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700,000 people diagnosed annually with malaria in Lagos- Commissioner

Prof. Akin Abayomi, Lagos State Commissioner for Health, says no fewer than 700,000 people were being diagnosed annually with malaria disease in the state.

Abayomi made the disclosure in a statement on Sunday in Lagos in celebration of the 2021 World Malaria Day.

The World Malaria Day (WMD) is commemorated annually on April 25, to create awareness on the global burden of malaria, and to mobilise support for the Roll Back Malaria strategies.

The theme for 2021 World Malaria Day celebration is: “Zero Malaria – Draw the Line against Malaria’’ with the slogan; “Stand Up–Take Action”.

Abayomi said malaria accounts for more than 70 per cent of the outpatients in the state public healthcare facilities, with more than 700,000 malaria cases reported annually.

According to him, 657,154 patients with malaria were seen in the state’s private and public healthcare facilities in 2020.

“Malaria is prevalent in the vulnerable groups – children under five years and pregnant women where the infection can be profoundly more severe,” the commissioner said.

He said the state topography and ecological features, vast coastal terrain, rapid urbanisation and poor drainages were major predisposing factors that contributed to transmission of malaria all year round.

The commissioner said that the state government over the years had demonstrated continued commitment to the control of malaria through various strategies.

He listed the strategies as promotion of Long-Lasting Insecticidal Nets (LLINs) utilisation, prevention of malaria in pregnancy using Intermittent Preventive Treatment with Sulphadoxine Pyrimethamine.

According to him, others are prompt diagnosis in the public healthcare facilities, using malaria Rapid Diagnostic Test (mRDT) kits or microscopy.

Abayomi said that the state also used effective case management with Artemisinin-based Combination Therapy drugs (ACTs) for patients diagnosed with malaria.

He said that awareness and sensitisation activities on malaria; procurement and supply of antimalarial drugs and commodities to the state healthcare facilities was also deployed.

The commissioner said that the healthcare system strengthening and operational research was also utilised to control malaria in the state.

“There has been marked reduction in the cases of malaria globally (between 2010 and 2019 with decline from 71 to 57 cases per 1,000 population at risk).

“Nigeria has recorded a decline in malaria cases (from 42 per cent in 2010 to 27 per cent in 2015 and 23 per cent in 2018),” he said.

Abayomi said that the National Malaria Indicator Survey of 2015, Lagos State Malaria Indicator Survey of 2017 and National Demographic and Health Survey revealed that the prevalence of malaria was low in Lagos.

“Although, malaria prevalence is low in Lagos State, the burden is still high as over 700,000 people are diagnosed with the disease annually.

“It is, therefore, germane that we Stand up and Take Action against malaria. By taking actions, we would be curbing the spread of the disease,” the commissioner said.

He stressed the importance of sleeping inside Long-Lasting Insecticidal Nets (LLINs) to prevent malaria, especially for the vulnerable groups –pregnant women and children under five years old.

“Pregnant women are also encouraged to take Sulphadoxine Pyimethamine to prevent malaria in pregnancy from second trimester,” he said.

The commissioner said that diagnosis, using either malaria Rapid Diagnostic Test (mRDT) kit or a microscope must be done before using Artemisinin – based Combination Therapy (ACTs) for treatment of fever.

“This is because not all fevers are caused by malaria.

“Diagnosis of patients with fever using microscopy or mRDT kit prior to treatment of the disease improves the overall management of patients with fever.

“This is also very important at this time as people infected with SARS–CoV–2 virus, which causes COVID–19, manifest symptoms like malaria.

“The distinction between malaria and COVID–19 is made only after proper diagnosis using appropriate test kits,” he said.

Abayomi added that testing for malaria was essential to reduce unnecessary use of antimalarial drugs, thereby preventing the emergence and spread of drug resistance.

He said it would ensure that antimalarial drugs were reserved for those suffering from the disease.

“It is also imperative that all malaria cases diagnosed are recorded in the appropriate data tools to ensure that all cases of malaria in the state are duly reported,” he said.

The commissioner said that collective action for environmental management include effective refuse disposal and waste management and covering of water storage containers.

Others were clearing of drainage channels, dredging of canals and channels, among others.

“Unkempt and dirty environment serves as breeding sites for mosquitoes; hence proper maintenance and management of the environment would prevent mosquitoes from breeding,” he said.

