Introduction
The world is full of fantasies and every one wants to be a part of these fantasies. There are some factors involved which keep a person active and smart. Health is a state of physical activeness which keeps a person mentally and physically fit. According to the world health organization, a health can be defined as a positive concept which highly emphasizes on social and personal resources as well as it is also concerned as physical capacities. There are two aspects of health: mental and physical. Physical health can be maintained by preventions, interventions and different physical activities. Malaria is a common disease usually caused by virus. Malaria is a vector brone infectious disease causes by different parasites usually it is caused by protozoan parasites. It is commonly found in different parts of world, especially United States, Asia and Africa. Each year many cases are recorded of approximately 515 million of malaria from different parts of the world. 90% malaria cases led towards death in South Saharan Africa. Usually malaria found in underdeveloped countries where high poverty and literacy rate is low as compared to European countries. Malaria is usually associated with poverty and it is also highly associated with economic development. Malaria is very common and now it has become a challenge for underdeveloped countries to protect malaria. Malaria causes numerous deaths in different countries. This disease is caused by protozoan parasites and it can be protected by using different strategies and preventive measures. There are a number of parasites but only four parasites can inject human, the most serious forms of disease caused by Plasmodium falciparum. Other three types of parasites can also be injurious to human health but however preventions are available to prevent human bodies. It’s a common phenomenon that people usually get affected from malaria by a female mosquito’s bite.
Symptoms of malaria usually include fever, shivering, vomiting, anemia, and retinal damage. Symptoms of malaria may carry from person to person as it depends on human capability. There is no specification that who will be affected from malaria but usually children and pregnant women are likely to adopt malaria. Malaria can be diagnosed with the aid of different tests and technologies. Few diagnosis of malaria can be done by film tests, microscopic examination of blood films, field tests, molecular methods and laboratory tests. There are many drugs recommended by different doctors for malaria few of them are as follows: Artemether-lumefantrine (it’s a therapy and commercially known as Coartem and Riamet), Artesunate-amodiaquine (Therapy), Artesunate-mefloquine (Therapy), Artesunate-Sulfadoxine/pyrimethamine (Therapy), Atovaquone-proguanil, commonly known as Malarone (Therapy and prophylaxis), and Quinine (Therapy only), Chloroquine (Therapy and prophylaxis), Cotrifazid (Therapy and prophylaxis), Doxycycline (Therapy and prophylaxis), Mefloquine, trade name Lariam (Therapy and prophylaxis), Primaquine (Therapy), Proguanil (Prophylaxis), Sulfadoxine-pyrimethamine (Therapy; prophylaxis for semi-immune pregnant women) Hydroxychloroquine, common name Plaque nil (Therapy). Malaria is usually caused by bites of mosquitoes so it’s really easy to prevent yourself from malaria by taking some preventive measures. Symptoms of malaria in Guatemala usually appear after 10-15 days of mosquito’s bite. Person usually feels weak and lazy after 15 to 20 days of mosquito bite. Malaria needs proper diagnosis and on time treatment if not treated properly than it could become a life threatening disease as it highly affect blood cells and blood circulation. There are some facts about malaria which are listed below:
- Malaria is preventable and curable disease
- After every 30 seconds a child dies due to malaria.
- More than one million people dies from malaria mostly infants and pregnant women and most of them found in underdeveloped countries and in Africa.
- Malaria is a kind of disease which can be transmitted in all ages.
Malaria is a kind of disease which is contiguous i.e. it can transmitted form one person to another. Malaria is usually caused by mosquito’s bite. This disease has been recognized by thousand of years and it mostly not found in the most northern areas of the world. It’s a serious problem in much of the tropical regions of the world.
Malaria Causes
It’s a common phenomenon that malaria is usually caused by protozoan parasites. When a mosquito bites a person an infection begins after 10-14 days. Infection begins from infected mosquito. The parasite travels to liver from mosquito’s bite where parasites start reproduction, then after some days parasite leaves the liver and travels to the blood stream where it infects red blood cells. The parasite usually infects the blood stream where it destroys the red blood cells and there it releases more parasites in bloodstream. If a mosquito bites an infected person than again if he bites another person, second person will also get infected with malaria. Basically there are four species which highly infect humans: Pvivax, Povale, P Malarie, P falciparum.
In most parts of the world people usually get affected from malaria by mosquito bites however some regions have other causes of malaria. In some regions of the world people get infected with malaria due to drug use, A large number of people get infected with malaria because of organ or kidney transplant, babies born to mother who did not know they are infected.
