ECOWAS Program to Eradicate Malaria

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QUESTION
Why can I find no mention on your website of the ECOWAS program to eradicate malaria in their countries?

ANSWER
Thanks for bringing up ECOWAS. Since 2011, ECOWAS leaders have signaled a commitment to eradicating malaria in their region by 2015, and pilot programs are already underway in several countries, including Burkina Faso, Nigeria and Ghana. The program has centered on the use of larvicides for control of mosquito populations, thus reducing transmission. In April 2012, ECOWAS signed an agreement with Cuba in order to revitalize joint efforts to eradicate malaria in both West Africa as well as the Caribbean island. Soon after, Venezuela entered the agreement, pledging $20 million to the cause. These funds
will help support the construction of manufacturing facilities for biolarvicides in Nigeria, Cote d’Ivoire and Ghana, among other things.

In August, the Commissioner of ECOWAS emphasized the need for community engagement in the fight against malaria. A road map for measuring future progress was also drawn up by health advisers from the region; the next high-level ministerial meeting to evaluate the program will take place in West Africa, and will likely include Cuban and Venezuealan partners, in December 2012.

WHO recommends that Larviciding is indicated only for vectors which tend to breed in permanent or semi-permanent water bodies that can be identified and treated, and where the density of the human population to be protected is sufficiently high to justify the treatment with relatively short cycles of all breeding places.

Malaria: When is Lab Testing Not Recommended

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QUESTION

When is parasitological confirmation not recommended?

ANSWER

It is always best to get a laboratory or rapid diagnostic test for malaria (parasitological confirmation) to make sure the person actually has malaria before giving treatment, and to make sure the treatment is appropriate. 

There are four main types of malaria which infect humans: Plasmodium falciparum, P. vivax, P. malariae and P. ovale. P. ovale additionally can be split into two  sub-species, P. o. curtisi and P. o. wallikeri. Each of these five kinds has a subtly different life cycle which results in slight variations in symptoms and also in treatment, so knowing which one a person has is important for choosing the most appropriate treatment.  For more information on this, check out the Q&As on Malaria Symptoms and malaria treatment.

Early treatment of malaria is essential to saving lives, so in communities that do not have ready access to simple lab testing, international agencies like WHO and UNICEF have developed standardized algorithms, to guide community health workers in early identification and treatment of malaria (particularly in children) without laboratory  confirmation. While this approach has been taken to save lives, where possible, laboratory confirmation of malaria is recommended.

URGENT HELP ON MALARIA

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QUESTION

I 25 yr old male from Lagos, Nigeria. I have been having frequent malaria since 2006 till present. My symptoms are always weakness of the body, feeling cold sometimes not always and also my mouth got better most cases. I have been to the hospital several times and the doctor told me my frequent malaria is because my blood genotype is AA and also am having a malaria parasites. I was given drugs and injection in most cases. It got to a stage I had to stop consulting the doctor and start making use of self description because the malaria goes and comes back and its cost me much money in going to the hospital every time.

The weakness is always my problem because will be restless and unable to study well even during my exams. I remember there was a period I sat down in front of my house and started crying cos I was fed up on getting weak during Xmas period while my mates were having fun. I also remember cases where I walked into one of the biggest pharmacy in my area and ask the guy which malaria drugs is the most expensive cos I was thinking the most expensive should be the most effective. He brought out some drugs which I paid some money.

I was free from malaria for the past 4 months not of recent I started having heavily symptoms mentioned above. I have taken several drugs like chloroquine 2-2-1 and Combisunate(arthmeter and lumefactrine),still yet no positive response.The Cold had stopped but my body is till getting weaker. I am just confuses don’t know what to do. I even thought of going for a HIV test soon cos I believe am not the only AA that stays in House. Others, I mean some of my family and neigbours do have often and it disappears immediately after taking some drugs.

I am fed up seriously and really don’t know what to do again.I hope you can help.

ANSWER

Thanks for your question. Getting infected with malaria doesn’t have anything to do with whether you are blood type A or O or anything else. Some people do have natural resistance to some types of malaria—for example a lot of people in sub-Saharan Africa are “Duffy negative” which means they are resistant to Plasmodium vivax malaria; other people carry the sickle cell gene, which also provides some protection.

However, it is not common to have so many repeated attacks of malaria. The first thing to do is to make sure you are protecting yourself sufficiently from mosquito bites. You can’t get malaria if you aren’t bitten by mosquitoes, and the type of mosquitoes that transmit malaria usually bite at night. As such, it is crucial to sleep every night under a long-lasting insecticide treated bednet. If you have one, it might need to be re-dipped in insecticide to make sure it keeps working effectively. Also, you should make sure all your windows and doors are properly screened to prevent mosquitoes from coming in; many people also do something called “indoor residual spraying” where they spray insecticide on the walls inside their house to kill any mosquitoes which might come in. If you live in an urban area, this might not be necessary if you can get good screens, or indeed if you have air conditioning (mosquitoes do not like cooler environments). Finally, you should try to wear long-sleeved clothing in the evenings and at night, again to stop mosquitoes from biting.

Finally, I think it is important to make sure that you are diagnosed properly. In many places I have been to, hospitals don’t do a proper check, but if someone has even a few of the symptoms of malaria, they just give them treatment. This is not good—you need a proper diagnosis, both to see what kind of malaria you have (so you can get appropriate treatment) and also to make sure you actually have malaria, and not something else which is being ignored because they think you have malaria!

In fact, your symptoms of fatigue, weakness and cold are not very typical of malaria, which is usually characterized by very high fever interspersed with chills, nausea and body aches. As such I think you might want to talk to a doctor about other possible explanations for your symptoms, especially since they are so persistent.

