Improving Malaria Diagnosis

In most hospitals and clinics  across Nigeria, malaria diagnosis is often based on  patient’s symptoms. The  symptoms of malaria (fever, chills, sweats, headaches, muscle pains, nausea, photo-phobia and vomiting) are not specific to malaria. When the above symptoms are not properly diagnosed, complications could occur. While clinical diagnosis is inexpensive, and can be effective, misdiagnosis of malaria infection is common .
Our late president was reported to have received treatment for chronic malaria, while he was suffering from a kidney  problem (complication of malaria?) Misdiagnosis often leads to the unnecessary prescription of malaria medications,  which are becoming increasingly expensive, as drug resistance grows globally, and new medicines are required for  effective treatment. Thus, increasing the accuracy  and “turn around  time” of malaria diagnosis is becoming more important.

Diagnostics can range from complex tests  that need specialist’s  skills and equipment, (this can only be carried out in a laboratory setting), or rapid tests, such as dipstick tests (that can be performed in the patient’s own home.) Also, low-cost, good-quality diagnostics that can be used easily, are available.

This is of particular importance to this country, where poverty, poor access to treatment facilities, and inadequate health systems can cost patients seeking treatment their lives.

The standard method for detecting plasmodium infection is the microscopic examination of stained, thick and thin blood smears. Although fairly effective and inexpensive, this method is laborious and time-consuming, and its sensitivity drops with the decrease of parasites.

In Nigeria, the task of examining microscope slides for malaria parasites is often left to the microscopist,  who may have learnt the job on the bench, only after a few months’ training. The workload is always overwhelming.

As quality is compromised, the first casualty is the patient, and then the society at large. Expertise,  quality of the slide preparation, and reading are paramount to accurate diagnosis.  Other important factors  include, quality of  equipment used,  steady  electricity supply,  and availability of necessary reagents.
Apart from many patients visiting hospitals with malaria complains, all blood samples available for transfusion should be screened for malaria parasites, in order to prevent transfusion-induced malaria.

Due to widespread malaria resistance to chloroquine and sulfadoxine-pyrimethamine (SP), treatment templates have shifted to Artemisinin-based Combination Therapy (ACT). Due to the increased cost of ACT, and the need to minimise resistance, due to  inappropriate use of it, there is an immediate need for improved diagnostics for malaria.

More realistic methods for the diagnosis of malaria, like the Rapid Diagnostic Tests (which detect circulating antigens) are now available, extends  accuracy in malaria diagnosis to areas where microscopy services are not available, or out of regular laboratory hours. These tests are simple and do not require a laboratory setting. Even non-clinical staff, can, with little training, learn to perform the tests  and interpret the results. The age-long microscopic practice of examination of  slides for malaria parasites is being retired, and more accurate and quicker methods are now available.

For any meaningful antimalarial programme to be put in place, simple diagnostic tools  should be made readily available by  government,  so that accurate malaria diagnosis can be made. This could help put a stop to self prescription  of antimalarial medicines, as a frontline remedy for all types of fever, chills, headaches, etc.

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