Malaria: Taking the Sting Out

WHEN I was about ten years old, I came down with malaria. The mere memory of it still makes my knees jiggle, and I can smell the acrid chloroquine pills which left a bitter after-taste that stayed with me for days and made my urine yellowy and stinky of medication.

I remember feeling sweaty and cold at the same time that I was not sure whether to cover myself with a blanket or jump in a tub full of ice-cold water. My appetite for food was next to nothing; no matter how much my mother tried to entice me to eat, I would simply throw up.

As an African child, I was very lucky to have survived though the memory of my illness still sends shockwaves up my spine. Unfortunately, the chloroquine pills that saved my life are not considered as effective across Africa anymore because the malaria parasite has become resistant. With each dose, the little pest has evolved, so to speak.

Malaria is a big killer on the continent. Of the 30 countries ranked as high-burden malaria countries in the world by WHO, 18 are in Africa.  Continue reading

Why Tuberculosis Matters to Women’s Health

Tuberculosis (TB) has a major impact on women’s sexual reproductive health and that of their children.

For pregnant women living in areas with high TB infection rates, there are increased chances of transmission of TB to a child before, during delivery or after birth.

The disease, especially if associated with HIV, also accounts for a high incidence of maternal and infant mortality.

Unfortunately, there is little to no attention about women’s vulnerability in the current discussion and media blitz of a resurgent TB internationally, and in particular, sub-Saharan Africa.

In sub-Saharan Africa, TB is threatening to unravel public health developments gains around increased HIV awareness yet the solutions are not easy, particularly where they concern the well-being of women.

There is need for huge financial, human, research and technological investments to fight the problem, but such investments will work only if they radically put women’s health needs at the core.

More importantly is the need to align TB services and sexual reproductive health services, so that men and women know about the implications of the disease to their sexual lives and households.

In sub-Saharan Africa, however, there are pervasive systemic factors driving TB and drug resistance which cannot be ignored in the search of an effective solution to the problem.

A myriad of social and economic factors, as well as weaknesses in the health care system, inadequate laboratories combined with high HIV infection rates are fueling the resurgence of the TB in the region. Food insecurity, poor sanitation and overcrowding also contribute to the easy spread of the disease.

According to WHO, although Africa has only 11% of the world’s population, it accounts for more than a quarter of the global TB burden with an estimated 2.4 million TB cases and 540,000 TB deaths annually.

Governments in the region are grappling with inadequate infrastructure and the increasing threat of drug-resistant strains and co-infection with HIV.

HIV infection increases the likelihood of active TB more than 50-fold. An estimated one-third of the 24.5 million people living with HIV (PLHIV) in sub-Saharan Africa also have TB.

For women in the region, the prospect of a growing TB epidemic is harrowing, but discussion about the disease rarely sheds light nor seeks to address women’s specific needs.

Given the high rates of HIV infection among women in the region – the majority of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women – it is clear that they are the largest group at threat to develop active TB, and more likely drug resistance.

Even with the availability of TB drugs women’s socio-economic status and gender roles including child-bearing and caring puts them at high risk of both HIV and TB infection.

For many women in the region, the costs required to access health care centers for TB treatment are usually out of reach due to poverty and undermined socio-economic positions.

The social stigma associated with a TB diagnosis and its association with HIV forces both men and women to delay going to get tested for the disease. In some cases, when men in marital relationships test positive for TB, they are likely to withhold the information, thereby increasing the likelihood to spread the disease to both their partner and children.

Moreover, women in the region are largely responsible for the upkeep of the family, including looking after children, which may also affect consistent uptake of TB drugs. When a woman is infected with TB, the likelihood of spreading the disease to young children is very high.

An additional concern for women is that the uptake of TB drugs interferes with contraceptive use, pregnancy, and fertility.

According to researchers, Rimfampicin, a key component of TB treatment can reduce the effectiveness of oral contraceptive pills and possibly other hormonal methods, such as implants, injectables and emergency contraception.

TB in pregnant women not only increases the rate of maternal mortality, but is also a major factor contributing to the risk of mother-to-child transmission of the disease.

A study conducted in South Africa revealed mother-to child-transmission of TB in 15% of infants born to a study cohort of pregnant women in which 77% were HIV-infected. Maternal HIV/TB coinfection also increases the risk of mother-to child transmission of HIV.

Screening and treatment for TB in pregnant women at antenatal clinics must therefore be a major public health priority in the region. Information about TB needs to be an integral component of sexual reproductive health services.

To be precise, women infected with TB need to be empowered so that they can take control of their own care and lives.