Finally, in Nigeria, you should NOT be given chloroquine to treat malaria, unless your case is confirmed as not being caused by Plasmodium falciparum. Virtually all the Plasmodium falciparum in Africa is resistant to chloroquine, and so it is no longer an effective treatment. Instead, first-line treatment for malaria is recommended as an artemisinin-based combination therapy, such as Combisunate which you mention above.

Testing for Dormant Malaria

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QUESTION

When malaria is dormant in the body can it be detected in a blood test?

ANSWER

Not directly, no. A normal malaria blood test consists of a thick or thin smear, which is often stained and then looked at under a microscope; with these tests, you would not be able to see any sign of the malaria which is lying dormant in the liver. However, there is another type of blood test, known as serology, which looks for the body’s antibodies against malaria. These are proteins produced by the immune system when the patient becomes infected with malaria. These antibodies are specific to the type of malaria the person was infected with, and can persist for many months and even years. As such, if a patient was infected with one of the types of malaria which can become dormant (i.e. P. vivax and P. ovale), a serology test might be able to tell whether the patient had ever been infected with one of these two types, and then suggest that they might continue to have a dormant infection.

Malaria Treatment Statistics

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QUESTION

Where can I find information on the ratio of malaria cases treated annually globally or per country?

ANSWER

A great resource for information on malaria is the World Health Organisation (WHO). They publish an annual malaria report which also includes lots of statistics about numbers of cases, numbers treated, and numbers of deaths from malaria. Some of the data is even available at the country level, I believe. You can download these reports, and also find out a lot more information about malaria, at the World Health Organisation malaria page.

Malaria or Kidney Infection?

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QUESTION

Two months ago my daughter was in Uganda working and when came back to the States she was hospitalized for 4 days with Malaria symptoms. Her tests came back negative they really didn’t act like they knew how to treat this. They kept telling her they didn’t know how to diagnosis Malaria. So they treated her for it. She now after 2 months is once again hospitalized with the same symptoms. They are telling her they think it is a kidney infection. Can malaria be misdiagnosed as a kidney infection. She once again has all the symptoms as malaria?

ANSWER

What tests did the doctors do to try to diagnose malaria in your daughter when she first got back to the States? Usually, malaria is diagnosed by a blood test, whereby a trained technician will look at the patient’s blood under a microscope. The technician looks for signs of the malaria parasite in the patient’s blood, and if seen, can determine the intensity of the infection as well as the species of malaria. This is important information for accurate treatment. Alternatively, rapid diagnostic tests, which utilize a droplet of blood in a device which looks similar to a pregnancy test, and can very quickly determine whether someone is infected with malaria. It is important to know that malaria cannot be diagnosed by looking at standard blood parameters. If you don’t think your doctors know what is afflicting your daughter, you should take her to a clinic which specializes in tropical or travel medicine. There, they will certainly know how to effectively diagnose your daughter.

Given that your daughter experienced a resurgence of symptoms two months after returning, if she did have malaria, then there are two kinds which she might have: Plasmodium ovale and Plasmodium vivax. The other types of malaria, including the most deadly kind, P. falciparum, are not able to come back and relapse once they are treated. However, in order to prevent future relapses, your daughter may also have to be treated with another form of medication called primaquine. I will emphasize again, however, that it is crucial to gain an accurate diagnosis before taking any form of treatment for malaria.

Medicine for Malaria

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QUESTION

is rotam and maladar malaria medicine?

ANSWER

I have never heard of Rotam, but Maladar is the brand name of a combination sulfadoxine-pyrimethamine, and is used to treat malaria. However, it should be noted that it is not recommended by the World Health Organization as a first-line treatment option, due to concerns about drug resistance, and also lack of efficacy against certain types of malaria.

Instead, first-line recommended treatment is of an artemisinin-based combination therapy, or ACTs, which combine an artemisinin derivative (such as artesunate, artemether or dihyrdoartemisinin) with another anti-malarial drug, such as lumefantrine, piperaquine or mefloquine. Common brand names include Coartem, Lonart and Duo-Cotecxin.

Effects of Malaria

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QUESTION

what are effects of malaria?

ANSWER

If a person becomes infected with malaria, they may start to experience the symptoms of the disease. These include high fever, aches, chills, nausea, headache, and sometimes more severe manifestations, such as severe anemia, impaired consciousness and even coma or death. These latter severe effects are more commonly associated with Plasmodium falciparum infection, the most deadly form of malaria.

Can malaria return?

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QUESTION

I got fever and weakness.  I went to the doctor and my malaria report is the ring stage of p.vivax. I take artemether and lumafetrime drug  but after ten days the fever  returns. What is this? Is this malaria or not?  Plz help. When my c.b.c was done before taking malaria drugs  my hemoglobin is 8.8 and leucocyte 6800 and sgpt is 52 but after treatment my sgpt is 45 and hemoglobin is 10.2 and leucocyte is 7800. Do I have malaria again?

ANSWER

The treatment for  uncomplicated P. vivax malaria as recommended by WHO (Guidelines for the Treatment of Malaria, 2nd edition 2010), includes a main malaria drug, i.e. choroquine in areas without choroquine resistance, and ACTs like artemeter and lumafetrine as in your case.  Along with this however, for cases of P. vivex, a course of primaquine should be given. The primaquine is effective in eliminating the form of vivax that can “hibernate” in the liver for months or years and resurface, causing relapse.  (Primaquine should not be taken if you have severe G6PD deficiency).  If your fever continues, however, you should return to the clinic so your doctor can examine you and take further tests to see if the malaria has been cured and if so, to determine what is now causing your fever.

P.