Malaria symptoms in Guatemala
Malaria symptoms involve fever, vomiting, anemia, retinal damage etc. A person develop a high fever which comes and goes every second day or after few days. In many people fever doesn’t comes and goes so often but they frequently feel body aches. People also complain of frequent headache, nausea, raging, sweating and weakness. When infection progresses a person feels better and he seems to recovering. Some people also develop little immunity and develop disease without any symptoms. Malaria can also be transmitted from mother body to her infant. Malaria is usually carried by mosquitoes in temperate climate but usually the rate of malaria is less in winter seasons as parasites usually vanishes in winter season. The malaria disease is one of the basic and important problems in most parts of tropics and subtropics. The CDC estimates about 300-500 million cases of malaria each year. People who travel a lot are likely to get infected with malaria as they face different seasons. Use of drug resistance parasite is also a big cause of malaria a global health problem. The parasites usually stay in liver about 8 days or as long as months.
Risk Factors
There are number of symptoms of malaria as stated above. Signs and symptoms indicates the time that when a person needs a doctor. People who have little immunity and don’t show any symptoms have high risk rate in malaria. When a person doesn’t pose any symptoms, then gradually a parasite grows and at the last stage malaria identified which is always dangerous for person’s health. Residents of a malaria region may show little immunity to the disease at some stage of life. People of serious disease poses high risk rate few of them are listed below:
Young children, infants and travelers coming from different region with no malaria, pregnant woman and an infant. An unborn baby also an ideal candidate who can affect with malaria. Poverty, lack of education contributes a lot in the increasing rate of malaria deaths worldwide. However, malaria can be reduced by taking some precautions and primitive measures.
Complications
Malaria is a preventable and curable disease and it can easily be controlled by medicine and different techniques (Mala, 1982). Some complications are involved in severe malaria cases, the most common complications are as follows: Anemia and Cerebral Malaria. Anemia usually caused due to the destruction of red blood cells. Cerebral Malaria is caused due to the parasite filled blood cells block blood vein to brain by which a brain damage can occur. There are number of complications is also involved in this case, other complications include: breathing problems, dehydration, liver failure, kidney failure, enlarged spleen. Other complications are: Cerebral malaria, Death, Mother-infant transmission, Low birth weight, Anemia, Jaundice, Enlarged spleen, Black water fever, Hematuria, Kidney failure, Liver complications, Brain complications, Enlarged liver, Hypoglycemia and Fluid imbalance. Disease database have another list of complication associated with malaria are as follows: Uveitis, Red cell abnormality on blood film, VDRL positive, Leuconychia Fits, Acute confusional state, Pyrexia of unknown origin, Haematuria, Aseptic meningitis, reduced level of consciousness.
Malaria can cause anemia and jaundice and if it rises to last stages it can lead to death, retinal damage and coma. Complications in malaria are secondary stages of malaria, symptoms and other disorders. In many parts of the world, doctors are not able to distinguish between symptoms and complication in some patients.
Misdiagnosis of Malaria in Guatemala
It has been observed from different surveys that malaria needs proper and on time judgment of disease. Proper on time treatment can safe person’s life. In most of the underdeveloped countries doctors are not able to distinguish between malaria and other disease. Misdiagnosis of malaria is very common in Guatemala and other regions. Misdiagnosis of malaria is as follows: Brucellosis, Toxocariasis, Changes disease, Dengue fever, Leishmaniasis, Marburg virus, fever, Trypanosomiasis, Typhoid fever, Schistosomiasis and Yellow fever. Alternative Diagnosis of malaria is: Flu, Influenza,
Typhoid fever, Dengue, Visceral Leishmaniasis, Amebic liver abscess, viral hepatitis,
Babesiosis, Typhoid fever, Leptospirosis and Relapsing fever. Now the basic question arises, why does misdiagnosis occurs in Guatemala? There are many ways by which a misdiagnosis can go in wrong directions. Usually disease player contributes a lot in misdiagnosis of malaria, patient, doctor, specialist and test. Patient plays a great role in misleading the doctor by not examining his body and symptoms properly. Patient can do misdiagnosis by wrong self diagnosis and not reporting symptoms, failure to complete ordered tests. Doctor play a pivotal role in wrong treatments and diagnosis of malaria since the doctor has to make a diagnosis, there are many ways by which a wrong diagnosis may occur some of them are as follows: doctor may familiar with only common diseases, over publicized disease, doctor’s skill levels, doctor bias, saving money and time, lack of time, don’t have a grip on an organ examination and sometimes in patients physical and mental behavior are hard to diagnose. Laboratory test can also led doctors to misdiagnosis of malaria if there is any human error, error margins, and false positive and false negative. These all factors play an important role in misdiagnosis of malaria in Guatemala. Malaria is a hot and critical disease in hot climate areas however it also occurs in temperate climate regions.