Abayomi appealed to everyone to remain committed to collective efforts toward effective malaria control in the state.

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NEWS & LIFE

2021 World Malaria Day: 953 lives lost to malaria in Borno in 4 years

Prof. Isa Marte, Borno state Acting Commissioner of Health, has disclosed that the state recorded 953 deaths, out of the over one million cases of malaria recorded in the state, from 2017 to 2020.

Marte made this known on Sunday, in Maiduguri, while briefing newsmen, in commemoration of this year’s World Malaria Day.

“The 2020 World Malaria Report shows that Nigeria continues to account for 25 per cent of the estimated global malaria burden, with mortality associated with malaria standing at over 80 000.

“In Borno, persons confirmed with malaria in 2020 stood at 359,366 with 370 deaths, the figure for 2019 was 330,587 with 240 deaths, 2018 was 237,971 with 110 deaths and 2017 was 143 with 231 deaths, according to DHIS2 routine data.

“These figures show that there has been an upward trend in cases from 2017 to 2020. This may be due to improvement in the reporting system and training on HMIS version, 2019 data tools, to monitoring and evaluation at all levels, across the state in recent years.

“However, a downward trend in deaths can also be observed, which could be attributed to improvement in early diagnosis and prompt treatment of malaria cases across the state,” Marte said.

He noted that the state government, through the National Malaria Elimination Programme (NMEP), in collaboration with other partners, ensured that 70.4 per cent of households had mosquito nets.

Marte also said that the state had observed four rounds of uninterrupted Seasonal Malaria Chemoprevention (SMC), largely due to the support of stakeholders like, NMEP and WHO, by which over two million children, between three months to five years, were reached every year.

“We have witnessed an uninterrupted supply of anti-malarial commodities, especially the supply of Long Lasting Insecticide treated nets.

“These were given free to pregnant women during antenatal care, children under five during immunisation sessions, and to newly resettled communities across the state via the Saving One Million lives programme, since 2017.

“The state government is finalising plans for a 10-year scale up of all malaria interventions across the state, through a soft credit support from the World Bank, effective this year, “he said.

Marte commended the support of partners like WHO, UNICEF, MSF, INTERSOS, Mentor Initiative, among others.

He urged the media to continue to mobilise members of the public to avail themselves of the services provided in the fight against malaria, for maximum impact.

The World Malaria Day was established by the WHO, and is celebrated globally on April 25 every year, to create awareness on malaria and discuss ways of preventing the scourge.

The 2021 theme is “Zero Malaria – Draw the Line Against Malaria”, while the slogan is, “Stand up and take action,” aimed at exploring and connecting the malaria scourge for elimination.

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EDUCATION HEADLINES

Africa making progress in defeating malaria – AU

The African Union Commission says the continent is making headway in defeating malaria through strong political commitment, increased funding, and innovations devised to improve malaria prevention and control.

According to it, most of the achievements have been realised through the “Zero Malaria Starts With Me’’ Campaign” ‎implemented by the AU Commission in partnership with the African Leaders Malaria Alliance (ALMA) and Roll Back Malaria (RBM) Partnership to End Malaria.

H.E. Amira Mohamed, Commissioner for Health, Humanitarian Affairs and Social Development, African Union ‎Commission, made the assertion in her message as the world marks the 2021 World Malaria Day on Sunday.

The News Agency of Nigeria (NAN) reports that World Malaria Day takes place annually on April 25 to highlight the global efforts to control malaria and celebrate the gains that have been made.

The theme for 2021 World Malaria Day is : “Zero Malaria – Draw the Line Against Malaria’’.

Mohamed said: “World Malaria Day 2021 comes at a time when healthcare systems in Africa bear the anomalous weight of the coronavirus pandemic.

“AU Member States have maintained their focus in the fight against malaria even as the pandemic continues to test the limits of health infrastructure at the country level.

“I take the opportunity to recognise and appreciate all AU member states for ensuring that comprehensive approaches like education, prevention, diagnosis, and treatment,– that have been proven to have tangible results in the fight against malaria, have been sustained during the pandemic.

“Today, the African Union Commission joins the world to celebrate the seven million lives saved, and over one billion malaria cases averted through life-saving mosquito nets, among other interventions.”

