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Oyibo: All fevers are not malaria

By Paul Adunwoke
14 August 2016   |   2:55 am
It is a disease caused by the protozoan parasite Plasmodium. Human malaria is caused by four different species of plasmodium, which include Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale and Plasmodium vivax.
Oyibo

Oyibo

Professor Wellington Oyibo is a Consultant Medical Parasitologist, and Director, Research and Innovation Office, University of Lagos. In this interview with PAUL ADUNWOKE, he spoke on the prevention, management and treatments of malaria.
What is malaria?

It is a disease caused by the protozoan parasite Plasmodium. Human malaria is caused by four different species of plasmodium, which include Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale and Plasmodium vivax.

Essentially, it is a disease caused by Plasmodium species, which causes acute fibril illnesses in human.

How should malaria and fever be treated?
There are misconceptions between general fevers and malaria fevers, which affect more people and are even more dangerous. Note here that not all fevers are malaria fever. Once most people have fever, they presume it must be malaria. As a result, they begin to treat themselves with anti-malaria medicine, which they would buy over the counter from medicine retailers. If they treat themselves and they don’t get better, they begin to think the drugs are not effective, which brings about a delay.

What should the public know about malaria?
There is need for enlightenments because other things can cause fevers. If we continue to assume all fevers are malaria, it would cause a lot of harm. The same thing applies to health workers, who treat and manage people with malaria down to all levels of health care, as well as the people on the street. Why do people assume all fever symptoms must be malaria? Now things are beginning to change. Several years ago, Nigeria was first among other countries, where malaria was endemic. This means 75 percent of children under five years had malaria. That was over 20 years ago, when we did not need laboratory tests.

During the period, Chloroquine was still efficacious as one of the most affordable medicine ever seen in the management of malaria. So, at that time, there was no need for laboratory tests because we were on the street. We had presumable treatments based on clinical symptoms of malaria; it was simple to say all fevers are malaria.

Then, if one had fever, the person would be advised to go and treat malaria. But today, such is not the case, what with control majors, health educations, availability of very effective malaria medicines and availability of treated mosquito nets, which people now use.

How would you rate malaria of old compared to what obtains now in the country?
Malaria rate has come down. Before, the country had no data concerning where we were in terms of malaria, as in the 80s, everybody was treated on the basis of fever symptoms. And with other malaria related symptoms, such as body rashes, headache and joint pains, you would know you had malaria.

Chloroquine was very good, and though it was not the only malaria medicine then, it could take care of any type of fever. If you had body reactions, due to environmental conditions, Chloroquine could quench it because it had analgesic property.

The artemisinin combination therapy (ACT) does not have the characteristics of the Chloroquine we had in the 80s.

In 2005, the country decided to change its policy from use of Chloroquine to ACT. In 2009, Plasmodium parasite changed in many forms and people began to see that malaria rate was not as high as it was in the 80s.

The World Health Organisation (WHO) came with the policy of testing before treatment, which is very important. For instance, when an individual overlabours himself, he begins to feel unwell. But the reason why he feels unwell is due to stress, which could manifest as malaria symptoms.

In many cities such as Lagos, there is about 15 per cent of malaria cases, which means few people have fever and malaria there. But by the time you begin to go to rural areas, such as Ikorodu and Epe, you begin to find 18 percent. It’s obvious malaria rate is coming down. So, the most important thing is management of fever, which should be noted by health workers and general public. People should no longer assume their sickness is malaria, because if they do and begin to take malaria medicines, it is wrong.

What are the major challenges in the treatment of malaria?
Most of the laboratory tests are not accurate. Most health workers, who conduct laboratory tests, but during their training, there was no emphasis on the accurate skills, need to be retrained. For instance, you see some laboratory tests showing positive, while there is no malaria. This is a major confusion.

Which of the medical tests is best for malaria tests?
It is the rapid diagnosis test, which is available in Nigeria; it is cheaper and easy to do. It does not last more than 30 minutes and is available even in rural areas. But confusions arise, when people feel they have malaria and rapid test shows positive, but when they go for laboratory test, it shows negative.

I recommend rapid diagnosis tests for malaria patients. When you go for rapid diagnosis tests in private hospitals and you are not satisfied, go for another medical test. It is no longer allowed to treat a patient without medical tests. You can conduct other laboratory tests and check the blood to determine whether the patient has antibiotics or not and it could also be common virus.

What should health workers know, when treating malaria?
In children, healthcare workers should inspect the ears and throats, because what is causing fever in children might be in these places. Managing malaria has now gone beyond touching the body to know whether the patient has malaria, just because the body is hot. It might not be malaria; so whether young or old, a medical test must be conducted, which must be followed up.

In those days, there was what we called Integrated Management of Childhood Infections (IMCI) for children. So, when children under five years fell sick because of fever and began to have convulsions, you did not need to delay by sending them to laboratory because they might die during the process.

IMCI guideline recommended at the period that as soon as the child is presented and seen by health workers and doctors, he/she should be given anti malaria drugs and antibiotics to tackle malaria and such other diseases as diarrhoea.

However, this is no longer recommended. Now the trend is to conduct a medical test and the results of the test must be made available at the health facilities. And then appropriate medicine must be available. When patients with severe malaria are presented, they should be given peripheral treatment before being taking to hospital that has required facilities.