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Wednesday, October 26, 2016

Experts open up on Malaria Laboratory Tests

Written by: Azoma Chikwe

Edited by: RCB Editors

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Mr Arthur Acho, 57, a civil servant, had fever and high temperature, he consulted the family physician who referred him to do a test. He was diagnosed of malaria and traces of typhoid fever. But instead of returning to the hospital for treatment, he simply bought his favorite anti – malaria drug in a pharmacy, took it and got well after three days.

Few days later, his wife, Stella, aged 48, also came down with fever, headache and other symptoms. She was also diagnosed of malaria and some traces typhoid fever. When treated for malaria, she got back to her feet.

Same week, one of their kids, Maxwell, 18, also took ill and was diagnosed of malaria and traces of typhoid fever. He was treated of malaria and he got better.
In three of them, the level of typhoid in their blood samples were negligible.

Mr Acho said, “the only ailments that had ravaged his home is malaria and typhoid fever. I can’t remember anybody being treated of any other disease in my home apart of malaria and typhoid fever. Each time we go to the lab, the diagnosis can be predicted, it is either malaria or typhoid fever or both.”

The story of the Acho’s is a common one in Nigeria. Most patients that are sent to the lab are diagnosed of either malaria or typhoid fever or both. It became a trend that people wondered whether the lab results were true. The psychology of some had been influenced by the trend that if they do a lab test and the result did not contain malaria or typhoid fever or both. They will doubt the result and crosscheck with another with another lab.

Some sick people had walked up to doctors, demand to be treated for malaria and insisted that it is the only ailment they suffer from. Others tell laboratory scientists that if the result did not contain malaria or typhoid, then the sample tested was not theirs, that they understood their bodies very well.

This kind of mindset concerning malaria and typhoid fever are common in our environment because of the high prevalence of the disease.

Some had blamed the recurrent malaria and typhoid fever results churned out from labs on QUAKERY. They said the labs are manned by quacks who told the people what they wanted to hear. Others said the labs are under – equipped, lacked equipment and reagents to detect other diseases except malaria and typhoid.

However, Experts in the field of laboratory findings, confirmed the lab results to be authentic and true. They said that the prevalence of Plasmodium (malaria parasite), the parasite that causes malaria in Nigerians is over 90 per cent. “If you test ten Nigerians for malaria parasite, almost ten of them will test positive to it.

Another group named National Malaria Eradication Programme (NMEP), who Dr. Godwin Ntadom is the Head of Case management argued that the regular malaria and typhoid results produced by labs in the country  is as a result of quackery and substandard labs, and urged people to test themselves using Rapid Diagnostic Test [RDT] with malaria test kits. 
Schlumberger Malaria Curative Kit
Ntadom further said that the malaria prevalence in Lagos state was about 2%, though there are some states that it is about 35%.

The NMEP promotes Rapid Diagnostic Tests while not condemning microscopy or lab tests. They argued that fever is one of the common signs and symptoms of malaria, which can as well be seen in other illnesses. And they also stated in their fact sheets that 97 per cent of Nigerians were at risk of getting malaria.

Despite this facts, research shows that majority of Nigerians treat all fevers with antimalarial medicines without consulting a health care provider and testing with RDT or microscopy to confirm malaria.

“RDT is an easy, safe and effective way to confirm whether the fever is malaria. This can also prevent clients from wasting time and money”, stated Dr. Godwin Ntadom.
According to National Malaria Indicator Survey (NMIS), malaria prevalence has declined from 42% in 2010 to 27% recently, but it still poses a significant risk to Nigerians.

Malaria prevalence by Regions are listed as follows:
- North Central – 32%
- North East – 26%
- North West – 37%
- South East – 14%
- South South [Niger delta] – 19%
- South West – 17%

Meanwhile Experts have the following facts below to say in this issue –
Medical laboratory scientists barely use malaria test kit, we only use it for research and not diagnostic purposes since the reliability on it for the test of malaria parasite diagnosis is just about five percent or low because of its insensitivity in picking up malaria parasites and thus they recommended Microscopy.
They stated that the malaria test kit which were made in European and imported into Nigeria by various health agencies, cannot be trusted to work well in African environmental conditions.