She urged all countries to collectively work with the fullest commitment to end ‎malaria by 2030.

“As a continent, we celebrate with great honour and pride the AU Member States that have been certified malaria-free.

“ I encourage these member states to lead continental knowledge-sharing initiatives so that best elimination practices are exchanged and scaled-up.

“ To date, 19 AU member states have rolled out the Zero Malaria Starts With Me campaign, seven of which launched in 2020 during the COVID-19 pandemic.

“While more member states are working towards launching the campaign, the commission welcomes the collaborative effort to urge Africa leaders to ‎step up and be a part of the zero-malaria movement,’’ she said.

The AU commissioner said that the Zero Malaria Starts With Me campaign was transforming the continent’s malaria response and inspiring global action.

“This campaign’s advancement and impact have demonstrated AU member states’ dedication to reach the targets set in the Africa Health Strategy and the Catalytic Framework to End AIDS, TB, and Eliminate Malaria in Africa by 2030.

“The campaign’s focus is to empower the youth’s involvement in the malaria response’’.

According to her, the leadership of youth in Africa is crucial as young people account for 75 per cent of the continent’s population and the youth are the driving force of the continent.

The AU Commissioner commended President Uhuru Kenyatta of the Republic of Kenya, for launching the Digital Youth Malaria Army initiative.

She emphasised the critical role of multisectoral partnerships in achieving significant strides towards the shared goal of malaria elimination, urging for increased partnerships and resources to innovate and improve surveillance programmes.

“ As we commemorate World Malaria Day 2021, I call on frontline health workers ‎, partners, and leaders worldwide and in Africa to share experiences and reflections on efforts and opportunities to reach the target of zero malaria.

“I reiterate that ending malaria’s scourge will have a long-term, transformative impact and save millions of lives.

“The commission ‎will continue to support the AU member states to draw the line against malaria,’’ she said.

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HEADLINES

FG needs N1.89trn to tackle malaria -Ehanire

The Minister of Health, Dr Osagie Ehanire, says Nigeria needs over a trillion naira to effectively combat malaria in the country.

Ehanire noted that the country required more than N350 billion to fight the disease in 2021 alone.

The Minister disclosed this on Friday at a press conference to commemorate the 2021 World Malarial in Abuja, with the theme “Zero Malaria”.

The News Agency of Nigeria (NAN) reports that World Malaria Day, celebrated every April 25, is an internationally recognized day, highlighting the global efforts to control malaria and celebrating the gains that have been made.

Since 2000, the world has made historic progress against malaria, saving millions of lives. However, half the world still lives at risk from this preventable and treatable disease, which costs a child’s life every two minutes.

“The implementation of the new strategic plan will cost N1.89 trillion; about N352 billion is required for the year 2021 programme implementation,” he added.

He noted, “The theme of this year’s commemoration is Zero Malaria – Draw the Line Against Malaria, and the slogan ‘Stand Up, Take Action’ which is to empower communities in various countries to take ownership of preventing malaria and providing proper care and treatment to those in need, are germane.”

According to him, the Federal Government does not have the adequate amount required to fight the disease this year.

The minister attributed this to the prevailing economic circumstances occasioned by the COVID-19 pandemic.

Ehanire called on the private sector, various corporate organisations, and patriotic individuals to support the government to tackle malaria.

He added that the government was working to establish a Malaria Council that would help to drive domestic funding for the elimination of the disease.

The minister said “the commemoration of World Malaria Day provides the government with the opportunity to share the progress made, best practices, and create awareness on the scourge of malaria. Malaria, a disease caused by a parasite spread to humans through the bites of infected mosquitoes, kills more than 400,000 people a year, mostly children in sub-Saharan Africa.

“As experts across the world step up efforts to combat the disease, a recent study shows that a malaria vaccine from the Oxford Institute is 77 per cent effective for the treatment of COVID-19.

“The study conducted by Oxford University and released on Friday indicated that clinical trials had been carried out on 450 children between the ages of five and 17 months.

“If safety is assured, health authorities say that it will become the key weapon in eliminating the disease, which is responsible for half a million deaths a year, mostly in children,” he explained.

NAN recalls that the World Health Organisation (WHO) had said “it is noteworthy that Nigeria has recorded a drop in malaria prevalence from 42 per cent in 2010 to 23 per cent in 2018.

