Malaria Treatment & Prevention

Many thanks to Dr Ayankogbe who has introduced a practical dimension to the discourse on malaria treatment in resource-poor settings. However, the concerns raised by him are not consequential enough to justify sticking to old ways of doing things and expect different results. In those days, treating malaria with chloroguine and analgin cost about 30 naira(less than 0.2 US dollars) ; compared to the present day in which cost of malaria treatment ranges btw 10 to 30 USD. And the cause of this exponential rise in cost is not unconnected with unbridled abuse of CQ by medical practitioners and populace alike; base on the presumption that all fever is due to malaria. If we do not want the 'Tsunami' resistance to Artemisinin derivatives currently speading across Cambodia to berth in Africa, we should all insist and advocate with our colleagues to adopt malaria diagnosis before treatment. This is in spirit of Patient-Oriented Evidence that Matters.

Thanks afolabi. What I am advocating for is that we should look for new ways to clincally diagnose Malaria as primary care physicians.In defining “Primary Care”, I am depending on the definition by The Institute of Medicine (IOM) in America who defined Primary Care as first contact care given by clinicians. In the Nigerian Context, that means general practitioners, general duty medical officers, Specialist Family Physicians (who have been trained to be generalist specialists)and Community Health Officers. I am A Family Physician Scientist. Global generalizations if issues in medicine and health have to be applied to the specific context of local situations. Africa is as diverse as the stars of heaven and yet every one refers to scientific findings “in Africa” as if Africa were a monolithic. Africa is not monolithic. In Nigeria alone there are over 350 ethic nationalities with different languages. You cannot therefore take the research findings in say Zambia for example and apply it to Nigeria, especially in Primary Care. Also, flash in the pan interventions cannot be compared to the every day routine findings that health workers on ground are faced with. Finally, data is emerging from indigenous generalist physicians who are now ...

Thanks afolabi. What I am advocating for is that we should look for new ways to clincally diagnose Malaria as primary care physicians.In defining “Primary Care”, I am depending on the definition by The Institute of Medicine (IOM) in America who defined Primary Care as first contact care given by clinicians. In the Nigerian Context, that means general practitioners, general duty medical officers, Specialist Family Physicians (who have been trained to be generalist specialists)and Community Health Officers. I am A Family Physician Scientist. Global generalizations if issues in medicine and health have to be applied to the specific context of local situations. Africa is as diverse as the stars of heaven and yet every one refers to scientific findings “in Africa” as if Africa were a monolithic. Africa is not monolithic. In Nigeria alone there are over 350 ethic nationalities with different languages. You cannot therefore take the research findings in say Zambia for example and apply it to Nigeria, especially in Primary Care. Also, flash in the pan interventions cannot be compared to the every day routine findings that health workers on ground are faced with. Finally, data is emerging from indigenous generalist physicians who are now researching what they do every day as primary care generalist physicians. Experience in Nigeria is showing that the data they are providing is changing the Primary Care health information landscape. More of these generalist specialist scientists are coming on board and the scientific world in Africa had better prepare themselves for earthshaking findings that will challenge the status quo. We shall use ICPC (international Classification of Primary Care developed by the World Organization of Family Physicians (WONCA))classification developed by physicians for physicians and let’s see what we will find for the Nigerian Primary Care scene in Malaria case management by physicians at the Primary Care level, the level of the physician of first contact. This is evidence based medicine

As a family physician with nearly 30 years of experience and many years of experience in treating malaria, I can unequivocally say that the clinical diagnosis of malaria (that is, without any lab testing) is impossible. Many studies have shown that about 20% of cases 'clinically diagnosed' with malaria, do not have malaria. The costs of treating patients unnecessarily, in terms of medication costs, resistance, and side effects, are excessive. We must use rapid testing to guide malaria treatment. Anything less is not practicing modern medicine.

Correction: I meant to say "about 20% of cases clinically diagnosed with malaria DO have malaria." About 80% of clinical diagnosed malaria DO NOT have malaria.

One of the challenges that we face at our clinic in Kenya, is that many of our patients will purchase anti-malarials over-the-counter. These medications range from Coartem, to SP, to oral quinine. They will often show up symptomatic after two days of sporadically taking several doses of the medication they bought. Any advice on how other facilities are dealing with this challenge?

Thanks Peter. But let me ask you sir, have you used the ICPC-2 process of diagnosis on your malaria cases?.Why dont upou use it first and then report your findings. In fact all of us lets use ICPC-2 classification to make diagnosis of malaria and lets report on our findings. To access ICPC, type ICPC-2 pager on google and download and use. And lets see what happens and please dont get me wrong. I am not saying you should not do lab investigations.I am only saying that clinical diagnosis can be more accurate than 20%. Thank you

Today, I was informed of the painful death of a young man, who is yet to marry.
He was not feeling well and reported to a private hospital. His blood sample was
taken and examined under microscope. as soon as malaria parasites were seen, the
doctor did not bother to examine him IN TOTALITY, to determine whether there are
any other signs and symptoms. He was treated for malaria but he was still
unwell; he reported to another facility, and they again treated him for malaria
(on admission). He died and postportem results showed he had internal bleeding,
from a punctured spleen. He had been hit by a vehicle some weeks back, but this
fact was overlooked! This is what is happening all around us; people are dying
when they need not die. Some of our doctors and nurses have simply become
"MALARIA DOCTORS". They have become too lazy to take a full histotory and do
thorough examination. it is really tragic!




DR CONSTANCE BART-PLANGE
NATIONAL MALARIA CONTROL PROGRAM MANAGER
P.O. BOX. K.B. 493, KORLE-BU ACCRA, GHANA
TEL: 233-0302-661484 /233-244-327180/233-20-7335260
FAX/TEL: 233-0302-687982
Oh taste and see that the Lord is good !!

in malawi RDTs were introduced when we started using lumfantrine/artemether com,bination therapy. but it is sad to note that most clinicians still give anti malarial treatment patients with a negative RDT test. This is worisome because of concerns costs for the management of malaria and development of resistance. there is need for health worker to learn to trus their test results.

Dear Elliot, thanks for being honest.Out there, guidelines are not bring followed when it comes to malaria diaagnosis and treatment. Maybe because clinicians have become so used to the disease! That is why, on the field, we must promote anything that will make clinical diagnosis more accurate-like the syndromic management of STIs for example