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)
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