‘Malaria still top list of killer diseases in Nigeria’

Unlike in developed countries where heart disease tops the list of killer diseases, a public health expert, Dr Gbemisola Daramola, has said despite the reduction in malaria cases globally, the disease yet tops the list of killer diseases in Nigeria.

Dr Daramola spoke at the Nigerian Medical Association, Oyo State branch Continuing Medical Education (CME) lecture with the theme “Presumptive Diagnosis of Malaria, So Common, So Wrong”.

Daramola, a senior medical officer, University Health Services, University of Ibadan, described malaria as a major public health problem in Nigeria that accounts for more deaths than any other disease in the country.

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According to her, “Malaria is a risk for 97 per cent of Nigeria’s population, of which under-five children and pregnant women are the most vulnerable.”

The expert said that the unprecedented success in the control of malaria world over before 2015 has been stalled based on the 2018 world malaria report.

According to her, “Data from 2015 to 2017 highlight that no significant progress was made within this period in reducing malaria cases globally. In Nigeria alone, between 2015 and 2016, there was an addition of about a million cases of malaria.

“Africa alone in 2017 accounted for 92 per cent of malaria cases worldwide and 93 per cent of malaria deaths worldwide. In 2017, of the five countries accounting for nearly half of all malaria cases worldwide, Nigeria alone accounted for 25 per cent of malaria cases.”

The expert decried presumptive treatment of malaria which is based solely on symptoms and signs, without establishing a diagnosis of malaria.

According to her, presumptive treatment of malaria, although common, is wrong according to World Health Organisation’s guideline for malaria diagnosis and treatment.

Dr Daramola declared “Presumptive diagnosis of malaria is not reliable, especially in Sub-Sahara Africa due to inadequate local epidemiological data on malaria and the presence of other febrile ailments which possess similar signs or symptoms with malaria. “Continuing this practice will lead to over-diagnosis of malaria, missed diagnosis of other illnesses that have both immediate and long-term morbidity and mortality.

“Laboratory-confirmed diagnosis and treatment of malaria reduces drug wastage, adverse drug events and engenders evasion of the imminent loss of confidence in anti-malarial drugs by the public.”

Professor Fatai Fehitola, a consultant pharmacologist and chairman at the lecture, stated that there is over diagnosis of malaria in Nigeria, like in many other countries of the world.

He dispelled the notion that malaria as a disease has specific signs and symptoms.

According to Professor Fehintola, “There is no malaria symptom; what we talk about is malaria-associated symptoms or malaria-related symptoms and signs, which means that there are so many other conditions that can present with it.

“So many things can cause fever, headache, body aches, vomiting and so on. Some cases of malaria will even present with cough, so you will not say every cough means upper respiratory tract infection, no.

“When you have this so-called malaria, if there is no malaria parasite in the laboratory film, there is no malaria.”

Chairman, NMA, Oyo State branch, Dr Akin Sodipo, corroborated that malaria is over-diagnosed in Nigeria.

He said the impression that Rapid Diagnostic Test (RDT) kits for malaria are not sensitive is wrong, adding that most of these test kits are only sensitive to Plasmodium falciparum, the causative germ for malaria.

Dr Sodipo assured that many mosquitoes seen flying around are not the anopheles mosquito that transmits malaria fever but culex mosquitoes that breed in dirty, stagnant waters.

He added that “If it gives a negative with the common RDTs, it does not mean that the person does not have malaria, it might just mean that the fever is not from Plasmodium falciparum.”