Prof Oyibo: Access to Diagnosis, Key to Malaria Treatment

Rebecca Ejifoma
 

Professor of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, Prof. Wellington Aghoghovwia Oyibo, has called for democratisation of malaria diagnosis across the country as Nigeria and the Republic of Congo rank highest among malaria endemic countries in Africa.

“Democratising malaria diagnosis will ensure availability and performance of a user-friendly malaria test made for the people, used by the people and useful to the people.” He  gave this crayon call during his inaugural lecture, ‘Parasitus Facultas Et Humanum Intelligentia: The Footprints of a Medical Parasitologist in the Neglected Tropical Parasitic Diseases, NTDs, and Malaria Landscape’ at the 7th  Inaugural Lecture of the University of Lagos. 

Oyibo added that there was need to urgently escalate access to malaria testing to the communities, including the informal private sector through the private propriety Medicine Vendor, PPMVs or Medicine Retailers who attend to over 60 percent of patients with fever is critical in attaining the malaria case management target that has the objective of ensuring that malaria test is conducted for 80 to 100 per cent of patients suspected to have malaria by 2018 and 2020.

The Director, Research and Innovation, UNILAG: “Access to malaria diagnosis targeted around ease-of-use for the people will promote malaria testing and appropriate management of the conditions. Again, in democratising malaria diagnosis, tests that would not require invasive procedures in blood collection are likely to promote testing. Also with expanded access to malaria testing before treatment in line with paradigm shift, the use of clinical criteria would no longer be practiced.”  

Speaking on laboratory-based malaria diagnosis, Oyibo noted that given the poor capacity of malaria microscopists, there were possibilities of them providing false positive malaria test results. “Clinical diagnosis of malaria based on symptoms is not specific; thereby resulting to over-diagnosis and over-treatment of malaria. One of our studies in 2013 showed 80 per cent over-diagnosis/treatment in children less than 12 years old that presented with fever in Lagos. Again, we recorded a 90- percent-malaria over-treatment among clients 20 years and above who purchased ACTs from medicine retailers in six states of the country.”

With this, he called for mandatory malaria rapid test according to World Health Organisation (WHO) and National policy before treating malaria; adding that malaria was a disease of public health concern in the country; hence, effective case management requires early diagnosis and prompt treatment.

Sadly, the Professor bemoaned the poor acceptance of interventions, especially new technologies for malaria diagnosis. “The mindset of healthcare providers and the patients on malaria RDTs’ performance and its outcome is a challenge in expanding access to malaria testing despite its proven performance.”

He, however, suggested that promotion of prior testing before treatment should be escalated so that savings from excessive use of medicines from government and organisations procurements could be used to strengthen diagnostic facilities. “There is need for private sector organisations to come on-board to support current elimination and pre-elimination plans for NTDs and malaria.”

Therefore, on the implications of current status of malaria in Nigeria and Lagos, Oyibo said although, the data on the status of malaria in Nigeria showed that the country is in the control phase with slide positivity of 27 percent, there is need for the country to work harder at getting prevalence down to attain the pre-elimination phase. “Nationally, malaria prevalence is higher in the Northern states than in the South; making the North reservoir of the parasites.”