The three other students going to Ghana and I are enrolled in a Twi language course. This class will be useful obviously to help us communicate when we get to Wiamoase, but there is another benefit inherit in the class. Since half of the class is Ghanaian the other field study students and I are already getting a small glimpse into the culture we will be attempting to assimilate into. I have made a few observations so far:
- Understanding and relating to the humor of the people seems like it will have to be learned rather than intuitive.
- We will need to be the ones taking initiative to cross the culture barrier, we cannot expect those in our area to do so in our behalf.
- It seems like social norms such as the teacher-student relationship are different and we will need to adapt to those norms.
I found an article called Malaria-related beliefs and behaviour in southern Ghana: implications for treatment, prevention and control. Researchers from Noguchi Memorial Institute for Medical Research studied the variables of malaria transmission in two locations in southern Ghana. They found that ecological factors play a major role in the occurrence or malaria transmission. For example, interference with the local ecology by building dams, mining areas and clearing rain forests for farming may create breeding sites for mosquitoes.
Also, I learned that Ronald Ross was the scientist who discovered Anopheles mosquitoes to be responsible for spreading the malaria parasite. This won him the Nobel Prize in Physiology or Medicine in 1902. The discovery of how malaria is transmitted laid the groundwork for developing strategies to combat the parasite.
Keywords: malaria related beliefs, ecological factors
Learning Journal 5
I studied another article from the Tropical Medicine and International Health publication entitle "How local community knowledge about malaria affects insecticide-treated net use in northern Ghana." In this study the researchers observed that health care educators and local citizens often had no real agreement on the definition of malaria. Locals would often not correlate the biomedical term malaria with what they perceived as a separate illness (which was actually malaria). They did not understand the use of bednets to control exposure to vector mosquitoes during nighttime. In general, health care educators/providers and locals disagree on the mode of malaria transmission. There were many implications from this article to suggest that the largest problem facing health educators in Ghana is a lack of common understanding between them and locals when it comes to the definition of malaria.
Keywords: community knowledge about malaria
Learning Journal 6
I studied an article entitled "Intermittent Screening and Treatment versus Intermittent Preventive Treatment of Malaria in Pregnancy: A Randomised controlled Non-Inferiority Trial." There are two methods for preventing malaria in pregnant women that were studied in this experiment. The first is called Intermittent Preventive Treatment with sulphadoxine-pyrimethamine and insecticide treated bednets. The second is Intermittent Screening Tests with a rapid diagnostic test and treatment of infected patients with amodiaquine+artesunate. In the first method all pregnant women are given preventive treatments whether or not they are infected. As a result, many women who would not have been infected with malaria are treated. The alternative method screens pregnant women in antenatal visits to the clinic and if their rapid diagnostic test shows they are infected with malaria they will be given an antimalarial drug. This article made me wonder how accessible these teatment methods are in the clinic in Wiamoase. Do women consistently attend their antenatal clinic visits enough for this to be effective? Can women buy the insecticide treated nets from the medical clinic?
Keywords: screening, treatment, amodiaquine, artesunate, sulphadoxine-pyrimethamine
Learning Journal 7
I studied an article entitled "Effectiveness of combined intermittent preventive treatment for children and timely home treatment for malaria control" and learned some interesting facts. IPT for children is more effective if distributed in homes, but the concern is that opening up that method of treatment could lead to the abuse of sulphadoxine/pyramethamine and the subsequent resistance of Plasmodium falciparum to it. Thus, treatment is limited to health care centers where the distribution is more controlled. What treatment method is currently used in Wiamoase? What is the possibility of implementing a new, more effective treatment method in the community?
Keywords: treatment for children, intermittent preventive treatment, timely home treatment
Learning Journal 8
I need to correct a statement made in the last journal entry. I thought the article stated that it was impossible to implement an IPTC program for home-based treatment of children because of the concern that the AS+AQ drug would be over-distributed and the P. falciparum parasite would develop a resistance to it. In the results of the study it was shown that implementation of a home treatment program was possible with local assistants trained to give the home-based IPTC and timely home treatments. The research authors had to go to the community twice a year to collect IPTC forms and at the beginning of each round of treatment for a few days to supervise the local research assistants. Other than these visits, the home-based treatment program was self-sustained within the community. The results of this research showed that this treatment method was successful with a decrease in febrile malaria incidents in children dropping by 88% over a period of one year. Is it feasible to implement this program in other communities? What is the total cost of this type of treatment compared what is currently done in Wiamoase? If IPTC is so effective why do people not just go to the clinic three times a year to get treated? Or do they in some locations? How do I find out the situation in Wiamoase?
