Please: Login/Register

The Latest Edition of "Eyes on malaria" magazine will be out very soon!! | CALL FOR ARTICLES: AMMREN is inviting journalists / writers / scientists interested in reporting on malaria to send articles for publication in its international magazine “Eyes on Malaria” and for posting on its website. Please contact the AMMREN Secretariat for more details click here. Enjoy your stay!. Volunteers and interns urgently needed to work with an NGO working in the area of malaria and health. Apply through - ammren1@gmail.com / ammren1@yahoo.com. Journalists interested in reporting on and writing articles on health issues should please reply through this email: ammren1@gmail.com

ANNOUNCEMENTS:::

TIPS ON MALARIA

  • HOW CAN MOSQUITOES BE CONTROLLED?

    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.

  • HOW CAN I PROTECT MYSELF FROM MOSQUITO-BORN DISEASES?

    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.

  • WHO ARE AT RISK?


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.
     

MAGAZINE EDITIONS

  • Sixth Edition

  • First Edition

  • Second Edition

  • Third Edition

  • Fourth Edition

  • Fifth Edition

  • Seventh Edition

  • Eighth Edition

  • Ninth Edition

  • Special Edition

  • INESS Edition

  • Tenth Edition

  • INDEPTH Edition

  • Eleventh Edition

  • Twelfth Edition

  • Special Edition

  • Special Edition

Getting it Right

There are raging debates taking place now about whether health workers should continue to rely on clinical suspicion to treat suspected malaria cases or depend exclusively on evidenced-based laboratory or rapid diagnostic tests before dispensing anti-malarials to patients who present with a fever.

The debates follow criticisms that even in the absence of confirmed cases of malaria, clinicians still presumptuously dispense anti-malarials, once a person presents with fever, because of their “die-hard” habits.

These arguments are however countered by some health workers who say that practical considerations dictate that once a child, for instance, has a fever, that patient must be treated for malaria to
avoid the progression of the disease to its severe form, which may take the life of the child.

Available data in Ghana suggests that less than one-third of malaria diagnosis are confirmed with laboratory tests and that, regardless of the season, clinical staff in all part of the country diagnose roughly 40 to 50 per cent of all sick children as having malaria, said a report released by Ghana's National Malaria Control Programme (NMCP) recently, which assessed the burden of malaria and control activities in six large cities across Ghana.

The wide spread treatment of all fever cases as malaria is not peculiar to Ghana but runs across sub-Saharan Africa and this situation has no doubt become a challenge because of over-prescription of anti-malarials, drug resistance, misdiagnosis and neglect of other febrile or fever-related illnesses such as pneumonia.

Two decades ago, the World Health Organisation (WHO) released a report quoting Thomas Sydenham, the noted English physician born 1624, who said that, "fever is nature's engine which she brings into the field to remove her enemy." The physician was renowned as a founder of clinical medicine and epidemiology because he did emphasize detailed observations of patients, among other things.

It has been said that since the beginning of man's recorded history, fever has always featured as an important sign of ill-health. The WHO's 1993 report on the management of fevers in young children with acute respiratory infection in developing countries, said experiments by the great French physiologist, Claude Bernard, which demonstrated that animals died when their body temperature was raised above normal coupled with the beginning of the use of the thermometer in medical science, led to the opinion that the presence of fever meant a threat to one's health.

The report noted that majority of parents get extremely scared when their child develops a fever and this unwarranted fear of fever among even highly educated parents of infants and young children was not only common but led to an overly aggressive treatment of fevers.

It noted that such "fever phobia" may stem from the attitudes of doctors, nurses, other health professionals or from widespread advertising by drug companies among other factors and advised that there was the need for a more rational approach to the management of fever. It has been 20 long years since the WHO made some recommendations in its report urging that all febrile children should be carefully assessed to find the cause of the fever.

The issue of the proper management of febrile illnesses continues to take centre stage today. In January 2013, the WHO's Global Malaria Programme and the Special Programme for Research and Training in Tropical Diseases met to review available evidence and current practices in the management of fever in peripheral health-care settings.

A report from this meeting noted that health workers may ignore negative test results and still treat the patient with anti-malarial, following years of treating fever as an assumed case of malaria.

