Bednets and Mangoes
Community members gathered for the malaria information session and bed net coupon distribution
This week began with an outing to a village meeting on mosquito nets and malaria prevention. Two students at UMU, one from Canada, the other from the Netherlands, who spent the semester in Uganda decided that they wanted to distribute bednets to the people in the area. They bought the nets in Kampala (the capitol city) and worked with the hospital in Nkozi to set up a village meeting where they could hand out coupons to receive the nets for free from the hospital.
At first it looked like no one was going to show. The sky looked like rain and the country road in front of the home where the meeting was to be held was disserted. But slowly villagers began to arrive. Time is very relaxed here so beginning the meeting 45 min to an hour later was not unusual.
Nurse explaining how to use a bed net
A nurse from the hospital had accompanied us to explain to the villagers some general information about
malaria and to explain how to use the bed nets. She explained in Luganda, the local language, while a student translated for us to the side.
Some of the misconceptions about malaria were very interesting. For example, some members asked the nurse about whether or not mangoes were safe. Because malaria rates go up during the rainy season (more opportunities for breeding for the mosquitoes) and mangoes are also in season then, some had assumed that mangoes actually cause malaria.
At the end of her talk, the nurse demonstrated how to set up a mosquito net in one’s home and even had some volunteers pose as bedposts. Then villagers were given coupons to collect the nets a couple of days later at the hospital. They were also given handouts about ACTs (A/L) written in Lugandan. Overall it was a very good showing and a great way to spread the word about malaria.
One of the students who helped to organize the gathering handing out coupons
Drug Collecting
Later in the week we were able to get down to business and start collecting antimalarials for testing.
Originally, we intended to collect forms of artemesinin. The first line treatment recommended by the government is Artemether/Lumefantrine(A/L) which is an Artemesinin Combined Therapy (ACT) derived from artemesinin. Artemesinin derivatives are the only antimalarials available to which the malaria parasite has not developed resistance. The only problem with A/L is that it is much more expensive (up to 60 times!) than other antimalarials which are available.
What we found when we made the rounds was that although A/L is the most effective medicine, quinine was the drug purchased most often according to sellers. Quinine has been used to fight malaria for a long time and has even been found to have harmful side effects, but it is also one of the cheapest anti-malarials available. Other antimalarials include chloroquine, quinine, sulfadoxine/pyrimethamine (commonly known as Fansidar), and mefloquine. All of these drugs are cheaper but much less effective than A/L. Using these antimalarials has multiple downsides. Obviously, for the patient, a cheaper but less effective medicine is not a good option as it may not actually cure them. Also, objecting more parasites to the medicine increases resistance to it—so the effectiveness of the medicine decreases even more.
We also found that A/L is not only not purchased, most of the time it is not even available. The majority of the shops we visited did not even stock A/L because the demand was so low.
In the end, we collected quinine samples from about seven shops and will bring them back to the states with us for testing!
Soon we will leave UMU and go on to Entebbe where we will catch our flight home. Time has gone be very quickly here, but it has been a good trip. Hopefully, the results of our research can be used by those at UMU and other development groups around the sub-county to improve malaria treatment and drug quality in the area.
Some community members who were not as interested in the bed net descriptions 
Signing off,
Alison
This post was written by alison.case