However, the two percent Malaria prevalence for Lagos was unacceptable to them.
Nigeria is a tropical country and malaria plasmodiasis is very high. Malaria is a tropical disease and it is only suffered by people in the tropics like Africans, Asians and some South American regions. And any data gathering that is solely on information produced in temperate regions about malaria plasmodiasis may be lacking in accuracy.

We have instances of Nigerians or Africans who carried malaria to the temperate regions, because of lack of proper diagnosis, they could not be treated there and some died, because malaria parasite is alien to them in temperate regions. That is the problem of the malaria test kit and the likes that were made in Europe.

When the agencies brought the malaria kit, they went to public health facilities and introduced it to them and they began to use it, but those of us in the private sector used microscopy which is 95% accurate in terms of diagnosis of malaria parasite, because we want to heal and not keep our patients.

For somebody to say that Malaria paracetamia in Lagos state is 2%, is not factual. 

Lagos State
Most of the data sampling that gave that figure were not done in the laboratory but on the road side. They put canopies on the roadside, gathered people and tested them with malaria test kit and because the parasite detecting power of the test kit is low, they concluded that those people do not have malaria.

It is even wrong to conclude and generate data with one method. Those who are doing this data collection are not even trained medical lab scientists. They used graduates of biological sciences who are not even parasitologists. A situation where pharmacy shops do malaria tests is not acceptable, under the roll back malaria programme, they commissioned pharmacy shops to do malaria test using these test kits.

Practically, over 90% of lagosians are living with malaria parasites, it is only in some villages in Nigeria that you can think of lower statistics especially those who live on hilly landscapes, and there are no stagnant water around.

What we are talking about is parasite count, the population of parasites per white blood cells. Not whether it is there or not, because we know that 90% of Nigerians who live in urban areas have malaria parasites. They all have it, but it depends on the quantity of the parasite present. The malaria test kit picks the parasite when the number of malaria parasite is very high.

An experienced lab scientist do not just do malaria test and conclude, there are other tests that can be done to confirm that a patient has malaria. Like full blood count. Why?
The full blood count give the following:
- The patient’s red blood cell count
- The patients Haemoglobin level
- The patients white blood cell count

Dr. Enabulele said, “It is a misleading figure. If you take that to handle malaria issues, a lot of people will die. Malaria test kit is for serological diagnosis with antibodies which is does not give accurate diagnosis. You cannot use serological test to assess the level of malaria in the country.”

Malaria can always be diagnosed by seeing the parasite in the blood, not only seeing the parasite but determining the quantity in the blood. Virtually everybody will have malaria parasite in the blood, but they may not show signs and symptoms in the person until the level of parasites reaches to about 1 million per ml of the blood. 

Even then, when laboratory scientists see the one million parasites, they say one plus, if they write two plus, that means they saw more than one million per ml of blood.
Malaria parasites has two life cycles, in anopheles and in men. That is why it is difficult to develop a malaria vaccine. Even in men, at what stage of the parasite will the vaccine attack because the parasite keeps changing and each new stage comes with a new protein coat. 

Both in mosquito and in man, the parasite is undergoing different stages. Development of malaria vaccine has not been successful. Has the one they said they developed been clinically tried?

By the time a patient is down with malaria, he or she is 50% gone, because the rate of parasitemia will be so high and the destruction of the red blood cells equally high. Almost everybody in Lagos is a malaria parasite carrier. 
Because the type of anopheles that carry the parasite is what we call exogenous anopheles. You can put mosquito nets to protect yourself inside, but when you come outside, they will bite you.

There are 3 factors that attract mosquitoes;
- High level of Carbon dioxide
- High relative humidity
- Heat or warm environment

And all these factors can be generated by man. You will find that all these factors are very common in the tropics, so they are very good breeding grounds.

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