DODOWA TO LEAD IN EFFECTIVE MALARIA MANAGEMENT A GNA Feature by EUNICE MENKA

Accra, April 18, GNA - On a busy day at the Out Patients' Departments (OPD) of polyclinics or other public health facility one would see long queues and anxious patients waiting for their turn to get to the consulting rooms.

Mothers would be seen rocking hot feverish crying babies, just trying to calm and bring them some relief.

Impatient and overworked health workers would also be moving along crowded busy corridors trying to keep order. These health workers sometimes become easy targets of frustrations of weak and tired ill people, who cannot bear the inevitable delay to get to the consulting rooms.

Doctors would be rushing through their diagnosis and consultations because of the sheer weight and sight of these long winding queues. It is not uncommon in such situations to find that once a patient presents with fever, headache or loss of appetite that patient is likely to leave the consulting room with a malaria prescription. Statistics from most public health facilities in Ghana indicate that over 40 per cent of all OPD cases are malaria related. Malaria is endemic in the country but not all patients who present with headache or a fever would be suffering from the condition. Presumptive and sometimes mismanagement of malaria cases at health facilities is not uncommon.

The practice of presumptive diagnosis and treatment of malaria is sometimes dictated by practical considerations. Promptness of malaria treatment reduces the progression of simple malaria to severe malaria especially in children.

A clinician would, therefore, want to treat a child for the condition on clinical suspicion with no laboratory confirmation just to deal with any unforeseen complications.

Presumptive diagnosis becomes more critical when the practitioner realises that patients are waiting in long queues.

Although, a doctor may want a laboratory confirmation to accurately diagnosis the presence of malaria, things could prove difficult when the health facility, situated in a rural area, has no laboratory. However, the problem of inaccurate dosing through presumptive diagnosis of malaria without a laboratory confirmation or the use of microscopes could also pose serious problems.

The use of sub-therapeutic treatments for malaria, for instance, could lead to the spread of drug resistance.

The introduction of a rapid diagnostic kit to facilitate malaria diagnosis at the health facility is, therefore, very necessary. It is, therefore, welcoming news that the Dodowa Health Research Centre in the Dangme West District of the Greater Accra Region, is set to conduct a trial into the use of rapid diagnostic testing kits for malaria. The test is the first in the West Africa Sub-Region. East Africa has already taken the lead.

The device will make it possible for doctors and prescribers to detect the presence of malaria in a patient within seconds. Presumptive diagnosis of malaria cases could be a thing of the past if the examination proves successful in Dodowa and the Dangme West District in general.

The kit does not need electricity, laboratories, microscope and specialized technicians to operate. The device could be very useful in rural settings and poorly endowed areas such as the Dangme West District.

The trial at the health centre would, therefore, boost the management of malaria in the District that has no hospital but has one laboratory, two pharmacists, four health centres, seven community clinics and one Catholic Clinic.

The Dodowa Health Research Centre would recruit some 6,000 adults and children for the rapid diagnostic kit trial, which would last two years.

Dr Evelyn Ansah, Dangme West District Director of Health Services, told journalists from the Africa Media and Malaria Research Network on a visit to the Centre, that the use of the kit would cut down on time, over diagnosis and over prescription.

"If it works well and there is proper response by the prescribers, it would reduce over diagnosis which leads to over prescription. It would cut down on patients getting drugs that they do not need. If it works we would be advocating its use to the Malaria Control Programme and to any health facility," she said.

The use of the microscope is the standard method for malaria diagnosis done at the laboratory and these instruments are only available in hospitals and some health centres. It has an accuracy of 70 per cent to 75 per cent depending on how well the equipment is maintained, uninterrupted supply of good quality reagents, trained staff and good quality monitoring and supervisory methods.

Maintaining a quality assured microscopy service is a major challenge of the health care delivery system and it can also be time consuming especially in the rural areas. The introduction of the rapid diagnostic kits would, therefore, solve some of these problems.

Presumptive diagnosis would be eliminated and the over exposure of the population to the risk of drug toxicity would be reduced if the Dodowa test becomes successful and is consequently replicated in communities nation-wide.

Patient, who presents with a headache that does not need a drug-related treatment, could be treated appropriately. But for want of time, some doctors would perhaps find out that a patient who presents with headache has a social story directly linked to the headache. The headache could have been brought on by a domestic fight, financial crisis or one of the numerous social stories that doctors get to hear from patients in the secrecy of their consulting rooms.

However, the challenges of over worked health personnel and choked health facilities with long winding queue, sometimes give very little time to doctors to have enough time for patients. Some East African countries have already seen the usefulness of cutting down on presumptive malaria diagnosis. There are plans currently in Uganda to introduce the rapid diagnosis tests for malaria in a bid to improve the management of the disease.

Dr Emmanuel Otaala, Ugandan State Minister for Primary Health Care, said the Ministry would soon decide on which malaria tests to recommend for use in all government health facilities. He said these at a recent workshop organised by the Ministry of Health, together with the Malaria Consortium in Uganda. Dr Sam Zaramba, Director-General of Health Services in Uganda, also said people had to shift from treating malaria, based on presumption to targeted treatment based on tests based on parasitological diagnosis.

Rapid diagnosis tests are already in use in countries such as Mozambique, Zambia, Ethiopia and Tanzania. The Dodowa Health Centre should, therefore, be assisted to ensure a successful trial so that Ghana could lead in the effective management of malaria in the West Africa Sub-Region. 18 April 07