“This problem is made more difficult given the absence of guidance and medicines for the management of non-malaria febrile illnesses,” the report added.

The meeting recommended that in managing malaria at the community level, there should not only be diagnostic testing and treatment for confirmed malaria cases but also an assessment and management should be carried out for acute respiratory infections and diarrhea. The call is that the correct management of non-malaria febrile illnesses should be promoted especially in children and also in high malaria endemic areas, because a patient can often have both malaria and other diseases, like pneumonia. The need to encourage research which looks at new strategies for effective diagnosis and treatment of febrile illnesses, was another recommendation made at the meeting.

Community intervention
A recent study on community-based management of fever in children with anti-malarials and antibiotics treatment in rural Ghana, has brought to the fore the need to research on febrile illnesses and shift attention to other fever-related diseases to cut down on the over-reliance on fever symptoms to treat malaria.

The study aimed at evaluating the impact of adding the antibiotic, amoxicillin (AMX), to the anti-malarial, artesunate amodiaquine, (AAQ) to treat fever among children aged, 2-59 months under a home malaria-management strategy.

Under this AAQ+AMX combination study, AAQ was used to treat malaria and AMX was for treating pneumonia, in line with Ghana's national drug guideline. The study was conducted among children in the Shai-Osudoku and Ningo-Prampram districts (formerly known as the Dangme West District) in the southern part of the country and led by researchersfrom the Dodowa Health Research Centre and others elsewhere.

Funding for the study was provided byvarious organizations including, UNICEF, United Nations Development Programme (UNDP), World Bank, World Health Organisation (WHO) and the Netherlands Organisation for the Advancement of Tropical Research.

According to the researchers, it was based on the fact that in malaria endemic Africa, children with pneumonia can easily be misdiagnosed and treated as having malaria because of similarities between malaria and pneumonia symptoms.

Both diseases, in their severe forms, present with fever, rapid breathing, chest in-drawing, with rapid decline to death among others.

The argument by the researchers is that the similarities in symptoms between malaria and pneumonia provide opportunities for missed diagnosis, over and under treatment and therefore the right diagnostic tools and effective medication are needed to aid health workers determine if a child has malaria, pneumonia or both in order to treat the child quickly and appropriately within the Communities.

The researchers aimed at assessing if adding an antibiotic to the anti-malarial treatment under the home management programme would help reduce mortality. During the study, trained community health workers dispensed the anti-malarial drug (AAQ) alone, or together with the antibiotic (AAQ+AMX) to children with fever. In total, 5818 and 660 1eligible children were treated in the AAQ and the AAQ+AMX clusters respectively.

The researchers concluded that the treatment of uncomplicated fever episodes among the children with the anti-malarial or in combination with the antibiotics at the community level by trained community health workers, resulted in the reduction of deaths in comparison to those treated with standard care that included treatment at home, by traditional healers, care from drug retail shops or from the formal health sector.

Since the study ended, Ghana's Child Health policy has supported the management of malaria and pneumonia at the community level by trained community-based health workers. The researchers, who led AAQ+AMX study have meanwhile, noted that the use of rapid diagnostic test (RDT) kits was feasible and would improve the ability of these workers to distinguish between malaria and pneumonia, and deal with other diseases. Although, they do acknowledge that the use of RDTs have not always led to rational use of anti-malarials.

Confirming malaria cases
Currently, the WHO malaria treatment guidelines (2010) recommend that parasitological confirmation of malaria be carried out before treatment but the researchers have said that some experts have cautioned against a policy that abandons presumptive treatment for RDT use at all levels.

Despite these differences, there is however some consensus on the usefulness of improving malaria diagnosis at community level through the use of RDTs. What needs to be addressed is the up-scaling of the RDT to make it universally accessible.

Meanwhile, the WHO has said that most African countries are not yet there since RDT coverage is still below 40 per cent in the region. It is hoped that with a massive up-scaling of the use of RDTs, coupled with continuous education for health workers, a clear distinction could be made between malaria and other diseases associated with fever to improve upon the health of people.

 

Editions: 
Eleventh Edition