systems, and also on homes.
How important is health communication in preventing and managing malaria and sickle cell disorder?
Sickle Cell Disorder is worsened by choices made by partners, and malaria is mostly caused by not managing living environment well. They are all behavioural. Therefore, Health communicators will have to design programmes of social behavioural change communication to combat both diseases
What strategies can be used to effectively communicate health information to the public?
It should be environment specific. You have to look at the culture of the people in that environment, their attitudes etc before you can design a programme that will resonate with them. You must also use a channel of communication that is cheap, accessible and popular to communicate with them.
How can health communication help reduce stigma and misconceptions surrounding these conditions?
By running an educational campaign to educate the public. Public health must be taken seriously in Nigeria, and government on all levels must work with professionals, NGOs, donor agencies to create media and educational activities for the public.
What role do healthcare professionals play in promoting health communication and education?
Healthcare professionals like doctors and nurses or others do not have the expertise. It is strictly health communication professionals that have the competences to drive it
How can we ensure that health information reaches remote and underserved communities?
By taking the message to them. By localising the information using the context of the community and by allowing them through a participatory strategy to determine the message and the channel that will resonate with them. It has to be bottom – top approach.
