Accurate Diagnosis of Malaria

Malaria poses one of the greatest challenges to the health system in Malawi. Those most affected are young children and pregnant women.

It has been estimated that approximately 40% of the mortality rate of children under the age of five years is due to malaria.

Children under the age of five suffer at least 9 episodes of malaria a year while the adult person experiences about 6 episodes of malaria a year.

According to reports, the effects of malaria in the country are enormous. The cost of consultation, treatment and hospital admissions on the health system is high and leads to loss of productivity and earnings for the family.

Having a high mortality rate, correct diagnosis of malaria is essential to quick and effective treatment.

According to the Malawi Medical Journal of June 2006, the majority of malaria diagnosis at primary and secondary level facilities is based on symptoms and treated empirically with sulphadoxine pyrimethmine (SP).

Because of the difficulty experienced in the peripheral health clinics to diagnose malaria correctly due to of lack of equipment and trained lab technicians, treatment is given on the symptoms presented by a patient.

This is preferable to not treating the patient at all or in some cases waiting for the results of blood smears sent to a larger clinic or hospital, which could take time.

However, treating malaria-like symptoms can lead to some misdiagnosis and resistance in the malaria parasites that results in the need for a more toxic and expensive drug to be used to kill the parasite.

The SP drug commonly used these days can, in most cases be purchased over the counter in most grocery stores, even to little shops in the rural areas. This has led to people treating themselves for malaria because of symptoms when in some cases they have an infection of some other kind

*Jessa who works on a farm just outside Lilongwe says when she has a fever (malungo) she purchases SP from a little thatched shop on the road near her home. She says many women can buy the drug from many of the small stalls along the roadside and treat their families without having to go to hospital.

Jessa lives in the village close to the farm and it is evident that this is a common practice among the people in her community.

The concern at present is the resistance of the malaria parasite to the first line treatment of SP.

Several Lab Technicians in clinics visited around the City Centre say the most common form of diagnosis they use is the malaria blood film slide. Using blood drawn from a patient on a glass slide, the slide is placed under the microscope and studied by a lab technician who can identify the malaria parasite as well as other parasites.

"We also do whole blood tests - antigen tests to look for the malaria parasite and this can often reveal the plasmodium falciparum (the most common and lethal malaria parasite in Malawi). This is when the patient is treated for malaria," one technician said.

When asked how accurate the blood film slide is, another technician said in most cases it is accurate but said it could give a false reading for other reasons. "If a person had already taken some malaria treatment, the parasite can in some cases not be seen," she said adding: "Sometimes, the parasite is not seen but we recommend that a person take anti-malaria drug like SP because the parasite might be hiding in the body."

According to Dr Storn Kabuluzi the National Malaria Control Programme Manager, possible misdiagnosis is being addressed by the clinician's diagnosis of symptoms presented by the patient and referral to the lab for testing is done in order to confirm that the malaria parasite is present.

"A clinician will examine the patient then, upon what he sees he will send them to the lab," Kabuluzi says its not so much wrong diagnosis but a resistant of the parasite to the commonly used SP.

The Ministry of Health is currently in the process of working towards introducing new malaria treatment and is expecting to provide training in the proper use of the drugs for those who are expected to dispense the treatment.