Prevention
Every thing needs proper diagnosis and proper judgment. On time decisions and proper management of any task help in immediate recovery. Health is a very important issue in the world but unfortunately, in underdeveloped countries there is a lack of education and treatment options which usually convert disease in severe cases. Malaria is a preventable and curable disease and it can be treated well by adopting some preventive measures and precautions. Self examination has of great significance and helps a lot in recovery. Patient has some duties to perform rather than depending upon doctor and other paramedical staff. Doctors usually recommended every one to examine body after every 5 days and if any abnormal thing appears so he must consult a doctor at his earliest. Only proper judgment and diagnosis can bring back a person from a disease. Malaria is a curable disease and first symptoms appear in form of fever. Unfortunately millions of people do not consider fever a dangerous thing; they take normal medicines for treating fever meanwhile malaria resides on bloodstream and damage red blood cells due to which a person feels sick and weak. There is a strong need to educate people and create awareness in them about malaria. Patient has some responsibilities which are as follows: Patient must note down all symptoms what a patient experiences, must note down key personal information, make a list of all medication patient is taking, must take a family member or friend with you etc. Patient must have complete information about malaria in order to recover from it soon. For better recovery patient must know the answers of following questions:
- What are the symptoms faced by patient?
- What are the possible causes of malaria?
- What kind of tests does the patient need?
- Is patient condition chronic or temporary?
- Are there any restrictions which patient needs to follow?
- Should the patient needs to visit a doctor?
- What websites should patient visit for better knowledge?
Malaria in Guatemala
Malaria is very common in Guatemala and has become a great challenge in Guatemala for health providers. Malaria is a very common disease found in 1500 meters The risk of infections are more likely in the provinces like Alta Varapaz, Baja Varapaz, Ixcan, Petén and San Marcos and to a lesser extent in the provinces of Esquintla, Huehuetenango, Izabal, Quiché, Retalhuleu and Suchitepequez of Zacapa. There is no risk of malaria below 1500 meters. In past few years, medicine field has gained so much success and still many researchers and scientist are working in this field in order to make better and effective drugs of different diseases. Guatemala is raising lots of funds in order to fight against malaria. Children are more likely to adopt malaria and negative behaviors. However every disease has its precautions and medicines. If disease is diagnosed at earlier stage then it’s always easy to fight against it in limited time. But due to the lack of knowledge millions of people do not consider any unusual symptoms as a serious matter. Thousands of people do not feel good to visit a doctor in some cases like fever, cough, sneezing etc. Self medication is a good approach but sometime it causes unbearable damages to human health and life. Many people in Guatemala consider self medication as a complete treatment of their disease.
Control and prevention is necessary for parasites disease as they are contiguous so there is always a strong need to diagnose malaria at its early stages in order to prevent patient from severe conditions. Preventions and control of parasites disease highly depends on adequate knowledge of interaction among factors and related issues for instance human behavior, environment, lifecycles of parasites. Socio culture behaviors contribute a lot in preventions of malaria in Guatemala. Socio culture factors in large parts determine transmission and persistence of parasites cycle. The significant determinants of malaria in large parts are poverty, lack of education, deficiency in home technology, high level of demographic density and ruralism (Muela, & Ribera, 2000). Above stated interventions has of great significance and play a pivotal role in reducing increasing rate of malaria in an isolated manner. Number of different interventions is implemented in order to control the increasing rate of malaria in America. Holistic approach has proved one of the best approach in control and preventions of parasitic infection in different parts of the world. Holistic approach emphasizes on educating people about malaria, causes, and symptoms so that people can deal with malaria effectively. Holistic approach combines awareness along with society infrastructure helps in producing favorable results. If all these actions implemented properly than they surely help in improving quality of life. In order to improve quality of life every person must take precautionary measures to keep his health and safe and disease free. Control and prevention of parasites disease usually depends on an adequate environment and available knowledge about any disease.
Population highly affects rise in malaria in certain parts of the world. There are number of preventive measures which can help in reducing high rate of malaria. The use of insecticide impregnated mosquitoes’ nets and other material in America is considered as the best primitive measure against mosquito’s bites (Voorham, 1997). Most of the researchers proved that wrong health indicators always misguides patient to take precautionary steps. Specifically, low incidence of malaria, the high prevalence of Pvivax malaria along with relapsed cases in America and the relationship between human behavior patterns biting patterns of malaria vectors allow easy implementation of precautionary measures. The use of mosquito nets has increased a lot and millions of people are using this as primitive measure against malaria. However, it is highly recommended by doctors that only well organized large scale trails and intervention is considered when they are based on through understanding of dynamics of malaria transmissions (Voorham, 1997).
