CHIOMA Haruna, a foodstuff seller at Mile 2 Market, Lagos was busy selling her wares when Aisha, her little girl of eight years, came back from school, saying she was sick. Mrs Haruna went to a medicine seller, who, after listening to the symptoms, said her daughter had malaria, a common disease caused by parasites spread by mosquitoes. The medicine seller sold her malaria drugs.
For about two days, Aisha felt relieved. But she was later sent back to her mother from school because she was unwell again and her mother took her to a nearby General Hospital, where she was diagnosed with typhoid fever. She was admitted to the hospital for several weeks.
Aisha’s condition became quite serious; she found it difficult to breathe and couldn’t eat anything without being sick. Because Mrs Haruna was at her daughter’s bedside, she was unable to go to the market for several weeks. She also spent all the money she needed to run her business on medical expenses.
The experience of Mrs Bolatito Joseph was slightly different when she brought her son to the clinic because his temperature was very high and had refused to suck breast milk. She suspected that his son had malaria.
“I think he has malaria because his body temperature is very high, he is restless and had stopped taking breast milk,” she told the doctor while he was busy assessing him.
“How do you know that your son has malaria,” interjected the doctor who was already writing on a small card that he be tested to know why the boy was sick.
At the laboratory, a blood sample was taken and put under a microscope to look for malaria parasites. Within the hour, the result indicated there were no malaria parasites in his blood.
This scene plays out routinely across sub-Sahara Africa, where many people assume that every feverish child has malaria and should be treated with malaria drugs, without giving thought to other causes of fever such as typhoid fever and dengue fever.
Due to increasing level of poverty, many people resort to self-medication and use of herbal preparations without any thought of the consequences of self medication, including deaths. Oftentimes, they assume, based on their symptoms, that they can guess what is wrong with them.
Unfortunately, time is not taken out to ensure that tests are done to ascertain the real cause of the problem before resorting to presumptive treatment which leaves the chance for complications to set in. Of course, this could be fatal.
Nowadays, malaria is just one of many causes of fever in most endemic contexts, and often a fairly rare one. Unfortunately, more than half the paediatric fevers treated in public health clinics in Africa are caused by diseases other than malaria.
Fever is one of the most common medical signs and is characterised by an elevation of body temperature above the normal range of 36.5–37.5 °C (97.7–99.5 °F) due to an increase in the temperature regulatory set-point. It is a normal response to a variety of conditions, the most common of which is infection. As a person’s temperature increases, there is, in general, a feeling of cold despite an increase in body temperature.
But a study carried out by scientists at the Nigerian Medical Research Institute (NIMER), Yaba, Lagos, on the pattern of pathogens in children less than five years of age with febrile conditions in Ilorin, Kwara State, found that only 21.4 per cent of these children tested positive to malaria.
The study, also corroborated that malaria was not the commonest cause of feverish conditions, in a presentation by Mr Christian Enwuru an assistant chief medical laboratory scientists, NIMER indicated also that an increasing level of resistance to many antibiotics that are used in the treatment of diseases in children.
Mr Enwuru stated: “In most hospitals when children are brought in for fever, it is taken as malaria, but it is not always the case. A child with Candida in the throat can present similar to children with malaria.
“A lot of talks are on about children not responding to treatment, some talk about typhoid fever but more than 80 per cent of these disease causing germs are resistant to three or more antibiotics.”
In addition, a study by Oxford University and other research groups, whose authors cautioned against the “continued indiscriminate use of anti-malarial drugs for all fevers across Africa” said that more than half the paediatric fevers treated in public health clinics in Africa are caused by diseases other than malaria.
In an ideal world, all fevers reaching clinics should be tested for malaria, using a reliable diagnostic test because all feverish conditions cannot be said to be due to malaria fever, said Dr Sam Awolola, Coordinator, Malaria Research Programme, NIMER, Lagos.
“In the past, what we have been doing is presumptive diagnosis when people come to the clinic with high body temperature and there after such is treated for malaria.
“But not all fevers are malaria. There are other things that can make the body temperature to go up such as infectious disease such as pneumonia, skin inflammations such as boils or abscess and bacterial infections like typhoid fever and urinary infections.
“There are different kinds of fevers; we have yellow fever, dengue fever, and several other types of fevers. Some of these fevers mimic malaria fever and that was why WHO is saying that before a person is treated for malaria, rapid diagnostic testing must be done to ascertain that the problem is actually malaria.
“Even when the person is dying the clinicians can use their initiative to start doing something while waiting for the result of the rapid diagnostic testing to confirm the problem to be malaria.”
Nowadays, rapid diagnostic testing for malaria has become available, making it possible to confirm diagnoses without health workers, a microscope or a laboratory.
It takes about 20 minutes to get a result with a rapid diagnostic test. Interestingly, some experts believe that rapid diagnostic testing for malaria is more reliable than a microscope diagnosis because it is less prone to human error.
In sub-Saharan Africa, many countries have a policy of “universal diagnostic testing”, while some countries have set a goal of testing before treatment in children aged five and older, judging it too risky to delay treatment in younger patients.
Yet it can be equally risky to treat someone for malaria based only on the assumption that they have the disease, because it could result to the wasting of ACT [anti-malarial artemisinin-based Combination Therapy], while increasing the risk for drug resistance. Also, not treating the underlying disease and the drug delay can be fatal.
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