MALARIA is a serious infection. It is com­mon in tropical countries such as parts of Af­rica, Asia and South America. It is caused by a parasite called plasmodium. The parasite is passed to humans from a mosquito bite. There are four main types of plasmodium that cause malaria – plasmodium falciparum, plasmodi­um vivax, plasmodium ovale and plasmodium malariae. Recently, another type has been dis­covered called plasmodium knowlesi. Plasmo­dium falciparum is usually the most serious of the pack.

Every day, half of the world’s population keeps fighting against malaria. For this about billion people, every day is a malaria day. April 25 every year is, however, designated the World Malaria Day, a day the whole world come together to put the issues that border around malaria on the front burner. The day also offers the world an opportunity to high­light the advances that have been recorded in malaria control and to continued investment and action to accelerate progress against this deadly disease.

The day was initially adopted as Africa Ma­laria Day in 2001, a year after the historic Abuja Declaration was signed by 44 malaria-endemic countries at the African Summit on Malaria. It aimed at providing education and understand­ing of malaria as well as spreading information on implementation of national malaria-control strategies, including community-based activi­ties for malaria prevention and treatment in en­demic areas. It was later adopted by the World Health Assembly, World Health Organisation (WHO)’s decision-making body, in its 60th session in May 2007.

The theme of this year’s celebration is ‘End malaria for good’. The theme reflects the vi­sion of a malaria-free world set out in the “Global technical strategy for malaria 2016- 2030” and adopted in May 2015 by the World Health Assembly. This strategy aims at dramatically reducing the global malaria burden over the next 15 years. It targets re­ducing the rate of new malaria cases as well as reducing malaria death each by at least 90 per cent; eliminating malaria in at least 35 countries; and preventing a resurgence of malaria in all countries that are malaria-free. The timeline of 2016-2030 is aligned with the “2030 Agenda for sustainable develop­ment”, the new global development frame­work endorsed by all UN member states.

Although WHO’s World Malaria Report 2015 shows a major decline in global ma­laria cases and deaths since 2000 as a result of the massive expansion of effective tools to prevent, diagnose and treat malaria like the insecticide-treated mosquito nets, diagnos­tic testing kits and anti-malarial medicines, there are still serious challenges to be tack­led. Globally, there were an estimated 214 million new cases of malaria and 438,000 deaths caused by the disease in 2015 alone.

Nigeria accounts for about 100 million new cases and about 300,000 deaths annu­ally, a statistic that makes her the country with the highest number of malaria casual­ties worldwide. These figures show that Ni­geria accounts for almost 25 per cent of glob­al malaria incidence and, together with the Democratic Republic of Congo, accounted for more than 35 per cent of malarial deaths in the world. According to WHO, malaria is responsible for 60 per cent of outpatient visits to health facilities; 30 per cent of child­hood deaths; 25 per cent of deaths in children under one year; and 11 per cent of maternal deaths This is alarming as it is unfortunate, although not very surprising. Since the ‘Roll Back Malaria’ programme, we are yet to have any other significant national project on malaria in Nigeria. One of the major con­tributors to the reduction in global incidence and mortality of malaria is the adoption of diagnostic testing before treatment. A medi­cal test is a kind of medical procedure per­formed to detect, diagnose, or monitor dis­eases, disease processes, susceptibility, and determine a course of treatment. In this era of evidence-based medicine, health practi­tioners who know their onions insist on hav­ing empirical evidence of a diagnosis before they can administer appropriate treatment.

Empirical evidence is the only factor that distinguishes ‘laboratories from laborato­ries’. While every laboratory reels out mere numbers as results, quality laboratories de­liver diagnostic facts. All over the world, the major factor in medical investigation is the quality control processes. To show how important this is, the International Standard Organization dedicated a section to medi­cal laboratory quality process, tagged ISO- 15189. In Nigeria, only one laboratory has this international accreditation. Diagnosis is at the core of WHO’s recommended 3T’s (Test, Treat and Track) in malaria interven­tion. Accurate diagnosis will show whether or not a patient has malaria; what type of ma­laria he or she has; if the infection is caused by a parasite that is resistant to certain types of drugs; if the disease has caused anemia; and if the disease has affected the vital or­gans.

Early and accurate diagnosis is the essen­tial foundation on which to build an effec­tive malaria management as it provides the evidence of presence or otherwise of the dis­ease condition. It also guides the doctor on the choice of treatment option and drug pre­scription. Testing also helps in tracking the patient’s progress in the treatment regime. To underscore the importance of accurate testing, the WHO recommends “prompt ma­laria diagnosis either by microscopy or malaria rapid diagnostic test (RDT) in all patients with suspected malaria before treatment is adminis­tered.” Diagnostic testing improves the man­agement of all patients with febrile illnesses as misdiagnosis can result in significant morbidity and mortality. It also helps to reduce the emer­gence and spread of drug resistance.

Effective diagnosis eliminates unnecessary loading of a patients’ system with heavy anti­malarials and the attendant possible damage to their body organs. Accurate testing precludes the possibility of malaria early enough to arouse the doctor’s suspicion of another probable dis­ease that could be the cause of the patient’s sickness. Effective diagnosis prior to treatment reduces the cost of treatment and also fast tracks patient’s recovery. When malaria is diagnosed effectively, treatment cost is reduced as the doc­tor knows the type of malaria and the causative parasitic as well as the level of the infection. Testing will assist the doctor in ascertaining the best treatment regime for the patient.

It will also save the doctor some time and re­sources he would have deployed in further tests. It will also facilitate the patient’s better and faster recovery.

As Nigeria joins the world in celebrating this year’s World Malaria Day, our policy makers, health practitioners and indeed all stakeholders should adopt the WHO-recommended 3T’s to malaria intervention so we could improve our malaria-related statistics. It is heart rending that when many countries like Argentina, Costa Rica, Iraq and even Morocco and Sri Lanka are recording zero incidences of malaria in 2015, Nigeria is recording more than a quarter of the number of globally incidences and fatality. Ac­curate testing prior to treatment is the way to go.

.Dr Busari (consultant pathologist with PathCare Laboratories, Lagos)

Malaria is deadly… #readytobeatmalaria #saynotomalaria #endmalaria. Perfect health is yours, from all of us at ARCVIEW INVESTMENTS LIMITED!

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