Children are most likely to adopt malaria and are affected by mosquito bits soon (Bill, 2007). A Number of parents use different tools and medication in order to keep safe their child form mosquito’s bite. Immunization programs have contributed a lot in this domain. The role of intervention is really important in order to control increasing rate of malaria in children. Finance and other issues are really important and have of great significance in dealing with malaria in Guatemala. Finance plays an important role in controlling malaria. Pregnant woman needs strong care against malaria as there are high chances of infecting malaria form mother to unborn infant. Malaria posses’ serious health consequences for both mother and infant and now have become a great challenge for pregnant women. By taking some primitive measures this can be controlled effectively and by implementing different precautionary steps a public health challenge can be resolved. Roll Back malaria (RBM) is widely known as supportive agency of world health organization helps in reducing burden of different health issue by taking some precautionary steps (Karen Glanz,2007). For malaria RBM usually recommend use of following tools as precautionary step against malaria: use of bed nets and insecticide treated nets, effective case management, intermittent preventive therapy etc. in many parts of America, a comprehensive national malaria program is in progress for the production of malaria free America. Component of national malaria program are specifically designed in order keeping in mind the strategy to reduce the burden of malaria from WHO which include integration of malaria control with the aid of general health services and use of indoor spraying (World Health Organization. 1999).
Spraying strategies are beneficial as they help in reducing overall malaria exposure both for general population and pregnant women (Res, 2008). Pregnant women needs more care and attention same in case of malaria than general population as any infection can be dangerous to her infant. Beside malaria control program there are several issues and challenges faced by RBM in different regions of world. There is a strong need of implementing measures against malaria and to focus on social culture issues, drug policy which helps in implementing highly centralized malaria control program. RBM and WHO needs to take strong steps in malaria domain (Indian, 2008).
Economics of Malaria Control interventions
Numerous countries are following different strategies to fight against malarias. Usually human behavior and patient patterns are the main hurdles in the proper treatment of malaria. Usually, many patient do not feel good while treatment so they usually avoid to take treatments in start. The economic rate of government intervention in controlling malaria is highly based on balance of equity and market failure. Poverty is the second hurdle mostly comes in way of effective interventions (Kachur, 2001). Market failure is also a big issue which comes in the way of effective interventions. Malaria treatment is widely available and numerous doctors are treating malaria by their own ways. Treatment in both public and private sector is hanged by low quality of care, lack of proper care and attention, inefficiency in service delivery and lack of adequate care. Demand is always influenced by prices, lack of proper information usually makes situation critical and dangerous. Poorly trained staff and in propitiate prescription by health workers are also main hurdles in the way of proper treatment of malaria. In Guatemala, health workers are also suffering from lack of information about equipments and propitiate treatment. Improving malaria case needs some changes in order to make it more protective and effective. In order to improve malaria case management, there is a need of changing whole structure of health system as a whole, as in many places malaria cases pose a significant share of total utilization.
Health Belief Model
HBM is highly based on person’s action that he will take care if he feels any abnormality in his body. The core assumptions of HBM are listed below:
Perceived susceptibility, Perceived severity, Perceived barriers, Perceived benefits, Perceived cost, Demographic variables (for example age, gender, ethnicity, occupation)
Socio-psychological variables (for example social economic status, personality) Perceived efficacy, Health motivation, Perceived control, Perceived threat (Health belief Model, 2008).
Literature Review
HBM is a physiological model for promoting uptake of services offered by social physiologist. It attempts to explain physical and mental behaviors of a person infected with any disease. HBM model was constructed in response of failure of Tuberculosis (TB) health screening program, since than HBM has been adopted in number of regions. It is widely used in exploring a variety of long and short health behaviors including HIV aids. Core elements of HBM: perceived susceptibility is one’s opinion abut getting affected with any abnormal behavior, Perceived severity is one’s opinion how the condition is critical, perceived benefits are expected benefits from taken action, Perceived barriers are tangible and intangible hurdles, Self efficacy is one’s own ability to adopt positive behavior.
