When Sarah Folorunsho, a four-year-old girl diagnosed with chronic malaria, was admitted at Gbagada General Hospital, Lagos her response to treatment was very low. The symptons that preceded her death were high temperature, abdominal discomfort, convulsions, paleness, jaundice and anaemia.
Jamiu Onisede, 18, who was diagnosed with cerebral malaria suffered a similar fate. The parasite affects all body organs and impairs their functions. This very dangerous type of malaria often leads to death because the parasite eats into the brain tissue. Deadly yet so easily contracted, malaria is a parasitic disease responsible for the death of thousands every hour and at least a million souls annually, 90 per cent of whom live in sub-Saharan Africa. The most vulnerable are children under five, while pregnant women and the unborn foetus are also at grave risk. 500 milllion cases are discovered yearly.
The invasion of the red blood cells by the malaria parasite depresses the activity of cells in the bone marrow which are responsible for the production of red blood cells. The excessive destruction of the red blood cells leads to jaundice–yellowness of the eyes and skin–which also affects the kidneys. Unfortunately, despite global efforts to control it the prevalence rate of the disease remains very high. Indeed, the World Health Organisation, WHO, affirmed that “malaria continues to claim the lives of children and incapacitating adults. The disease is holding back the development of the entire continent”. Malaria is endemic in Nigeria, as well as other parts of sub-Saharan Africa, and despite effective preventions, treatment methods and cure, it remains a big burden.According to Dr. Dupe Adedeji, a medical practitioner at Lagos University Teaching Hospital, LUTH, Idi-Araba, Lagos:
“Malaria is caused by hemosporidian protozoa of the genus plasmodium (the malaria parasite); it is spread by the female Anopheles mosquito.” Plasmodium falciparum, the commonest strain of plasmodium responsible for the majority of human infections, is the cause of most forms of malaria. Its mode of infection involves the female Anopheles mosquito transmitting the parasite into the human body through a bite on any part of the body in form of sporozoite, which then undergoes metamorphosis in the liver before invading the red blood cells.
The resulting symptoms include high temperature, fever, vomiting, abdominal pain, sweating, inflammation of the spleen, headache, dizziness, lethargy, excessive sleepiness, inability to sleep, loss of libido in men, jaundice and anaemia. Diagnosis of malaria is complex and requires equipment such as microscopes or rapid diagnostic test. There is frequent over-diagnosis of malaria in many hospitals, partly due to a historical tendency to treat all fevers with anti-malarials. In addition, there is large-scale under-diagnosis of malaria as many do not seek, or are unable to reach, healthcare. The situation is worsened by the fact that symptoms of malaria are non-specific and many people with malaria also have other illness.
Dr. Adedeji explained that there is need for blood sample to detect the presence of the malaria parasite in the blood, and also determine if the disease is at an acute or chronic stage. Treatment of malaria is not as easy as one would imagine. The parasites undergo changes in the liver before invasion of the blood. One tends to attack the parasites in the blood, while some parasites are still present in the liver, waiting to invade the blood. Therefore, attacking the parasites in the blood alone does not necessarily put an end to the disease.
Unfortunately, resistance to many anti-malarials such as chloroquine (CQ) and sulfadioxine-pyrimethamine (SP), is widespread. This has mainly arisen due to the large-scale deployment of single anti-malaria drugs as the sole therapy (monotherapy). As a result, many anti-malarials have been rendered virtually useless against P. falciparum. Ruth Madu, who lives at Pipeline area of Idimu explained her predicament: “Over the years whenever I had malaria I took chloroquine, but lately the parasite has developed a resistance to it and I experience relapse. I had to switch to Fansidar.”
Deborah S. Ukog, a pharmacist with Neimeth International, said the WHO recommends that malaria be treated with Artemisinine-based combination therapies, ACT. ACT is the simultaneous use of two or more drugs with independent modes of action and different biochemical targets, of which one component must be artemisinin or a derivate. It can be co-formulated (single tablet) or co-administered (separate tablets).” The goal is to improve treatment and reduce or delay the development of anti-malaria resistance. The probability of resistance mutations arising to two drugs with different modes of action is very low.
“Single drug therapy is not advisable, due to the resistance of parasite after prolong usage. There are serious side-effects on the use of some sulphur-containing malaria drugs. If you discover any irritation such as pus, itching, swollen spots on the skin, discontinue the use of such drug,” Dr. Adedeji advised. Many non-governmental organisations are dedicated to fighting malaria. The Roll-Back Malaria, RBM, Partnership, an alliance of WHO, UNICEF, World Bank, UN Development Programme, the UK Department for International Development, DFID; malaria endemic countries, donor NGOs, the private sector and academia, was established in 1998 to provide a global approach to combating malaria. Over 190 countries have signed up to the UN Millennium Development Goals, MDGs, a set of shared targets, especially on how to halt the incidence of malaria, monitoring evaluation and also to improve maternal and child health.
In Nigeria, there are many fake drugs being paraded in the market as cure for the the disease. But pharmacists advise that one should purchase a prescribed malaria drug with NAFDAC registration number from a registered pharmaceutical outlet to beat the fakers. Mrs. Christiana Obiazukwo, the Head of Public Relations Unit of the National Food and Drugs Administration and Control, NAFDAC, Lagos, revealed the process of registration. “We test for many things, such as the active ingredient of a particular drug, which is very important. If you are saying it cures malaria, it must contain the active ingredient claiming that cure, which has to do with the efficacy of the drug. To certify the registration of any drug, it must have satisfied series of tests run on it and the monitoring of best manufacturing practice.”
Medical practitioners say it is better to prevent malaria than battling with a cure. It starts from the immediate environment with the destruction of mosquito larvae and draining swamps, avoiding accumulation of stagnant water to inhibit mosquito breeding – strategies that are effective in certain specific areas related to breeding preference of predominant mosquito species. There should also be indoor residual spraying, IRS, of houses with approved insecticides. The WHO recently recommended greater use of IRS in certain areas and endorsed DDT for this purpose. For pregnant women, intermittent preventive treatment, IPT, is necessary for malaria prevention. This involves administering a full course of an anti-malaria drug or drugs at regular intervals, regardless of whether the woman is infected. It is recommended that children under the age of five and those traveling to malaria endemic areas have prophylactic treatment. Also of great significance is the use of insecticide-treated net that is expertly manufactured. The long-lasting nets require constant re-treatment.