A study in Malaria World this week ‘Assessment of malaria treatment interventions: a critical analysis of government initiatives and causes of treatment failure at Port Loko Government Hospital, Sierra Leone’ by Sao Babawo et al has useful information on important factors for malaria occurrence and the ineffectiveness of the conventional treatments.
Healthcare workers and women of childbearing age were surveyed. The study assessed the effectiveness of government interventions such as the distribution of insecticide treated bed nets, indoor spraying with insecticides, and availability of anti-malarial drugs (ACTs). These interventions failed and authors blamed failure on the implementation or inconsistent supply.
(Or perhaps nets, insecticides and artemisinin based drugs are ineffective because the conventional understanding of malaria is incorrect?)
The most interesting observations came from the surveys of healthcare workers and of the women of childbearing age. The women considered the most important factors for malaria occurrence to be poor environmental sanitation (33.7%) and sub-standard housing (11.0%). Not sleeping under a bed net (6.7%) and lack of access and availability of health services (5.0%) were considered less important.
What is also interesting is the health worker survey in which 73.3% reported that malaria was the most prevailing medical condition affecting pregnant women who attend a clinic. Also reported are Iron deficiency at just 13.3%, Pre-eclampsia 4.3%, Typhoid 8.3%, Others 0.7%.
It seems to me that malaria is the name given the illness in these clinics when a patient is generally unwell with generic symptoms. In a country free of malaria perhaps influenza, COVID or ‘viral illness’ would be the diagnosis. This fits with my recent experience in Kenya when my friend with chest and stomach pains and no fever was diagnosed with malaria and treated with artesunate because of a positive test. It is not even clear if all the women attending clinics in this Sierre Leone study were tested because stock outs of RTDs were also reported.