Critique
Health issue is one of the challenges face by today’s world. Program implemented by government in Guatemala are good but there are some weaknesses. Drug providers are of great significance and there is nothing properly implemented in order to promote them to provide reliable and authentic product. Nurses’ and Para medical staff spends more time with patient than a doctor so there is nothing advised for paramedical staff training. HBM is a good enough model for understanding the needs and requirements of changing behavior but it also needs development and testing for applicability in order to understand human behaviors (Journal of Advanced Nursing, 2008). Accessibility to health center and reliable drug is not easily available in Guatemala so there should be some governmental strategy for making it easy and approachable. Self efficacy is not easy as many people do not posses any knowledge of disease so there must be something to promote education and awareness programs in Guatemala. Perceived benefits must be in result of surveys and feedback from care seekers. Providing reliable products and safety drug products are the main issue in controlling malaria. Spraying and use of bed nets can cause other health issues as sometime they posses’ strong chemical which harm human skin and can cause breathing issues (Qingjun, 1998). There is a need to promote time to time clinical visits so that proper check up can be done accordingly. Negative behaviors usually occur due to the lack of information and unnecessary fear of getting affected. Governmental strategy is important to be implemented properly in this domain for effective and long lasting results. Many critiques are at level of HBM and HBM was reviewed with the aim of modifying it as there is nothing for nurses and paramedical staff education (Janet, 2008). It was reviewed to be focus on young families. Malaria is not incurable disease but on time care and proper diagnosis with proper medication is important in order to receive long lasting results. Health awareness and malaria intervention must be provided to young families so that self medication could not make situation worst. There must be some strategy to stop fake medicine supply in market. Health related behavior has been a great challenge for health providers. Understanding and being able to predict correct diagnoses is necessary in order to create smooth relationship with patient. A clear understanding is really important to identify the cause of behavior in order to judge the change (Davidhizar, 1983).
Current situation of malaria treatment
Antimalarias drugs are widely used method of malaria control in symptomatic cases. Usually people seek treatments from different places like private clinics, modern health providers, nongovernmental organizations, traditional healers, private dealers, shops and markets (Snow, 1992). Most often people seek fever medication which appears as a symptom associate closely with malaria. In sub Saharan Africa and Guatemala usually people seek for medication from shops and dispensaries. Diagnosis is highly based on clinical symptoms alone. Dispensaries usually do not offer advanced treatment of malaria required by sever cases of malaria. Outside Africa transmission rates in treating malaria is less intense (Kara and Catherine, 2004). In Asia and Latin America people usually seek treatments form general medical facilities, in Latin America laboratory test are also used for the diagnosis of malaria. In some regions of the world lab treatments are not available people usually given presumptive treatment for their immediate symptoms. Informal sector is widely used for treating malaria worldwide. It’s one of the commonly used methods for treating malaria. Around 60% malaria cases are treated initially by private providers mainly by purchasing medicines for fever from shops (Taylor, 2001).
It’s a common practice that usually person starts treating malaria by self medication. There is no effective malaria vaccines are available however spraying method is widely used to prevent malaria. Use of bed nets, clothes, curtains and hammocks are also very common. Government in many regions promotes the idea of using ITN as one of the malaria control objective. House holds also prevent Malaria. Malaria is a disease which needs proper and on time care and it can only be happen when seeker posses care some knowledge and reliable information about malaria and must know its treatment options.
Weaknesses in malaria treatment
There are some weaknesses in malaria treatment program in both private and public sector in Guatemala (Bitran, 1995). The three most significant weaknesses are as follows: low quality care, inefficient service delivery and lack of proper utilization of adequate care.
Low Quality Care
Malaria needs special care and attention in early stages to prevent it. Malaria is a curable disease and precautions can prevent it at early stages. Self medication is a good approach but still it needs to be done along with doctor’s advice. Low quality care lies in both private and public sectors: quality can be measured by two aspects: Technical Quality and perceived quality.
Technical Quality: both private and public sectors face numerous technical equipments in malaria treatment. Various technical difficulties are related to malaria diagnosis. Sometime a surgeon also finds difficulty in diagnosing malaria. Many essential drugs including antimalarias are frequently out of stock in health care centers and even in number of lower health care centers most medicine and anti malarial drugs are not available. Inappropriate and unauthentic prescription and use of unreliable drugs are very common. It’s a common practice that people in Guatemala usually save their money by purchasing low cost medicine for the treatment of fever (a first symptom of malaria). In Malawi 74% of malaria affected children attend clinic and only 17% took the correct dose. Over dosing causes number of complications in severs cases, and over dosing is common practice in Guatemala. Usually people take medicine from different shops and dispensaries where they ask for medicine by name rather than a service including diagnosis and service.
