health talk:with Dr Johannes Marisa
Coronavirus has sent shivers all over the world. The world’s attention has been distracted by the virus, which continues to ravage both small and big nations. As of Thursday, the world had recorded more than 3,8 million cases with more than 265 000 deaths. Europe remains the most affected continent with the UK topping the list. More than 75 000 Americans have succumbed to this deadly virus with Africa losing less than 2 000 people so far and recording about 50 000 cases. South Africa has recorded more than 7 800 cases with 153 Covid-19-related deaths. We ought to pray about this scourge and our God will see us through.
While at one point coronavirus seemed to be subsiding, it remains to be seen if the new surges in United Kingdom, Brazil, Germany and United States deaths have any other extraordinary explanations. Coronavirus is real and remains a global threat politically, economically and socially.
Africa has been tormented left, right and centre by treatable diseases like malaria. We noted that three weeks ago, Zimbabwe lost more than 131 people from malaria. Possibly, it was because the country was caught unaware due to the attention on Covid-19. While the nation got so livid with only four Covid-related deaths, malaria was busy taking our people down and we woke up from slumber to the news of this parasitic disease.
What is malaria?
This is a parasitic disease that is transmitted to humans through the bites of infected mosquitoes. Plasmodium Falciparum is the most dangerous parasite of the human malarial parasites. While the disease is uncommon in temperate climates, malaria is very prevalent in tropical and sub-tropical countries.
Signs and symptoms
While lately everyone seems obsessed with temperatures related to Covid-19, it should be noted that malaria presents with fever as well on top of the following:
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lHeadaches (also present in Covid-19).
lMuscle pain and fatigue (also present in Covid-19).
lChills (also present).
lSweating (also present).
lLoss of appetite (also present in Covid-19).
lNausea and vomiting (can also be there in Covid-19).
lChest and abdominal pains (also present in Covid-19).
In our current practice, we have noted that there are some patients who deliberately avoid reporting Covid-19 symptoms to clinicians for reasons best known to themselves. Instead, they stay at home, claiming to be on self- quarantine yet it is malaria. More so, some clinicians have also rejected patients with high fever even without attempting to take the slightest of history. This has been catastrophic!
Who is at risk of developing malaria?
lChildren below five years.
lThose travelling from non-malarial areas to malarial areas. Tourists coming from European countries to Sub-Saharan countries should be mindful of malaria, hence the need for suppressive prophylactic drugs like proguanil, mefloquine, doxycline (to be stopped four weeks after returning home), the use causal prophylactic drugs like Malarone and primaquine which can be stopped seven days after coming from a malarial area.
lPregnant mothers.
lPatients with HIV and Aids.
lNon-immune migrants.
lPoor people living in rural areas who lack access to health care.
Suspect malaria especially with the currently high climatic temperatures. Rural areas like Rusape, Muzarabani, Chipinge and other areas bordering Mozambique are high-risk areas. Enquire about history of travelling to such areas if you are a clever clinician.
Complications of malaria Malaria can cause serious complications which include the following:
Cerebral malaria: Swelling of the brain or brain damage may occur with such symptoms as seizures coming.
Anaemia: Malaria damages red blood cells with resultant anaemia.
Renal failure: Kidneys can go into failure. This can kill. Make sure your kidney function is tested
Jaundice: Yellowing of eyes can come as a result of red cell destruction. Suspect malaria in a patient with high fever and yellow eyes and passing yellow urine Thrombocytopenia: Low platelets can come as a result of malaria with resultant bleeding. Do full blood count and check for haemoglobin and platelets.
Hypoglycemia: Low sugar can come from parasitemia or the use of quinine as treatment.
Diagnosis of malaria
Diagnosis comes from a combination of history taking, physical examination and blood checks. Many clinicians now skip the history-taking aspect because of Covid-19 fear, putting the life of many in danger.
lRun rapid tests for malaria (result within 20 minutes).
lSend blood for malaria parasite (microscopy).
Treatment
Treatment depends on whether the malaria is complicated or uncomplicated. Uncomplicated falciparum malaria requires Coartem, a combination of Lumefantrine and Artemether.
Complicated malaria requires the use of Artesunate initially as an intravenous/intramuscularly until the patient can take oral ACT. Surprisingly, very few pharmacies have Artesunate in stock. We get headaches when we try to find this drug in private practice. Can whoever is responsible for this drug make sure we have enough stocks?
lDr Johannes Marisa is a medical practitioner, an educationist and a public health practitioner who can be accessed on [email protected].
