Is it really malaria?

Monday, May 19, 2008 (The Daily Graphic Pg 27)

Article: Lucy Adoma Yeboah

FOR the first time in eight years, the annual event which was instituted in 2000, known as “Africa Malaria Day” was on March 25, this year, commemorated as the “World Malaria Day” on the theme, “Malaria-A Disease Without Borders”.
The idea of changing the Africa Malaria Day to the World Malaria Day came about when in May , 2007, the World Health Assembly, attended by delegates from all the 192 member states of the World Health Organisation (WHO), looked at the latest malaria reports and observed that the global awareness of the disease remained low in spite the high death toll and cost of it.
The World Health Assembly, therefore, resolved that instead of the Africa Malaria Day, the World Malaria Day would be commemorated each year to provide education and understanding of the disease and also spread the information on a year-long intensified implementation of national malaria-control strategies, which include community-based activities for malaria prevention and treatment in endemic areas.
The Africa Malaria Day, which hitherto was considered an African affair, was instituted in 2000 when the historic Abuja Declaration was signed by 44 African malaria-endemic countries, including Ghana, at the African Malaria Summit in Abuja, Nigeria.
This year’s commemoration of the first World Malaria Day on the theme “Malaria-A Disease Without Borders” is significant. That is so because according to the WHO, nearly 40 per cent of the world’s population is at risk of suffering from the disease. These are found mostly in Asia and Africa, with Africa south of the Sahara being at a higher risk of infection. Indeed, records have it that about 90 per cent of all the cases are recorded in sub-Saharan Africa which include Ghana.
One of the reasons for choosing the theme: Malaria-A Disease Without Borders is that, mosquito, the insect which transmits malaria carry the disease from country to country through airplanes and vehicles without any immigration checks.
Malaria has been noted to bring about poverty and underdevelopment due to the amount of money spent in managing the various episodes people living in endemic areas suffer. It is one of the main causes of absence from work and also school absenteeism among school children and teachers.
In his address at the World Malaria Day celebration in Accra, where hundreds of people made up of health personnel, community based non-governmental organisations (NGOs) in malaria control, corporate bodies, development partners, various sponsors of malaria control programmes in the country and the public were assembled, the Minister of Health, Major Courage E. K. Quashigah (retd) said there was the need for governments, corporate bodies and international institutions to unite for an aggressive scale-up of malaria control.
“Malaria has defeated us for so long, it is a time for us to defeat it and leave a nation free of this menace for our children to inherit”, the Health Minister stressed.
The well attended event was organised by the National Malaria Control Programme (NMCP), of the Ghana Health Service (GHS) with sponsorship from the United Nation’s Global Fund and a number of international and local bodies.
To be able to fight the disease, the health minister saw the need to begin the fight within the communities Ghanaians lived in, and called on the people to be responsible for their immediate surroundings and destroy the breeding grounds of mosquitoes.
Quoting from a well known statement made by the Greater Accra Regional Minister, Sheikh I C. Quaye, Major Quashigah said “Malaria does not respect immigration laws. The mosquito does not need visa to travel from country to country”.
One would not be wrong to state that the WHO might have learnt from Sheikh Quaye when it chose the theme for this year’s celebration as: “Malaria— A disease without border”.
To the Regional Minister, mosquitoes do not need visa to travel to his territory, the Greater Accra Region.
In her presentation, the Programme Manager for the NMCP, Dr (Mrs) Constance Bart-Plange, expressed disappointment that malaria continued to be considered the number one disease in Ghana in spite of all the efforts at reducing it, and wanted to know whether the high number of cases usually recorded at health facilities are actually malaria cases .
She mentioned some of the interventions as increase in the use of insecticide treated nets (ITNs), the use of malaria preventive drugs during pregnancy, indoor residual spraying (IRS) as was being piloted in Obuasi and its environs by AngloGold Ashanti and larviciding where mosquito larvae are killed through chemical application at their breeding grounds and also environmental management.
On management and treatment of the disease, Dr Bart-Plange said enough education had gone on to let the people to appreciate to receive proper treatment and pointed out that the country had always followed recommendations made by the WHO hence the promotion of the use of artesunate amoadiaquine.
Without denying the fact that Ghana is a malaria endemic country, the Programme Manager believed that there is the possibility that many of the diseases recorded as malaria in the country’s health facilities might not be malaria after all. Her reasons are that many diseases present symptoms similar to that of malaria so without proper diagnosis, one might be forced to conclude that all such diseases are malaria and record them as such.
To her, there is the need to differentiate between malaria and other fever-causing diseases and treat them accordingly.
She pointed out that fever, which is increase in temperature, is one of the main symptoms which is always taken as malaria, adding that not “all fevers are malaria”. Other symptoms such as headache, chills and vomiting are also associated with uncomplicated malaria and are always concluded as malaria.
Dr Bart-Plange added that diseases such as urinary tract infection, typhoid, tonsillitis, meningitis, influenza, viral hepatitis, HIV/AIDS, pelvic infections, appendicitis and beginning of pregnancy also show similar signs as those that manifest in malaria infection.
She went further to state that a sign such as change in behaviour which occurs in severe malaria is also found in mental disorder, typhoid psychosis and brain tumour; convulsions, which occur in severe malaria also occur in epilepsy and brain defects and another symptom, difficulty in breathing also affects people who have pneumonia and asthma.
Other forms of symptoms of malaria include reduced urine output which could also manifest in people who suffer from renal disease; severe anaemia could occur during worm infestation; coke-like urine could be side effect of certain medications and a health problem called haemolysis and also spontaneous bleeding which is a symptom of severe malaria is one of the symptoms of leukaemia.
Her point is; how then can any health worker conclude that one is suffering from malaria when he or she is showing any of these signs without conducting proper laboratory test to actually determine the cause of the patient’s ailment?
Dr Bart-Plange based her argument on the fact that only few fever cases are confirmed by laboratory tests as malaria and again pointed out that only 14 per cent malaria cases are confirmed through microscopy (laboratory test).
She expressed the fear that if other diseases are not properly treated but wrongly handled as malaria, patients are likely to die from the lack of adequate treatment, a situation which she said could lead to deaths which could have been prevented.
In order to actually detect and treat malaria, laboratory confirmation is crucial because according to Dr Bart-Plange said “not all fevers are malaria”.
Looking at the conditions of the country’s health facilities where there are usually the lack of staff and adequate laboratory equipment, one may ask whether it is possible for every patient who reports at a health centre, especially the public ones, to be tested through microscopy to determine exactly what is wrong with him or her.
That notwithstanding, it will save all us, as a nation, if individuals involved would make some efforts to go for laboratory tests if they realise that although they have been given adequate treatment for malaria, the symptoms remain. For all you know, your ailment might not be malaria but something else which needs a different treatment.
Laboratory testing is important in diagnosing diseases. That is the more reason why Dr Bart-Plange expressed appreciation for the role being played by President George Bush’s Malaria Initiative (PMI) which she said will support among other things, laboratory diagnosis as part of the fight against malaria in Ghana for the next three years.
The programme which is to commence this year will help in determining the actual number of people who suffer from malaria so as to know how to tackle the problem effectively.