Poor quality drugs are also easily available in different drug stores and shops. Poor drug quality is usually caused by lack of quality control in manufacture and degradation during storage. In Guatemala fake drugs are easily available and it has now become a major concern for responsible authorities.
Taking behavior into account
Both public and private sector has responsibility of dealing effectively with malaria. However the public sector role in fighting against malaria goes beyond private sector. In order to ensure delivery of effective service in public sector, it’s really important to consider different determinants involved in the behavior of patients and health workers. For effective interventions it is necessary to recognize the role played by the private sector and there is also a strong need to target government interventions at changing the behavior in adopting different measures (Ault, 1994). Negative behaviors usually appear in result of poor knowledge and unreliable information and it can only be prevented by providing better information to care seekers.
Changing the behavior of care seekers in Guatemala
In Guatemala number of services is provided, they will fail to create an impressive impact on health outcomes if not properly implemented and if are not used by care seekers (Baume, 1998). First of all policies are required to be revised keeping in mind the changing mind of care seekers. Secondly, policies must have elements for the patient to take proper medicine and proper dose on time. Interventions usually influence by demand and supply behaviors and are affected by a wide range of factors which includes income level, accessibility information, perceived quality, cost and quality of treatment. Care seekers must have complete information about disease and its interventions. Pre-packaging drugs are also helps in changing behavior of care seekers.
Behavior of NGO and public sector provider
Public sector in Guatemala is providing health services to different health care center and NGO has also of great significance but the crucial behavior of providers has a great impact on effectiveness of health program by accurate diagnosis, drug recommended and the advice seek by the care seeker. Behavior can be changed by providing quality education, training and job aids.
What can be done?
Malaria has now become a challenge and government is failed to control in Guatemala. Malaria grows very soon but government failure also needs to address. By following ways treatment of malaria can be improved:
- By providing proper information to care seeker about disease, types and interventions.
- By Recognizing the incentive and encourage provide to provide reliable products.
- Involve private providers in intervention implementation program
- Simplifying the dispensing and using drug process.
Guatemala Sample:
Table 1. Interventions. The Global Fund to fight AIDS, Tuberculosis and Malaria in Guatemala, Geneva Proposal to Global Fund (2004).
Malaria is an endemic that has severely affected the third world countries such as Guatemala, which is already ridden by poverty, malnutrition, and civil war. The research proposal envisages on elimination the mortality rate of malarial cases in Guatemala, by launching a series of educational and eradication programs, simultaneously treating and launching nation-wide awareness campaigns. A total of US$ 15 million is requested in terms of cash over a 5 year eradication program. This will be supplemented with a meager US$0.5 Million, which will be generated from Government funds.
More than half the population is living in poverty conditions, with 16% of the population living in extreme poverty conditions. Guatemala is housing its own problems, such as a geographic barrier, linguistic problems, lack of education, coupled with an in access to job opportunities, thus isolating the country socially, politically and economically. This low literacy rate created a sense of ignorance among the masses, and the public is usually unaware of the high risks that are associated with contracting this fatal viral disease. Moreover, they are unaware of the methods of eradication, and rectification, if someone does get infected. Thus, the dire need of the time is to launch educate the masses and elevate their standards in order to prevent them from luring the parasite. There was a similar Malarial awareness program conducted in the recent past that included representation by public participation programs, community, academic and religious groups to reduce the mortality rates.
The objective of the current proposal focuses on Malaria, caused by the Parasites, P. viva and P. falciparum, and eradication of the Plasmodium, in order to reduce mortality rates by at least 70%. This is an enormous task, keeping in view the low poverty and literacy rate of the country. The Malarial parasite is caused by a host of Plasmodium, and many more strains should have been taken into consideration.
The first intervention of the program was to increase the number of community programs throughout the country for control of the malarial vector. This included conducting selective community based vector control actions in 360 of the most infected villages. A rigorous insecticide treated bednet (ITN) program was to be launched, focusing on treating larval breeding sits, accompanied by focal residual domestic spraying and management of the environment. The proposal requested a modest budget for conducting the ITN program, coupled with the country’s own resources generated by the National Ministry of Health, and the community’s resources. The program emphasized on targeted eradication in order to be more conserved due to limited resources. Initially, a biological, environmental, and socio cultural survey was conducted to localize the treatment. The proposal aimed in galvanizing academic and research institutions in this eradication program in order to improve the control of dissemination of the plasmodium virus. This was a positive approach, however, due to an already low literacy rate, and a low rate of school enrollment, it would be very effective to team the research activities with the community programs, the later should have been focused in particular.