The WHO said it was worrisome that, despite funding from government and partners, 44 per cent of household out of pocket expenditure is on malaria.

“It is estimated that malaria causes a significant loss in economic growth and puts a strain on household finances.

“Equally, the overall progress made in the first 15 years of this century, global trends in malaria case and mortality rates have been plateauing since 2015, particularly in the highest burden countries; Nigeria is one,” it noted.

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EDUCATION HEADLINES NEWS & LIFE

U.S. delivered 14.7m malaria doses to Nigeria in 2020 — USAID

The United States Agency for International Development (USAID) in Nigeria delivered 14.7 million malaria treatment doses and 7.1 million insecticide-treated nets to Nigerians in 2020, an official has said.

This is contained in a statement issued by USAID Mission Director in Nigeria, Dr Anne Patterson, in Awka on Friday.

Patterson stated that the deliveries were made to health facilities and communities through the President’s Malaria Initiative (PMI).

She further stated that 8.2 million of the 14.7 million malaria treatment doses were for pregnant women and children.

“The PMI said that in 2020, despite the constraints of COVID-19 pandemic, it also distributed 7.1 million insecticide-treated mosquito nets (ITNs) and provided 7.2 million rapid test kits.

“PMI trained 9,300 health workers to properly diagnose and treat patients for early detection of the disease.

“Led by the USAID and implemented together with the U.S. Centers for Disease Control and Prevention, PMI works with partner organisations to benefit more than 41 million people across Nigeria,” she added.

Patterson explained that the use of ITNs was one of the most effective measures to prevent malaria.

She added that since 2010, PMI had supported Nigeria in the distribution of more than 61 million bed nets, now in use in 43 per cent of Nigerian households.

She stated that the figure was up from just 23 per cent at the start of the initiative.

“Malaria is one of the leading causes of death among children in Nigeria.

“During pregnancy, the disease can pose a life-threatening risk to both mothers and babies. “Malaria also causes adults and children to miss work and school, contributing to economic hardship.

“We are pleased to see that our partnership with Nigeria has had clear success and will continue this support with proven methods of prevention and treatment against malaria.

“Yet, we need bold action to stop COVID-19 from holding us back. The United States is proud to partner with Nigeria to continue the fight,” Patterson stated.

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EDUCATION HEADLINES

WHO launches initiative to eradicate malaria in 25 countries by 2025

The World Health Organisation (WHO) is launching a new initiative which aims to halt transmission of malaria in 25 more countries by 2025.

The initiative is to be launched on World Malaria Day on April 25.

Thailand, South Africa and Saudi Arabia are among the countries the WHO aimed to make malaria-free.

The 25 countries would receive specialised support and technical guidance to help eradicate the disease.

Countries in South-East Asia’s Greater Mekong region have already made great strides: the number of cases in the region comprised of Cambodia, China (Yunnan Province), Laos, Myanmar, Thailand and Vietnam fell by 97 per cent between 2000 and 2020, the WHO said in a statement.

But the Coronavirus crisis has emerged as a serious challenge to malaria responses worldwide. “More than one year into the pandemic, substantial disruptions to health services persist across the globe,’’ WHO said.

In many countries, lockdowns and restrictions on the movement of people and goods led to delays in the delivery of insecticide-treated mosquito nets or indoor insecticide spraying campaigns. Malaria diagnosis and treatment services were also interrupted.

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.

Globally, 39 countries and territories have been recognised as malaria-free by the WHO. Eleven countries have been certified malaria-free in the last 20 years.

In 2019, there were an estimated 229 million cases of malaria worldwide. The estimated number of malaria deaths stood at 409,000 in 2019, according to the WHO.

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EDUCATION NEWS & LIFE

FG cautions Nigerians against treating malaria without lab test

The Federal government, on Tuesday, warned Nigerians to undergo tests before taking anti-malarial treatment, because not all fevers are symptoms of malaria.

Chinelo Ogbodo, Chief Community Development Officer, Advocacy Communication and Social Mobilisation guidelines (ACSM), National Malaria Elimination Programme (NMEP), gave the warning at the review meeting of the ACSM guideline, in Akwanga, Nasarawa State.

According to Ogbodo, the government was hopeful that by 2025, every Nigerian would have understood the meaning, causes, treatment and preventive measures for malaria.

