Wednesday, April 14, 2010
Fever = Malaria. The deadly consequences of misdiagnosis. (special re-post)
Our daily reading materials and briefings remind us of the various wars for, over and against, that Africans face on a daily basis. Whether it be water, HIV/AIDS, diabetes, or famine, we spend a lot of time learning about new developments and the charities that are working the front-lines combating them. After years and even decades of education, we are often surprised and shocked to learn that the positive influences the world is trying to accomplish may actually be having a negative impact. Students of science and macro-economics know all too well of the sheer number of unforeseen forces that impact decisions and outcomes. The battle against Malaria wages on. It is fought on a daily basis by not only medical personnel but by the victims themselves.
Before I move onto the opinion article I recently uncovered at allAfrica.com, a daily African news site, I think it important that I share some staggering stats on the disease itself.
Malaria is one of the planet's deadliest diseases and one of the leading causes of sickness and death in the developing world. According to the World Health Organization there are 300 to 500 million clinical cases of malaria each year resulting in 1.5 to 2.7 million deaths.
Children aged one to four are the most vulnerable to infection and death. Malaria is responsible for as many as half the deaths of African children under the age of five. The disease kills more than one million children - 2,800 per day - each year in Africa alone. In regions of intense transmission, 40% of toddlers may die of acute malaria.
About 40% of the world's population - about two billion people - are at risk in about 90 countries and territories. 80 to 90% of malaria deaths occur in sub-Saharan Africa where 90% of the infected people live.
Sub-Saharan Africa is the region with the highest malaria infection rate. Here alone, the disease kills at least one million people each year. According to some estimates, 275 million out of a total of 530 million people have malaria parasites in their blood, although they may not develop symptoms.
Of the four human malaria strains, Plasmodium falciparum is the most common and deadly form. It is responsible for about 95% of malaria deaths worldwide and has a mortality rate of 1-3%.
In the early 1960s, only 10% the world's population was at risk of contracting malaria. This rose to 40% as mosquitoes developed resistance to pesticides and malaria parasites developed resistance to treatment drugs. Malaria is now spreading to areas previously free of the disease.
Malaria kills 8,000 Brazilians yearly - more than AIDS and cholera combined.
There were 483 reported cases of malaria in Canada in 1993, according to Health Canada and approximately 431 in 1994. The Centers for Disease Control and Prevention in the United States received reports of 910 cases of malaria in 1992 and seven of those cases were acquired there. In 1970, reported malaria cases in the U.S. were 4,247 with more than 4,000 of the total being U.S. military personnel.
According to material from Third World Network Features, in Africa alone, direct and indirect costs of malaria amounted to US $800 million in 1987 and are expected to reach US $1.8 billion annually by 1995.
Sources : The Malaria Control Programme, World Health Organization, Third World Network Features, Health Canada, The Centers for Disease Control and Prevention, and Desowitz, Robert S. The Malaria Capers (More Tales of Parasites and People, Research and Reality). W.W. Norton & Company, New York, 199
Those are the facts if a bit outdated. The article that I'm referring to above is a bit more current. I've posted excerpts from it following, but the general idea is this; blindly prescribing medication for a disease that an individual may or may not have based on the simple medical observation of a fever, could be setting the stage for an alarming and even deadly spread of an already deleteriously unforgiving disease. All because the WHO said so. Please - I'm not recommending that people not listen to the WHO. I think they are a necessary medical resource that do their best to draw the world's attention to some of the most negatively affected areas of the planet. But critically speaking the WHO must recognize the importance of learning from past mistakes and learn to make critical changes on the so-called fly.
Global warming, drug resistant viruses and the mobility of people in a shrinking world are going to make the science of future global medicine an extremely challenging, exciting and critically necessary vehicle for the delivery of much needed treatments in an ailing world.
1. ...Kenya adopted, and is still using the previous WHO guidelines, which dictated that all fevers among children below the age of five be treated as malaria without diagnosis.
2. But a recent research in Nairobi's Korogocho slums appearing in the Malaria Journal clearly indicates that the guideline had a tragic loophole.
3. The study conducted by the African Population and Health Research Centre, among others, screened 983 people who had gone to Korogocho health centres with fevers, and none was found to be malaria-positive.
4. Yet most had been given anti-malarial drugs or a prescription in respect, with the existing policies.
5. The research by no means declares Nairobi a malaria-free zone. But it is a clear message that Kenyans are being given expensive anti-malarial drugs for wrong reasons.
6. This is likely to compromise their immunity, and the malaria parasite is likely to develop resistance.
7. At the same time, the recommended drugs for malaria treatment in Kenya (Artemisinin Combination Therapy - ACT) cost about Sh500, which is expensive for slum residents, and a loss to the government and donors in cases of free treatment.
8. In the 1950s, quinine was the ultimate drug used to manage malaria. But, health researchers developed another drug to manage uncomplicated malaria, so that quinine was preserved for complicated malaria.
9. As a result, evidence shows that through the controlled exposure of quinine, the drug is still highly effective.
10. To replace quinine, amodiaquine drugs were developed for management of uncomplicated malaria. The drug was extremely effective to a point that many Kenyans still live with memories of chloroquine and malariaquine tablets, with the popular dose of 4-2-2-2.
11. But existing policies allowed the drugs to be sold across the counter, thus over-exposing them to people who could self-prescribe for fevers suspected to be malaria.
12. At the same time, its bitter taste made people genuinely suffering from the disease abandon the dose half-way, once they felt better, or because of side effects. As a result, the malaria causing parasite developed resistance.
13. This paved the way for a new generation of anti-malarial drugs known as Sulpadoxine-Pyremethamine, commonly referred to as SP.
14. As if we had not learned any lesson from the previous experience, the drugs were in retail shops for anybody suspected to be suffering from malaria, often without diagnosis.
15. Many still recall Metakelfin and Fansidar; the malaria parasite mounted resistance against them within a very short time, rendering them useless for malaria treatment.
16. Luckily, the Chinese discovered herbal medicine from a Chinese plant called artemisinin. Studies found it to be highly efficacious against malaria, prompting the WHO to adopt it. Thus, a combination of this drug with any other is to date the recommended treatment for malaria.
17. But once again, nobody looked at past experience; hence a policy guideline was issued indicating that all fevers in children be treated as malaria using the drug without necessarily diagnosing them.
18. ...As a result, the possibility of the disease mounting resistance against them is high, making the war against the killer disease fiercer...
Read the original article: Required Testing for Malaria Will Save Lives and Money by, Mr Esipisu at allAfrica.com
Another excellent site to check out is Africa Fighting Malaria, a non-profit health advocacy group working in South Africa and the United States. The organization serves to educate and research the impact of this devastating disease.