Management of malaria

Malaria accounts for over 60% of outpatient visits in Nigeria and is responsible for 30% and 11% mortality in under five years old and pregnant women respectively. These problems have further been compounded by the high level of resistance to the first and second line antimalarial medicines in the country. The Federal government of Nigeria is committed to the global effort to reduce the problem of malaria by 50% by the year 2010. Most cases of malaria are treated on clinical features and it is inevitable that some patients without malaria may be treated with antimalarial drugs. Thus, in areas of high transmission, the diagnosis of malaria is made in the presence of fever in spite of the presence of other diseases. The basic investigations include: Blood smear for malarial parasites, Haemoglobin & white blood count, Blood sugar level, Urinalysis, Electrolytes and urea, Blood culture, Chest x-ray, Blood gases and lumbar puncture in unconscious patients. Rapid Diagnostic Tests (RDTs) include the. ParaSight F test, OptiMal Assay, Polymerase Chain Reaction and detection of antibodies by Radio immuno assay, immunofluorescence or enzyme immuno assay. In 2001 the WHO issued a statement that led to a major change in the treatment of malaria. Monotherapy with dihydroartemisinin, other artemisinin derivatives and other antimalarial medicines are not recommended. Treatment must be used in combination with another effective antimalarial drug. Recommended antimalarial is Artemether-Lumefantrine and in the rare case of a patient not responding to ACT, Quinine is recommended. Other ACTs available include Artesunate + amodiaquine;. Artesunate + mefloquine; Dihydroartemisinin + piperaquine+ trimethoprim. Corticosteroids are not recommended while Prophylaxis are recommended in sickle cell anaemia and in non-immune visitors. Nigerian Medical Practitioner Vol. 49(5) 2006: 94-10