Keywords: home based treatment
Learning Journal 9
I had an interview with my facilitator who had visited Ghana in 2008 to ask some questions about how my preparatory research so far applied to Wiamoase. This proved to be very useful since a lot of the treatment methods I have been researching are not applied in that community. The main thing I learned is that in Wiamoase there is no IPT or home based treatment of any kind. From what he said, I concluded that as long as the situation hasn't changed since 2008, any treatment of malaria in Wiamoase is done in the clinic. The reason for this was that there were not enough personnel to have home visits for administering AS+AQ or SP, and also that their method of treatment was essentially 100% effective. It seems that if a person displays severe symptoms of malaria (fever, aches, etc.) they will visit the medical clinic and receive treatment which always works. This led me to a lot of new questions: Why is the mortality rate for malaria in Ghana so high if even in rural areas there seems to be adequate treatment. Why are there so many studies being done for IPT if that isn't cost effective or practical? Is Wiamoase very much different from the other locations where these studies were conducted?
Keywords: wiamoase treatment, intermittent preventive treatment, home based treatment
Learning Journal 10
So I really need to revamp my project question. I think I can learn about all of the different treatment methods before I even get to the field. It sounds like it's pretty common knowledge that ITN's work really well for vector control, AS+AQ and SP are 100% effective (that is, until Plasmodium falciparum develops a resistance to it, but that research needs to be done in a lab). From what I have learned about Wiamoase, they are content with these treatment methods. But I feel like I really need to get specifics about the location. Is there a way for me to get some kind of contact in the community before I go? If I could have an informant that I could get information from as I prepare I think it would really help me make my preparation meaningful. Or maybe I need to spend more of my preparation time learning research methods and techniques so that even if I am not an expert on the topic I am researching I could at least have more adequate skills to conduct the research when I'm there. Right now I feel limited by the fact the the location I am going to is fixed and that I don't know how to get information on the specific location aside from asking my facilitator, but that's not necessarily what he is supposed to do. What I need to do is find out how to get information on Wiamoase and what there is to study in that location. That's where I'll focus my research for the next while.
Keywords: insecticide treated nets, project question
Learning Journal 11
So, new development. I am learning that a lot of the problem isn't that the treatment the clinic offers isn't adequate, but that a lot of people do not have access to the clinic. I didn't even consider that infants die from malaria because they cannot get treatment, I was assuming that everyone could get help if they really needed it. This is a whole different issue than what I was thinking. That explains why there are so many studies done of in-home prophylaxis treatment, not everyone can get to a health care center. If one of the Millenium Development Goals is to decrease the infant mortality rate for infants due to malaria what action is being taken near Wiamoase to achieve that goal? Are there groups that are working on distributing bednets or intermittent preventive treatment near Wiamoase?
Going this direction with my project question would mean I would be spending a lot of time away from the clinic I think. Is there anything even being done for preventive treatment near Wiamoase? Can I go online and find organizations that are working on distributing bednets and/or treatmentm for infants in rural areas?
Keywords: non-governmental organizations, millenium development goals
Journal 12
I searched on the internet for any NGO's near Kumasi that are working on getting bednets distributed. All I could find were ways to donate money to the organizations. I think looking for NGO's isn't the best way to go about finding what is being done to make bednets or prophylaxis more accessible. What is the government doing to work on this? I'm guessing the Ghana Health Ministry will have a program running to address distribution in rural areas. Is there a nationwide program that should be implemented in Wiamoase as well?
The problems I foresee facing the distribution of bednets and prophylaxis treatment are (1) funding and (2) personnel. What other problems face this project? Are bednets subsidized enough to make them affordable to the people that need them most?
Is this the direction I really want to be going with my project? This is turning out to be more of a public health type issue than I realized.
Keywords: non-governmental organizations, bednets, prophylaxis
