How malaria is over-diagnosed, treated, by NMEP

*USAID re-launches campaigns to tackle stolen, counterfeit commodities
More revelations have emerged on how malaria is being over diagnosed and treated in Nigeria even as the United States Agency for International Development (USAID) has started a campaign to tackle stolen and counterfeit commodities.

Head Case Management, National Malaria Elimination Programme (NMEP), Dr. Godwin Ntadom, at a consultative meeting/training on ways to improve the coverage of malaria by the media said: “Yes the issue of over diagnosis is not in doubt. We over diagnose malaria, we over treat malaria, and we exaggerate malaria all over. You always say an individual has malaria when you have done a test and you have detected parasite in the blood. Without that you cannot say any individual has malaria. You don’t know malaria by feelings. Some people will say, ‘I know how I feel when I have malaria. I will have dreams, I will have headache, my mouth will be bitter.’ All those ones are in the past.

“There was a time in Nigeria when if an individual presents with a fever, you go ahead and treat as malaria and you have not done anything wrong. Because then the endemicity was very high, you can be 50 to 75 per cent correct. But a situation where the prevalence has gone so low like Lagos having about two percent and Kebbi State 65 percent. You are most likely to be right when you treat individuals with fever in Kebbi State. But if you do that in Lagos or Kogi States, you either are two per cent or six per cent correct, which is a failure and which means you are wasting antimalarial medicine and that is what we trying to avoid.”

Ntadom said although malaria control interventions in Nigeria have evolved over the years with a lot of laudable strides made in the implementation of activities in Nigeria, not many Nigerians are sufficiently aware of the laudable initiatives and what they can do to prevent malaria.

Ntadom at the consultative meeting organized by NMEP in collaboration with Health Communication Capacity Collaborative (HC3), which is supported by USAID, provided updates on the national response and suggestions were made by the media on ways to advance the quality of malaria information available to the population.

Ntadom further stated: “Generally, if an individual has another disease and you continue treating yourself for malaria and what you actually have is another disease, what you have done is delaying treatment for that condition because antimalarial can only treat malaria, it cannot treat Ebola, it cannot treat Lassa fever, it cannot treat anything else. So if you wait for 24 hours before you make another decision, the individual would have been sicker. Probably, crashing the figure was helped by over diagnosis because some years back they did mass diagnosis that is whether you have the symptom or not, everybody was treated for malaria. That was another method of malaria control; in the past they called it mass diagnosis. Lets say Lagos has achieved that and it helped them to bring down malaria figure to a very low level. That was one of the challenges but is now acting as an advantage. But we don’t need to continue in that light. At this point, everybody presenting with fever must be tested before treatment.”

Ntadom said the situation could cause the malaria parasite to develop resistance to the drugs. “If people who don’t have malaria have antimalarial medicines regularly it will get to a time you will not even be finishing your therapy. Maybe you use it for one day and you say you are okay and drop it. If it is not malaria but viral infection, when you take antimalarial for one day, you will be okay. Those are some of the factors that lead to resistance and it will be building over time,” he said.

Meanwhile, the USAID Office of Inspector General (OIG) is launching “Make a Difference” (MAD) campaigns to solicit the involvement of local communities in the fight against those who prey upon malaria control programs in Nigeria and elsewhere.

The MAD campaign’s main objective is to obtain actionable information concerning the theft, transshipment, resale or falsification of anti-malaria drugs and commodities within countries receiving funding from the USAID President’s Malaria Initiative (PMI).

The PMI and the HC3, both supported by USAID, in a joint press statement noted: “The MAD malaria hotline is a central feature of the campaign that allows community members to report information on distributors, sellers or manufacturers of stolen and counterfeit malaria commodities. Relevant and actionable information from individuals will merit cash rewards. The overall aim of the MAD campaign is to encourage citizens to participate in strengthening and protecting malaria programs within their countries. The campaign initially launched in Nigeria in December 2015, and will be re-launched in September 2016 with a new hotline phone number.

“The U.S. Government through the USAID OIG will reward individuals for specific information concerning the theft or falsification of anti-malaria drugs.

“Cash rewards up to thousands of dollars are offered through the OIG for relevant and previously unknown information. The amount may vary depending on the extent to which the information is new to the OIG and leads to the arrest or conviction of individuals for participating in anti-malaria pharmaceutical crime. Systemic changes to the USAID malaria project that result from the hotline could result in additional payments.”

They said reported information on distributors, sellers or manufacturers of stolen and fake commodities could merit a reward. “Note that reported information needs to be unknown to the OIG at the time of receipt for consideration of a reward.”

The PMI and HC3 urged anyone with information concerning the theft or falsification of anti-malaria medicines to contact the OIG through the MAD Hotline. “OIG may ask follow up questions to help determine whether the information might be considered for a reward.”

According to the statement, a variety of medicines are stolen or falsified. While there are various differences between falsified and legitimate medicines, they are not always apparent, as illegitimate manufacturers continue to perfect packaging. Theft and falsification is not limited to any specific brand name.

A few indicators that can help identify stolen or falsified products, according to the press statement, are:
•USAID branded malaria commodities for sale. All USAID branded malaria commodities should be free to beneficiaries.
•If a product states “Not for Sale” and it is being sold, then it was stolen.
•If you scratch and text the number under the scratchpad on an ACT box and get a message back saying the medicine is not authentic, then it is not authentic.

According to the statement, generally, anti-malaria medicine provided free of charge through government health facilities is less likely to be substandard or falsified. “Medicines sold by hawkers, street vendors, and unlicensed drug sellers are more likely to be stolen or falsified.”