She said that the guideline was a document that detailed the planning, coordination and implementation of ACSM activities, to guide increasing awareness about malaria and develop activities that would help increase the demand for malaria products and services.

The expert charged Nigerians to test every fever and know its cause before treatment.

“Malaria is one of the so many conditions that could lead to fever in an individual.

“So you need to run a test; every individual presenting symptoms of malaria or fever must be tested before you give them antimalarial drugs, when they test positive.

”Nigerianas must understand that malaria is not common, there are various types and levels of the disease, like complicated and uncomplicated malaria, we also have severe malaria.

”When you treat fever with malaria drugs, without going for a test before treatment, you have succeeded in treating blindly without knowing what you are treating or the level of what you are treating.

”When somebody has malaria, and treats without testing, he or she has abused the drugs because you do not know the level of the malaria you are treating. When death occurs as a result of malaria, people term it as witchcraft or spiritual causes,” she said.

Mrs Samuel Owoya, an NMEP staff, advised Nigerians to sleep under the Long Lasting Insecticidal Nets (LLINs) every night, as she cited malaria as a major cause of morbidity and mortality in the country.

She explained that Nigerians must adopt the right health seeking behaviour for the elimination of malaria.

Nigeria, she explained, had adopted the use of LLINs as one of its interventions for malaria prevention, and it was recommended that every person should sleep under the LLIN every night.

Owoya said that LLINs were a type of mosquito net that had been treated with insecticides that repel and kill mosquitoes, adding that LLINs were safe and effective in protecting oneself and family members against malaria.

She said that when correctly used, an LLIN every night significantly reduced a person’s risk of being infected with malaria, in addition to saving the time and money spent on treating the malaria.

”To use and care for your LLIN, tuck the LLIN under your mat, mattress or bed, sew if torn, and wash with bar soap if dirty. Do not use LLINs for fishing or covering crops or animals,” she said.(NAN)

JESY/EBI/MMA

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Edited by Benson Iziama/Mouktar Adamu

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NEWS & LIFE

WHO inaugurates consolidated guidelines for malaria

The World Health Organisation (WHO), on Tuesday inaugurated Guidelines for malaria, bringing together the organisation’s most up-to-date recommendations for malaria in one user-friendly and easy-to-navigate online platform.

WHO announced the inauguration of the Guidelines in a statement issued from its headquarters in Geneva.

According to the UN health agency, they are designed to support malaria-affected countries in their efforts to reduce and, ultimately, eliminate a disease that continues to claim more than 400, 000 lives each year.

The statement stated that through the new platform, MAGICapp, users would find all official WHO recommendations for malaria prevention (vector control and preventive chemotherapies) and case management (diagnosis and treatment).

It stated that recommendations for elimination settings were in development.

“Links to other resources, such as guidance on the strategic use of information to drive impact; surveillance, monitoring and evaluation; operational manuals, handbooks, and frameworks; and a glossary of key terms and definitions.

“Users can access the evidence that underpins each WHO recommendation through the new web-based platform.

“There is a feedback tab to help identify recommendations that may need an update or further clarification, and inputs from stakeholders are also welcome by email ([email protected]).’’

The statement quoted Dr Pedro Alonso, Director of the WHO Global Malaria Programme, as saying, “these consolidated guidelines represent an important step in our efforts to deliver timely, evidence-based guidance to malaria-endemic countries.

“They will soon become a living resource that is updated periodically as new evidence becomes available, and as WHO guideline development groups bring forward proposals for new or revised recommendations,” he added.

According to the statement, the first version of the Guidelines for malaria – available online only – is a compilation of existing WHO recommendations on malaria.

“It supersedes two previous WHO publications: the Guidelines for the treatment of malaria, third edition and the Guidelines for malaria vector control.

“Four WHO guideline development groups focused on vector control, chemoprevention, treatment and elimination are currently convening to develop new or updated recommendations, and other groups will convene this year to address additional relevant topics.

“Recommendations on malaria will continue to be reviewed and, where appropriate, updated based on the latest available evidence through WHO’s transparent and rigorous guidelines review process.

“Any updated recommendations will always display the date of the most recent revision in the MAGICapp platform.

“With each update, a new PDF version of the consolidated guidelines will also be available for download on the WHO website.’’

