Kigoma — Revania Bruno, 29, a mother of two from Kasulu District in Kigoma Region has always opted to consult a doctor whenever she experiences malaria-related symptoms before starting using anti-malarial drugs.
In July this year she immediately consulted a doctor at Kiganamo Health Centre after she suspected she had malaria.
"I experience fever, headache and vomiting," she told a doctor during the consultation session at the centre.
The doctor took finger prick blood for malaria test using the Malaria Rapid Diagnostic Test (MRDT)--the recommended device that detects specific antigens (proteins) produced by malaria parasites in the blood of infected individuals.
The results showed she had no malaria infection. She returned home, prescribed paracetamol to reduce the severe headache.
"I always undergo malaria test before using the malaria-treatment drugs" says Revania during a recent interview with The Citizen.
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She added: "But I know many of my colleagues who tend to use antimalarial drugs without doctor's directive."
A month later, Revania, who is currently five-month pregnant experienced similar malaria-related symptoms. She re-consulted her doctor for the second diagnosis.
To her surprise, the second test results showed negative.
Revania's case is medically referred to as clinical malaria. It is when an individual shows all malaria-related symptoms like fever, chills, severe malaise, headache or vomiting, but he or she doesn't have the disease, instead requires a different treatment.
The medical policies recommend that health facilities should first diagnose malaria by assessing symptoms and a subsequent confirmatory blood test by microscopy or MRDTs.
However, The Citizen understand that this has always not been the case in many health facilities.
Challenges such as delay in delivery of certain materials such as MRDTs or lack of laboratory technicians in some areas has frustrated the directive.
The situation limit malaria diagnosis to symptoms such as fever only which results into over-diagnosis of malaria cases and consequently, inappropriate use of anti-malarial drugs says Dr Hussein Iddi, a registered clinician at Kiganamo Health Centre.
"Treating patients with malaria first requires a confirmed diagnosis. It has recently come to light that some people undertake anti-malarial medication without undergoing the test," he told The Citizen.
He further acknowledges that the use of MRDTs has helped addressing clinical malaria cases at the centre.
The method has made it easier for laboratory technicians to diagnose many patients at very short time, he said.
"Prior to the introduction of MRDTs, the doctors were examining patients' blood sample using the microscope," says Dr Hussein.
Dr Hussein is among healthcare providers in Kigoma who received comprehensive training on Malaria prevention, diagnosis and treatment under USAID Boresha Afya project funded by USAID and implemented by Jhpiego, Engender Health and PATH.
Through the project, Jhpiego in partnership with the health ministry conducted other interventions for malnutrition and family planning. The interventions were in line with the national health policy guidelines, targeting mainly pregnant women and children.
How malaria RDTs work
MRDTs assist in the diagnosis of malaria by providing evidence of the presence of malaria parasites in human blood. RDTs are an alternative to diagnosis based on clinical grounds or microscopy, particularly where good quality microscopy services cannot be readily provided.
Malaria RDTs were introduced in Tanzania by the Ministry of Health in 2008. The diagnostic test does not require a laboratory setting and can be performed by minimally trained personnel who are not laboratory technicians.
"The MRDTs are very rapid as results can be obtained within 20 minutes," says Kiza Kiseka, the Acting Regional Medical Officer (RMO) for Kigoma.
"The policy for the deployment of MRDTs is that the devices should be available at all levels of health care delivery (dispensary to referral hospitals)," he adds.
Since the introduction of MRDTs in the country, clinical cases have declined rapidly as only true malaria cases (confirmed with an MRDT or microscopy depending on the level of care) are treated, the RMO discloses. "The MRDTs are deployed at all levels of care. Therefore, it allows for the testing before treatment is administered to individuals who have tested positive. This increases access to testing by the communities," says Mr Kiza.
WHO recommendation on Malaria diagnosis.
The World Health Organization (WHO) recommends that early and accurate diagnosis of malaria is essential for both effective disease management and malaria surveillance. WHO further say high-quality malaria diagnosis is important in all settings as misdiagnosis can result in significant morbidity and mortality.
The WHO also recommends prompt parasitological confirmation of diagnosis either by microscopy or RDTs in all patients with suspected malaria before treatment is administered. This guidance has been adopted by the National Malaria Control Programme (NMCP).
"Antimalarial treatment should be limited to test-positive cases while negative cases should be thoroughly assessed for other causes of fever," says WHO country representative for Tanzania, Dr Tigest Mengestu in a recent interview with The Citizen.
The medical sources further demonstrate that parasite-based diagnostic testing of malaria improves the overall management of patients with febrile illnesses, particularly by helping to identify patients who do not have malaria and consequently do not need an antimalarial medicine but a different treatment. It may also help reduce the emergence and spread of drug resistance by reserving antimalarials for those who actually have malaria, the sources indicate.
Parasite-based diagnosis for all age groups
According to the WHO data, the number of countries that have adopted and implemented policies for the parasite-based diagnosis of malaria is increasing. Ninety-five countries and territories have adopted a policy to test all patients with suspected malaria before treating with antimalarial medicines.
The proportion of patients suspected of having malaria who receive a malaria diagnostic test has increased substantially since 2010, when WHO recommended testing of all suspected malaria cases.
According to 58 surveys conducted in 30 sub-Saharan African countries between 2010 and 2017, the percentage of children with a fever who received a malaria diagnostic test in the public health sector hit a median of 59 per cent from 2015- 2017, up from a median of 33 per cent for the period 2010-2012.
Malaria prevalence in Tanzania
According to the Tanzania Malaria Indicator Survey (TMIS) for 2017 conducted by the National Bureau of Statistics (NBS) indicates that the malaria disease prevalence rate dropped from 14.4 per cent in 2015 to 7.3 per cent in 2017.
The report said Kigoma was leading among regions with the highest rate of prevalence, at 24 per cent in children aged 6-59 months followed by Geita (17.3) and Kagera (15.4).
Referring to the malaria prevalence in Kigoma, the RMO highlights that the prevalence is attributable to the presence of refugees camps in the districts of Kakonko, Kasulu and Kibondo.
However, Mr Kiza says the government has embarked on joint strategic plans with the UN High Commissioner for Refugees (UNHCR) to reduce the malaria burden at the camps.
"The problem is when we provide them with treated mosquitoes nets, they don't use, they sell them," says Mr Kiza.
To further address the existing malaria burden in the country, the health minister Ms Ummy Mwalimu was quoted recently saying that the government will allocate enough resources in the areas with high prevalence rates to ensure the prevalence is reduced by 2020.
According to her, the priority will be put in destroying mosquitoes breeding sites, intensify testing of disease infection and provision of mosquito nets.