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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.
     

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  • Volume 1

PRESUMPTIVE MALARIA DIAGNOSIS, A THING OF THE PAST?

By Eunice Menka,Ghana

On a busy day at the Out Patients' Departments (OPD) of polyclinics and other public  health facilities, one would see long queues and anxious patients waiting for their turn to get to t h e c o n s u l t i n g r o o m s .

Mothers would be rocking hot feverish crying babies, just trying to bring them relief.

Impatient and overworked health workers would be moving along crowded busy corridors trying to keep order. These health workers sometimes become easy targets of frustrated, weak and tired patients, who cannot bear the inevitable delay to get to the consulting rooms.

Doctors would be rushing through their diagnosis and consultations because of the sheer weight of the heavy schedule and the sight of long winding queues. It is  not uncommon in such situations to find that once a patient presents with fever, headache or loss of appetite that patient is likely to leave the consulting room with a malaria prescription.

Statistics from most public health facilities in Ghana indicate that over 40 per cent of all OPD cases are malaria related. Malaria is endemic in the country but not all patients who present with headache or a fever would be suffering from the condition. Presumptive and sometimes mismanagement of malaria cases at health facilities is not uncommon.

The practice of presumptive diagnosis and treatment of malaria is sometimes dictated by practical considerations. Promptness of malaria treatment reduces the progression of  simple malaria to severe malaria, especially in children.

A clinician would, therefore, want to treat a child for the condition on clinical s u s p i c i o n w i t h n o l a b o r a t o r y confirmation just to deal with any unforeseen complications.

Presumptive diagnosis becomes mroe critical when the practinioners realizes that patients are waiting in long queues.Although, a doctor may want a laboratory confirmation to accurately diagnose the  presence of malaria, things could prove difficult when the health facility, situated in a rural area, has no laboratory. However, the problem of inaccurate dosing through presumptive diagnosis of m a l a r i a , w i t h o u t a l a b o ra t o r y confirmation or the use of microscopes c o u l d p o s e s e r i o u s p r o b l e m s .

The use of sub-therapeutic treatments for malaria, for instance, could lead to the spread of drug resistance.

The introduction of a rapid diagnostic kit to facilitate malaria diagnosis at health facilities is, therefore, very necessary. It is, therefore, welcoming news that the Dodowa Health Research Centre in the Dangme West Districts of the Greater Accra Region has begun a trial into the use of rapid diagnostic testing kits for malaria.The test is the first in the West African Sub Region.

East Africa has already taken the lead.Dr Evelyn Ansah, Dangme West District Director of Health, told journalists from the African Media Malaria Research Network, in Dodowa that the research findings will make it possible for doctors and prescribers to detect the presence of malaria in a patient within seconds.

Presumptive diagnosis of malaria cases could be a thing of the past if the examination proves successful in Dodowa and the Dangme West District in general. The kit does not need electricity, laboratories, microscope and specialized technicians to operate. The device could be very useful in rural settings and poorly endowed areas such as the Dangme West District.

The trial at the health centre would, therefore, boost the management of malaria in the district that has no hospital but has one laboratory, two pharmacists, four health centres, seven community clinics and one Catholic Clinic.

The research is also looking at various interventions including clinicians and patients perceptions on the use of rapid diagnostic test kits in the management of malaria. Dr Ansah said clinicians, sometimes, under the pressure of work or in the absence of laboratory facilities, in diagnosing malaria, have to base their diagnosis on only clinical suspicion depending on symptoms the patient presents with leading to wrong diagnosis
a n d w r o n g t r e a t m e n t .

She said the introduction of a malaria rapid diagnostic test made up of a simple kit could reduce wrong diagnosis and treatment.

Dr Ansah said the kit could be used in rural settings since it does not need electricity to function, and therefore in the absence of laboratory facilities such as a microscope, the presence of malaria parasites could easily be detected.

She said some studies conducted on rapid diagnostic test in parts of East Africa, however showed that some clinicians still by-passed the use of the kit and rather depended on syndromic diagnosis or diagnoses based on clinical suspicion.

Dr Ansah therefore said: “If over diagnosis continues in this era where an arte mi si n in- bas ed comb ination therapies is the first line drug, the intervention will be potentially more
expensive and unsustainable.”

“Misuse of drug will result in increasing drug pressure with attendant emergency and spread of resistance,” she added. The research at the Dangme West District is recruiting some 6,000 adults and children for the rapid diagnostic kit trial, which would last two years.

"If it works well and there is proper response by the prescribers, it would reduce over diagnosis which leads to over prescription. It would cut down on patients getting drugs that they do not need. If it works we would be advocating its use to the Malaria Control Programme and to any health facility," Dr Ansah said.

The use of the microscope is the standard method for malaria diagnosis done at the laboratory and the instrument is only available in hospitals and some health centres. It has an accuracy of 70 percent to 75 per cent depending on how well the equipment is maintained.

The availability of uninterrupted supply of good quality reagents, trained staff and good quality monitoring and supervisory methods are also essential. Maintaining a quality assured microscopy service is a major challenge of the health care delivery system and it can also be time consuming especially in the rural areas. The introduction of the rapid diagnostic kits would, therefore, solve some of these problems.

Presumptive diagnosis would be eliminated and the over exposure of the population to the risk of drug toxicity would be reduced if the Dodowa test becomes successful and is consequently replicated in communities nation-wide.

A patient, who present with a headache does not necessarily need a drug-related treatment. But for want of time, some doctors would perhaps find out that a patient who presents with headache has a social story directly linked to the headache. The headache could have been brought on by a domestic fight, financial crisis or one of the numerous social stories that doctors get to hear from patients in the secrecy of their consulting rooms. However, the challenges of over worked health personnel and choked health facilities with long winding queues, sometimes give very little time to doctors to haveenough time for patients.

Some East African countries have already seen the  usefulness of cutting down on presumptive malaria diagnosis. There are plans currently in Uganda to introduce the rapid diagnosis tests for malaria in a bid to improve the management of the disease.

Rapid diagnosis tests are already in use in countries such as Mozambique, Zambia, Ethiopia and Tanzania. The Dodowa Health Centre should, therefore, be assisted to ensure a successful trial so that Ghana could lead in the effective management of malaria in the West Africa sub-region.

 

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