Resistant Drugs / Protecting Pregnant Women from Malaria / An Iranian Tragedy

I'm Sarah Long with Bob Doughty, and this is the VOA Special English program SCIENCE IN THE NEWS.

This week -- a report on the problem of drug resistance. We tell about ways to protect pregnant women from malaria. And, later: their dream was simply to look each other in the face -- the tragedy of two sisters from Iran.

Two diseases common in children in developing countries can be treated and prevented. Yet the fight against malaria and diarrhea has become a struggle for health workers. One of the main reasons is the incorrect use of medicines to treat these diseases.

Diarrhea is an intestinal disease. It can be caused by food that has gone bad or was not cooked well, or by water that is not clean. It is a major killer of children under the age of five. Survivors often face problems with growth and development.

Children may get diarrhea several times a year. As soon as they appear to have it, antibiotic medicines are often given. Antibiotics are designed to kill bacteria.

But experts say antibiotics are usually not the best treatment for diarrhea. In fact, using antibiotics when they are not really needed creates another problem -- anti-microbial resistance. Germs learn to fight medicines that are used too often.

Diarrhea usually kills through the loss of water from the body. So it is important to get enough fluid. There are special powders to mix with water to help children regain their strength.

One product is a solution of sodium and glucose called oral rehydration salts. Sodium and glucose are more commonly known as salt and sugar. As a result of this product, the World Health Organization says the death rate which had been five million a year has dropped sharply.

Last year the W-H-O released oral rehydration salts with a new formula. The agency says the low-sodium, low-glucose formulation will reduce the severity of diarrhea and vomiting.

A group called the Rehydration Project has more information on its Web site. The address is rehydrate dot o-r-g.

Experts say breastfeeding reduces the risk of diarrhea in babies. And improving cleanliness in homes and communities -- such as washing hands before touching food -- can also help in prevention.

The problem of anti-microbial resistance is even greater with malaria. Malaria kills seven-hundred thousand children a year. Most are in Africa. Malaria is caused by mosquito bites that inject a parasite organism into the body.

In many countries, anti-malarial medicines are easy to find without a doctor's orders. People often take them as soon as they get a fever, just in case they might have malaria. For many years chloroquine [CHLO-roh-quin] has been used. But it has been used too often. The parasites that cause malaria are able to fight this medicine.

In nineteen-ninety-one, a study at a hospital in Kenya looked at children who died of malaria. It found that the death rate for those treated with chloroquine was twenty-five percent. The death rate for those treated with other drugs was ten percent.

Doctors say medicines that still work include a combination of chloroquine and a drug called pyrimethamine [py-ri-METH-a-mine].

There are even newer drugs. But because of the cost these are not yet widely used. Experts in the fight against anti-microbial resistance say people should ask questions about the medicines they are given. These experts say to take antibiotics only when a person knows the cause of a sickness -- and only when antibiotics would be the best way to cure it.

In some parts of Africa, adults have developed immunity to the mosquito bites that cause malaria. This means they do not get sick. But for women who are pregnant, the parasite can still affect their unborn baby. It can lead to babies who do not weigh enough to live. The problem is even worse for pregnant women who also have the AIDS virus, H-I-V. They are likely to become very sick themselves.

There are several ways to protect pregnant women from malaria. Researchers say nearly seventy-percent of pregnant women in Africa go to a health center or a doctor at least once while they are pregnant. The percentage of such visits is highest in Zimbabwe, Malawi, Uganda and Kenya. It is lowest in Ethiopia and Niger.

A medicine called SP, or sulfadoxine-pyrimethamine, can be taken during the woman's medical visit.

Doctors say all pregnant women in areas where malaria is a serious problem should take SP at least once after their unborn baby moves for the first time. Studies by the World Health Organization show that women who take SP at least two times during their pregnancy give birth to healthier babies. Experts say it is best to take SP once each month until the baby is born.

It is also important for pregnant women to sleep under nets treated with chemicals that kill mosquitoes. Babies and children should also sleep under these nets.

There are other ways to help protect pregnant women from malaria infection. Mosquitoes will come to places filled with water. So use dirt or rocks to fill in holes or other places where water might collect. Cut down bushes next to homes. And keep food containers covered.

In two-thousand, many African leaders signed the Abuja Declaration to "roll back malaria." The goal is to make sure that by two-thousand-five, sixty percent of pregnant women in Africa receive treatment to prevent malaria.

Ladan and Laleh Bijani wanted to live the rest of their lives normally. For twenty-nine years the Iranian sisters were joined at the head. Yet they were lawyers. They were famous. But what they wanted, they said, was to be able to look each other in the eyes without using a mirror.

The Bijani sisters had separate brains but shared an important blood vessel in the head. Doctors in the past had told them an attempt at separation was too dangerous. But Raffles Hospital in Singapore agreed to form an international team of experts to help them reach their dream.

The operation last week in Singapore was the first known attempt to separate adults joined at the head. It involved cutting and re-building the back part of the most important blood passage in the brain.

The sagittal sinus vein extends from the forehead across the top to the back of the head. The doctors planned to give the vein to one of the twins and build a new one for the other with a vein taken from the leg.

The hospital said Ladan and Laleh began to lose blood pressure after about fifty hours of surgery. The two sisters died of blood loss within ninety minutes of each other. People in Iran and Singapore cried at the news.

Some family members did not agree with the decision to separate the twenty-nine-year-old sisters from Firouzabad, in southern Iran. But people who knew Ladan and Laleh say the two understood the chances.

The doctors involved said the women knew the risks of possible brain damage and death. But the doctors also say that tests done before the operation showed a medical reason for the surgery. These found that the pressure inside the women's brains was two times what it should have been. The doctors said they felt that, sooner or later, the women's health would be in danger.

Some doctors who were not involved in this case questioned the decision to operate. These doctors say patients in a situation like the Bijani sisters would not have wanted to believe the warnings. They would only have wanted to believe that the operation would succeed.

Experts in medical ethics, though, say the doctors in Singapore appear to have acted correctly in their attempt to help the women. They say the hospital gathered a team that could do the operation and had a reasonable chance of success. In the end, they say, the decision had to come not from the doctors, but from the patients.

SCIENCE IN THE NEWS was written by Karen Leggett and Nancy Steinbach. Our producer was Cynthia Kirk, with audio assistance from Dwayne Collins. This is Sarah Long. And this is Bob Doughty. Join us again next week for more news about science in Special English on the Voice of America.