Not all fevers are COVID-19, they could be malaria —Expert

Prompt and effective treatment of malaria remains a challenge for malaria control programmes. Even as Nigeria joins others globally today to celebrate World Malaria Day, experts in this report by SADE OGUNTOLA say that not all fevers are COVID-19, they could be malaria.

Imagine a child in a malaria-endemic country right now. The child develops a high fever. Will the child get a malaria test and anti-malarial medicines, if positive? Or will the child stay home because of quarantine or the COVID-19 lockdown?

Every year, over 400,000 people, mostly children, die of malaria. Young children who are malnourished are particularly vulnerable to contracting malaria and dying from the disease.

Malaria is caused by parasites carried by mosquitoes. The insects pick up the parasite by biting someone who already has the disease. Malaria is then passed to other people when the mosquitoes bite them.

In Nigeria, many children with malaria are treated at home. Public health campaigns had spread the word: If your child has a fever, get them treated for malaria! Treatments are mostly incorrect due to caregivers’ poor knowledge of appropriate medications.

“Even with COVID-19 pandemic and reports that chloroquine is being used for its treatment, mothers for fear of COVID, shouldn’t treat malaria in children with chloroquine,” said Professor Ikeoluwa Ajayi of the Epidemiology and Medical Statistics Department, University of Ibadan.

COVID-19, caused by a newly discovered strain of the coronavirus, can lead to respiratory illness. It has, in a few months, infected millions of people and killed over 100,000. And currently has no treatment.

In many communities, especially in the rural areas, home management of malaria in children is fraught with wrong perceptions of the disease, its cause and treatment. These had encouraged treatment of malaria at home with drugs bought from shops and herbal preparations.

The antimalarial drugs bought were wrongly used and none of the respondents were aware of the current trend in malaria management with modern drugs.

Also, the use of health centres is the last resort for treatment for many due to difficulty in accessing health centres, scarcity of affordable drugs including antimalarial drugs, the attitude of health personnel and cultural beliefs, especially in rural areas.

Professor Ajayi declared that malaria is still a killer of children and so the concern that caregivers and mothers may be confused in terms of early diagnosis and treatment of malaria since the symptoms of COVID-19 disease and malaria in their early stages are similar. Or even result of self-treatment of malaria in children with chloroquine.

She stated: “The fear of COVID-19 by mothers could make them act in different ways, either to hide the child because of stigmatisation, delay seeking treatment or resort to self-medication.  And, the progression of the illness can result in complications and even death.”

Professor Ajayi said that uncomplicated malaria in children should only be treated with artemisinin-based combination therapy (ACT).

“We have to remind mothers that their children could have symptoms that looked like COVID 19 but it may still be malaria. They should take these children early to the health facility.  Chloroquine is not the drug of choice for treatment of malaria.

“The malaria parasite in Nigeria has been shown to be resistant to chloroquine, so to give a drug that is not effective to a child will make the disease to progress and even look more like COVID-19.”

Nobody is fully immune against COVID-19; everybody in the community is at risk. Even when there is a fever, she stated, “go to the community screening centre for COVID-19 to get tested or the health facility to have malaria parasite test. If there are signs suggestive of COVID-19 in addition to malaria, they will know better.”

Professor Ajayi warned that delay in treatment of malaria could have grave consequences.

“It can progress to severe malaria, with the child exhibiting such symptoms as difficulty in breathing, anaemia and other organs affectations. If it is still not identified and treated at that stage, it can lead to death,” she said.

The severe form of malaria is still prevalent and Nigeria is one of the biggest contributors to severe forms of malaria.  It is like a quarter of the global burden.

Dr Babatunde Ogunbosi, a consultant pediatrician, University College Hospital (UCH), Ibadan, said severe malaria is malaria in the presence of life-threatening complications such as jaundice, seizures, severe anaemia, kidney failure and loss of consciousness.

According to Dr Ogunbosi, although deaths from malaria in children have reduced significantly in recent years, the disease is still a significant contribution to child illness and death.

He added, “So if a child has a fever, don’t give paracetamol and wait two to three days. It is wrong and unfair to say that a child that has a fever you will give him or her paracetamol then wait for two or three days before consulting a doctor.

“Most children who die from severe malaria will die within the first 24 to 48 hours after symptoms occur. So, if a child has a fever, the child should get evaluated and treated if it is malaria, especially children less than five years.”

Many mothers often initially give painkillers to children with fever. When they finally seek proper medical attention, it is often too late for those who have malaria to respond to simple anti-malarial drugs, and they require expensive hospitalisation instead.

Previous mothers are encouraged to give the first dose of antimalarial medicine, if a child is down with fever before the child is taken to the hospital.

“This is only encouraged if there is no immediate or ready access to medical care. So in such a setting, it is acceptable to give the first dose of antimalarial medicine.  But the child should still be taken to the hospital immediately or as soon as possible.”

He added, “the first thing is a test, if you test and it is not malaria then it is not malaria. Then the child would not have to complete that dose but stop it and look for the cause of the fever.

“And if it is malaria, you treat and you track the patient because we live in a malaria-endemic area and all of us carry malaria parasite in our blood system.

“We need to track it because patients can develop complications when they have started treatment; also because there might be other things causing the fever aside from malaria.”

Countless germs can trigger a fever, one of the body’s most basic immune reactions. Based on symptoms alone, there is no way to determine what is causing a fever. The prominent causes of a fever vary widely from place to place and from season to season.

Even in places with the highest rates of malaria, only about half of the fevers are actually due to the disease. In 2014, the World Health Organisation (WHO) estimated that 142 million suspected malaria cases tested negative worldwide.

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