Friday, May 2, 2008
Health
experts say the majority of malaria cases in Mali are misdiagnosed,
which causes resistance to malaria drugs and leaves other illnesses
untreated.
“When people are sick in Mali, the doctor will
usually tell them they have malaria whether or not they test for it,”
said Fatou Faye, an infectious diseases researcher and trainer at a
privately funded medical laboratory, the Charles Merieux Centre in Bamako.
“The patients then buy anti-malarial drugs in the street and build up a resistance to treatment.”
As a result, according to research by Dr. Imelda Bates at the Malaria Knowledge Project
(MKP), part of the Liverpool University School of Tropical Medicine,
this means people miss other causes of feverish illness such as
pneumonia and meningitis, which can cause further illness and even
death.
Economic productivity is also affected, and
misdiagnosis can deepen poverty due to prolonged illnesses and money
being wasted on the wrong drugs.
Malaria is the most prevalent
disease among Malian children under five years old according to George
Dakono coordinator of the national project to fight against malaria.
“Shocking levels” of misdiagnosis
The discrepancy between real and assumed cases has reached “shocking” levels all over Africa according to the MKP.
Malaria
diagnostics in Mali rely on expensive equipment which most health
clinics, particularly in rural areas, cannot afford and do not have the
trained staff to use, Michel Van Herp an epidemiologist with
non-governmental organisation Médecins Sans Frontières (MSF) Belgium,
told IRIN.
As a result most doctors “make assumptions based on suspicion,” he said, leading to over-treatment of malaria cases.
Further,
according to Dakono and Faye, most people who develop a fever in Mali
do not visit a health clinic at all, either because they live too far
away or are unwilling to pay up to US$0.95 for a consultation. They
self-diagnose and treat instead.
Up to 70 percent of cases of feverish illness in children are diagnosed and treated at home according to the MKP.
Laboratories the ‘gold standard’
Mali needs more and better-equipped laboratories to combat mass misdiagnosis, according to Faye.
Valentina
Buj, a health project officer with the World Health Organization (WHO)
said “blood smear-tests in a laboratory are the gold-standard in
malaria diagnostics.”
But the majority of the 82
government-run laboratories around the country lack the right equipment
and trained technicians to diagnose malaria, Faye told IRIN.
The
Charles Merieux Foundation has set up a laboratory in Bamako to
diagnose malaria and other infectious diseases, train technicians from
health clinics around the country in how to use diagnostic equipment
and run a lab, and with European Union funding, to equip labs around
the country. Its aim is to replicate standards found in French
laboratories.
“We want to create a situation that for the
majority of diseases they encounter, they can accurately diagnose them
themselves,” Faye said.
Rapid diagnostic tests
But
for MSF’s Van Herp, laboratories are not the answer to improving
malaria diagnostics in rural Mali where clinics and laboratories are
few and far-between.
“We need simple, low-technology malaria
test kits, rather than buying more expensive equipment and carrying out
in-depth trainings which is hard to do in rural areas,” he told IRIN.
For him the answer is to get rapid diagnosis tests or ‘RDT’s,
which are small, easily transported and cost on average US$0.45, to
community health workers throughout the country so they can test people
village by village.
“The test takes 15 minutes to produce
results and it takes half a day to train a community health worker how
it’s used,” said Van Herp, “they are the only options for diagnosis at
the household level.”
The test is simple - if a person has
malaria, chemicals in the test react to a product produced by the
malarial parasite in their blood, causing a red strip to appear fifteen
minutes later. And where MSF has distributed them, the number of
patients seeking diagnosis for malaria has increased from one in four
to 100 percent.
Taking the kits country-wide is a challenge in
Mali -– they require a long shelf-life, sophisticated distribution
systems, and their results are unreliable in temperatures of over 30
degrees Celsius, which is Mali’s average temperature. “The technology
still needs to be finessed,” Buj said.
MSF nonetheless says it
plans to expand its programme, which currently is diagnosing 80,000
people in malaria-prone regions, across the country alongside the
government.
Funding
With
simple technology, improving diagnostics does not have to be expensive
– it would take US$61 million to cover Mali’s diagnostic needs
according to Van Herp - but it requires the government and donors to
take it more seriously.
The first step, according to the MKP
is cost-benefit analyses to map out malaria prevalence, resistance
patterns, and clinics capacity to analyse which diagnostics approach is
better – rapid tests or improving labs.
International donors
have stepped in to improve Mali’s efforts to fight malaria with US$126
million from the George Bush foundation and the Global Fund to fight
HIV/AIDS, malaria and tuberculosis committed over five years, but
critics say not enough of this money targets diagnostics.
“The
Ministry of Health is already subsidising medicines, staff salaries and
building health centres, and international funds are coming in, so why
shouldn’t it start supporting diagnostics fees as well?” asked Van
Herp.
According to a health practitioner in a government
clinic in Fana, a town north of Bamako, “if the government does not
support diagnostics, its other efforts will fall flat.”
WHO’s
Buj is positive Mali is going in the right direction. “When it comes
to… diagnostics, the situation is definitely getting better in Mali,”
she said.
Source: IRIN News http://irinews.org