Malaria over-diagnosis and over-treatment in Zambia (2)
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After a quick glance through this article, want to make the following comments that bear on standard practices.
1. Doing a cluster sampling on a population and having subjects to cut across all ages for a study on malaria is not ideal. It is a fact that malaria has varied clinical presentation especially between the adult and the pediatric age groups.
2. There was no mention of attempting to standardize the diagnostic tools and technicians that were used for the study.
3. From my little understanding of diagnosis using microscopy, it is related to the level of parasitaemia and the skill of the technician. It was a good thing to have conducted the research during the peak season for transmission. However, comparing microscopy with RDT which is relatively new and lacks adequate expertise in Africa, the latter I feel has a higher sensitivity in diagnosing malaria. This can be inferred from the fact that 35.5% of those with negative RDT got prescription as against 58.4% of smear negative subjects.
I had to mention sensitivity because it a well known fact that malaria accounts for most febrile illnesses in Africa such that even in the absence of lab. It will be the first thing to treat for all clinicians.
I don�t think this is the time to put so much energy on whether malaria is worth treating or not because the current disease burden cannot be overemphasized. Rather efforts should be concentrated on preventive measures that will provide for a lasting solution. Meantime, the choice for treatment should be based on its cost effectiveness/cost benefit. Should we allow countries to suffer from the loss of man hours as a result of malaria? Is it better to withhold treatment for malaria and treat for other febrile illnesses only to return to treating malaria after a "merry go round"? (This is what is obtained most times in Africa).
I rest my case for now.
Emmanuel Adegbe
FHI/GHAIN
Kano Field office,
Nigeria
mailto:immanuel4us@yahoo.com