The second objective of intervention was projected to improving the effectiveness of the diagnostic and treatment of malaria. Keeping in view of the low sanitation conditions in Guatemala, there was a dire need to improve diagnostic approach in order to eliminate or reduce the chances of false positive results, or vice versa. It was depicted that previous diagnostic assays were conducted with the local volunteer collaborators (VCs). However, due to lack of proper clinical facilities, and expertise, the VC system were rendered ineffective due to the increased mortality cases, ultimately yielding in fewer number of patients being diagnosed by the VC’s. Malaria diagnostics was usually poor due to lack of facilities, improper storage conditions for medicines, improper expertise, coupled with self medication by the locals, which ultimately yielded in a resistance to the anti malarial drug, chloroquine. This is galvanized by high immigrations. Although this was a good remedial measure, specialized training to VC groups would not have been so effective, as in the past, this VC program has already been proved to be ineffective, so, it is proposed to actually train communities, groups, masses, by means of seminars, conferences directly to the public, in their respective languages, in simple yet explicit so as to spread the message; pamphlets should be distributed, and pictured posters should be pasted on common places, to educate the masses.
The project aims in improving the VC diagnostic approaches, by introducing commercial diagnostic vendors, renovation of clinic, and training and improving the laboratory skills in the volunteers, on how to conduct proper, lab level diagnostic of malaria in remote areas specially. Likewise, a network was to be established in order to monitor the response of public to anti malarial drugs, coupled with an assessment of the efficiency of current treatment regimes. A program to show how detrimental the malaria virus is should be explained, as, probably, the public was taking it for granted that this virus is there forever. They should be aware of the fact that it can be treated, and can be prevented. Similarly, along with volunteers, it would be better to train the masses, and the public.
The third main intervention proposed by the Principle Investigators, was to strengthen the epidemiological information in order to assist in the overall health services for assisting in the malarial eradication program. A functional and reliable information system was proposed, that would be run and governed by majority of the locals. A weekly surveillance survey would be conducted across the parameters of Guatemala. It was depicted that previous such surveys were unreliable, due to a weak structure of the VCs, coupled with a rapidly deteriorating coverage by the volunteers and new risks posed by rapid deterioration in climate and socio-demographic conditions. It was detrimental to initiate a new and improved malarial eradication program to take immediate, effective and efficient remedial measures. The proposal aims in launching an improved system so that decisions made by the top authorities would be more effective. Decision making was more diverse, as it included community leaders and civil society, so that a more dilute community was approached in the exercise of decision making process. The information system was modified in order to improve the quality and quantity of epidemiology indicators, for a more thorough and timely flow of information to the health personnel. It was considered irrelevant to conduct another epidemiology study, moreover, with a weak volunteer structure, coupled with a low public participation rate, it was not considered to be very effective to strengthen information networks. However, the new, diverse community participation was deeply appreciated, as it could have been useful.
The fourth objective was targeted towards strengthening the capacity of the health service in order to promote the actions of the community for intersectoral cooperation. It was mentioned that previous such control programs were rendered ineffective due to lack of participation from the community including advocacy from the relevant sectors involved. A nation wide awareness campaign was launched to impart training to the masses regarding the prevention of malaria and remedies to eradicate the disease. However, it was mentioned that this would not be an easy task due to the multilingual population, the multicultural dimensions within the community, low literacy rates, and a low interest exhibited by the public, as they seemed to have become adapted to malaria, and were actually not very concerned. It was a major task actually convincing the rural tribes, and implementing the precautionary measures to be taken. With previous unsuccessful intersectoral programs, there was no difference in this program. A new dimension had to be taken, probably by conducting trainings within communities, instead of between the communities, for a more peaceful program.
A malarial control and learning unit was to be established, which was to be used as a training center for imparting knowledge to the rural masses. It was proposed that awareness about malarial could be introduced in syllabi of schools, and information could be included in textbooks, thus making this a compulsory education for children. Similarly, communication actions through communication based organizations, media coverage and advocacy by community leaders would be used as tools in this malaria eradication campaign. This was a strong approach, and could be effective means of launching a feasible campaign, as media, and community leader, academic introductions, will definitely be effective means of dissemination of information.
In addition, the proposal aimed in providing capacity to the health services, so that they could have more authority, and could exercise their duties with enforcement. It was depicted that community leaders actually lacked the skills to exercise their authority, and thus, a stern and firm action was needed now. Funds were requested for capacity building, human resource development, management and implementation of the above interventions, for the mobilization and establishment of sound and reliable malaria eradication campaigns.
