Tweaking The Problem Of Malaria Misdiagnosis | Independent Newspapers Limited
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Tweaking The Problem Of Malaria Misdiagnosis

Posted: Jun 22, 2016 at 6:53 pm   /   by   /   comments (0)

…As Drug Makers Smile To Banks

Malaria misdiagnosis is a big global issue. This is one reason the World Health Organization (WHO) recommends use of malaria rapid diagnostic tests (RDTs) to confirm suspected malaria symptoms. WHO also endorses prescription of anti-malaria, only to patients who are positive to the disease based on RDTs. Early detection, strong surveillance and patient follow-up are crucial in fighting malaria misdiagnosis. CHIOMA UMEHA was among eight journalists who recently participated in “Covering the Fight to Eradicate Malaria: A Fellowship for U.S. and International Centre for Journalists (ICFJ)” in Thailand and Cambodia under the sponsorship of ICFJ and Malaria No More programme. She compares efforts in tackling drug-resistant malaria in these countries to what is going on in Nigeria.

Sweating profusely and shaking with fever, Sourn  Morm, plantation worker, aged 35,  arrived at the local clinic in Sang II village, Da Commune, Memot district, Tbong Khmum Province, Cambodia.
Sprawled across the bed at the clinic, Morm complained of fever, chills, headache, sweats, fatigue, nausea even as he was vomiting.
Immediately, Leng Phal, plantation malaria worker, pricked Sourn Morm’s finger and squeezed out five drops of blood.
Phal checked his temperature and asked about his symptoms. He got a file and recorded Morm’s answers. Aged 58, Phal has been a mobile malaria worker for two years at Memot Rubber Plantation.
The select journalists who were on a study of on-going malaria research and development, drug resistance and innovation in Thailand and Cambodia had a chat with Phal. He has 30 years’ experience as a plantation worker.
“Many years ago, strong superstitious beliefs surrounded the malaria sickness in the province,” Phal explains. “Malaria was believed to be a spiritual attack and there was no awareness and diagnosis to address it properly,” he adds.
“However, today, all that has changed as plantation workers and their families who live and work in one of four sections, each has its own health worker hired by the plantation to offer assistance.”
Phal further says, the awareness about malaria and ineffectiveness of bad drugs, Clorokleen, was made possible by PSKhmer (PSK).
He quickly adds: “PSK coming was embraced by residents in the area after they trained some plantation workers on quality control assurance for diagnosing and treating malaria in Cambodia.”
They trained about 400 as health providers.  Phal is one out of the trainees who were enrolled in the Public Provider Mix (PPM) Network Programme of PSK.
Commenting, the Programme Manager for Technology Integration, PSK, Graham T. Smith, says that PSK has nearly 400 health providers in its PPM Network involved in quality control assurance in malaria diagnosis and treatment in the Asian country.
After their training, PPM workers receive quality-assured anti-malaria which usually increases their business reputation, the Programme Manager says, adding that their data play a large role in decision making.
Similarly, Malaria Technical Advisor for PSI Cambodia, Abigail Pratt, says Population Services International (PSI) and PSK partners easily track malaria cases, identify outbreaks and re-direct resources to where they are most needed through data collected by PPM health workers.
PSKhmer (PSK) is PSI’s independent, local network member in Cambodia.
The world health body recommends malaria rapid diagnostic tests (RDTs) and prescription of anti-malaria only for patients who have a positive test result.
The T3: Test. Treat. Track initiative of the WHO Global Malaria Programme sets targets of universal access to diagnostic testing in the public and private health care sectors as well as at the community level.
The story is different in Nigeria. Prompt and accurate diagnosis of malaria is a missing factor in a country where the disease is still a major cause of morbidity and mortality.
Despite the wide availability of Rapid Diagnostic Testing (RDT), many health workers in Nigeria, which carry a quarter of Africa’s malaria burden, don’t use it.
Unlike conventional microscopy testing in which laboratory technicians look for parasites in blood samples, 15-to-30 minute RDT procedures allow for diagnosis at the community level.
According to a recent study in the scientific journal Plos One, failure or refusal to use RDTs can lead to misdiagnosis and a waste of expensive malaria drugs.
“Most people (in Nigeria) wrongly assume that all fevers are malaria,” says University of Nigeria Professor Obinna Onwujekwe, the study’s lead author. “So once you have a fever, you’re most likely to get a malaria drug without diagnosis. That is wrong. Not all fevers are malaria.”
Onwujekwe’s team evaluated why health workers use RDTs less than 50 per cent of the time, despite adequate training to administer the quick test.
Their conclusion was that drug sellers put profit ahead of patients.
“First-line drugs are the expensive artemisinin-based combination therapy,” says Onwujekwe, explaining that RDT confirmation of a non-malaria fever means the patient wouldn’t be required to buy the anti-malaria drugs.
“They want to make money,” he says. “I mean, if somebody comes with fever and they say; go home (because you don’t have malaria), well, they lose money. … Because of that, there’s a lot of waste. Drugs are wasted (and) quite a lot of money.”
Onwujekwe says another problem is that many health workers don’t trust the rapid diagnostic test. They would rather diagnose someone strictly on their symptoms. “If the test says it’s not malaria, they don’t believe the test,” he says.
Confirming this, a don at the Lagos University Teaching Hospital (LUTH), Idi Araba, Lagos, Dr. Wellington Oyibo, laments, malaria is often misdiagnosed in Nigeria.
Expressing these views recently, at a workshop organised for journalists by ‘Malaria No More’ in Lagos, Oyibo notes, ‘no fewer than 300 diseases have similar symptoms like malaria.’
Malaria, he says, can only be diagnosed by using rapid diagnostic test (RDT).
The don explains: “Fever is the only way the body reacts when there are external factors in the body. Pneumonia, malaria and gastroenteritis; among other diseases can cause fever, but the RDT would show if it is malaria or not.”
On the use of Chloroquine, he says: “Chloroquine is not a recommended malaria drug despite being sold in the market. Artemisinin-based Combination Therapy (ACT) remained the ideal therapy for malaria treatment.”
He further explains, there was a policy since 2005 that people should not use chloroquine, stressing that it is a malpractice to use it.
Similarly, Prof. Innocent Ujah, Director General, Nigeria Institute of Medical Research, Yaba, Lagos, bemoans that malaria is widespread and a major cause of maternal and infant mortality in the country, but it is still being misdiagnosed as typhoid. This had prevented people from getting proper and accurate treatment, he adds.
“The truth of the matter, however, is that many illnesses that are treated as typhoid are actually malaria.”
He recommends commitment of health practitioners in providing their patients with adequate information on the use of ACTs, to prevent the abuse of anti-malaria drugs which leads to anti-malaria resistance.
The consultant also calls for concerted efforts in the control of malaria during pregnancy.