Clear, evidence-informed WHO recommendations guide managers of national malaria programmes as they develop polices and strategic plans to combat the disease tailored to the local context; they support decisions around “what to do”.

WHO also develops implementation guidance – such as operational and field manuals – to advise countries on “how to” deliver the recommended tools and strategies.

The consolidation of WHO’s malaria guidelines is one of a number of actions the Organisation has undertaken in recent years to make its guidance more accessible to end users in malaria-endemic countries.

The overall aim is to deliver timely, high quality recommendations through processes that are more.

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NEWS & LIFE

Malaria: Bauchi Govt earmarks N5m for fumigation

The Bauch State Government on Saturday started the fumigation of the state capital against malaria at the cost of N5 million, Mr Ibrahim Kabir, the Director General, Bauchi State Environmental Protection Agency (BASEPA) has said.

Speaking at the start of the fumigation exercise in Bauchi, Kabir said that the fumigation would be jointly carried out by the agency and Bauchi State Agency for the Control of HIV/AIDS, Tuberculosis, Leprosy and Malaria, (BACATMA).

“We are here at this moment to go and deliver a mandate given to us by the state governor. On 29th of November last year, the governor went for a condolence visit in one of the communities in Bauchi metropolis.

“He was approached by one old man who told him about the prevalence of mosquitoes in Bauchi metropolis and instantly the governor gave us a directive to fumigate the whole Bauchi metropolis against malaria vector.

“We are here together with BACATMA to conduct the exercise out of the governor’s kind gesture to the single individual’s request who met and complained to him about an issue and he instantly responded.

“I want to tell you precisely that we are going to fumigate Bauchi metropolis with N5 million only. We have the approval and we have the money with us,” he said.

Kabir further explained that the exercise would be extended to all the urban centres and rural areas in the state.

“We are not neglecting the rural areas, we are going to cover the entire state” he said.

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NEWS & LIFE

Malaria dangerous in pregnancy, can cause death — Parasitologist

Dr Adeniyi Adelodun, a Medical Parasitologist, says malaria can be a death factor for pregnant women if not properly treated.

Adelodun spoke at the Estate Youth Parliament (EYP) Health Talk in Lagos on Saturday.

“Malaria infection during pregnancy can have adverse effects on both mother and fetus.

“ Malaria is a life-threatening disease and typically transmitted through the bite of an infected Anopheles mosquitoe.

“Infected mosquitoes carry the plasmodium parasite and when this mosquito bites one, the parasite is released into the bloodstream.

“Once the parasites are inside the body, they travel to the liver, where they mature. After several days, the mature parasites enter the bloodstream and begin to infect red blood cells.

“Within 48 to 72 hours, the parasites inside the red blood cells multiply, causing the infected cells to burst open.

“The parasites continue to infect red blood cells, resulting in symptoms that occur in cycles that last for two to three days at a time,” he said.

On some of the effects of malaria during pregnancy, he said they include maternal anemia, fetal loss, premature delivery, intrauterine growth reeffects of malaria o tardation, and delivery of low birth-weight infants (<2500 g or <5.5 pounds).“Malaria can occur if a mosquito infected with the plasmodium parasite bites one. There are four kinds of malaria parasites that can infect humans: Plasmodium vivax, P. ovale, P. malariae, and P. falciparum.“ P. falciparum causes a more severe form of the disease and those who contract this form of malaria have a higher risk of death.“An infected mother can also pass the disease to her baby at birth, which is known as congenital malaria.’’On the management of malaria during pregnancy, he said: “For pregnant women, it includes the use of chloroquine, quinine, atovaquone-proguanil, clindamycin, mefloquine (avoid in first trimester), sulfadoxine-pyrimethamine (avoid in first trimester) and the artemisinins.“Even the World Health Organisation (WHO) now recommends that all women in the second or third trimester of pregnancy who have uncomplicated P. falciparum malaria should be treated with artemisinin-based combination therapy.’’According to Adelodun, the symptoms of malaria typically develop within 10 days to four weeks following the infection.“While in some cases, symptoms might not develop for several months and some malarial parasites could enter the body but will be dormant for long periods of time.“Common symptoms of malaria include shaking chills that can range from moderate to severe high fever, profuse sweating, headache, nausea, vomiting, abdominal pain, diarrhea, anemia, muscle pain, convulsions, coma and bloody stools,’’ he said.