It was proposed that activities would be implemented exclusively through team work, involving the several different communities prevalent in the country. This included participation by health personnel, researchers, NGOs, private- sectors, academic groups and religious groups, all working together like a team, towards a common goal. The Health District situational Analyses Forum would monitor, evaluate and decide the health actions, and would be the ‘top’ managing body. It was proposed that the NGOs, civil society and community health would function as an advocacy
Overall, this was a well conceived, deeply thought out research proposal which could be very effect in the eradication, and control of the deadly Malarial virus. Moreover, the budget was within a reasonable range, with a good proportion supplemented by the local government. If approved and implemented effectively, this would be a good project that could launch an effective country wide malaria eradication campaign.
Conclusion
Guatemala is a poverty ridden country where Malaria is one the most prevalent endemic. Its control and prevention is very important in this area as several people including adults and children loss their lives every year due this curable disease. With proper education, awareness programs it is possible to make people aware of this deadly disease. Several interventions have been proposed to prevent and treat malaria in this country. The most important is to make the environment clean and remove water standing in ponds, ditches, trenches and gutters. One of the mandatory steps would be to make the public aware of how to take such preventive measures to stop growth of mosquitoes. The Global fund’s proposal to “The Global Fund to fight AIDS, Tuberculosis and Malaria in Guatemala, Geneva Proposal to Global Fund (2004)” has detailed intervention steps to eradicate Malaria from Guatemala to around 70%. The interventions would include educating people, employing such preventive measures and treatment programs for the already affected population. However, there’s a need to employ very skilled and trained staff to commence all these changes. Some of the interventions were started but they did not reach their goals because of untrained and unskilled workers. Secondly plans were not followed according to the deadlines. Mosquitos’ growth is a cyclic process and continues wherever there is water standing in ponds and ditches. Hence a regular intervention with good implementation program is required to achieve this goal.
References
Ault SK, (1994), Environmental management: a re-emerging vector control strategy. American Journal of Tropical Medicine and Hygiene, 50(6Suppl):35–49.
Bill Briger, (2007), Malaria Intervention contribute to child mortality Reduction. Web.
Baume C, (1998), M. Care-seeking for illnesses with fever or convulsions in Zambia. Final Report: The BASICS Project, USAID.
Bitran R, (1995) Efficiency and quality in the public and private sectors in Senegal. Health Policy and Planning, 10(3):271–283.
Health Behavior and Health Education: Theory, Research, and Practice – by Karen Glanz, Barbara Rimer, and Frances Lewis. Health belief Model, (2008), Health Belief Model.
Hausmann Muela S, Muela Ribera J, (2000), Illness naming and home treatment practices for malaria – an example from Tanzania. Paper presented at workshop on People and Medicine in East Africa.
Indian J Med Res. (2008) 128(3):246-53, Control measures for malaria in pregnancy in India. Brooks MI, Singh N, Hamer DH.
Journal of Advanced Nursing, (2006), Volume 8 Issue 6, Pages 467 – 472 Blackwell Publishing Ltd
Janet Roden, (2008), revisiting the Health Belief Model: Nurses applying it to young families and their health promotion needs, BA, ma, PHD School of Nursing, Family and Community Health, University of Western Sydney, Sydney, Australia.
J Adv Nurs, (1983); 8(6):467-72, Critique of the health-belief model. Davidhizar R.
Kara Hanson, Catherine Goodman,(2004), The Economics of Malaria Control Interventions London School of Hygiene and Tropical Medicine
Kachur SP, (2001), Letter to the Editor. Tropical Medicine and International Health, 6(4):324–325
Mala L, (1982), 4(4):871-9.Sociocultural factors in the control and prevention of parasitic diseases.
Qingjun L, (1998), the effect of drug packaging on patients’ compliance with treatment for Plasmodium vivax malaria in China. Bulletin of the World Health Organization, 1998, 76(Supp. 1):21–27.
Snow RW, (2001), the role of shops in the treatment and prevention of childhood Malaria on the coast of Kenya. Transactions of the Royal Society of Tropical Medicine and Hygiene, 86(3):237–239.
Taylor RB, (2001), Pharmacopoeia quality of drugs supplied by Nigerian pharmacies. The Lancet, 357(9272):1933–1936.
The Global Fund to fight AIDS, Tuberculosis and Malaria in Guatemala, Geneva Proposal to Global Fund (2004).
Voorham J, (1997); 2(1):18-25, Use of insecticide-impregnated mosquito nets and other impregnated materials for malaria control in the Americas.
World Health Organization, (1999), the multi-country evaluation of IMCI: Overview and progress report. Geneva, (WHO/CHS/CAH/99.9).