Play with Malaria at your own peril

____________

OPINION

By Dr. Myres Lugemwa

The first two weeks of February were awash with news on “what’s up” and in the electronic media of:

1. A Link bus driver en’route Kasese who presumably had been reported having died on the steering wheel after cutting out from the main highway and successfully parked on the road shoulders only to realise that the same had had a blackout following a severe malaria bout as reported later by the PRO of Link Bus company.
2. Insidious deaths of young stars below the age of 15 years in Bukomansimbi District reported from having had their demise from a “strange disease” which was characterised by passage of Coca Cola colored urine commonly known as Haemoglobinuria or Black Water syndrome in medical lingua; a recently common sign in some patients nursing bouts of severe malaria.

Suffice it to note that this scenario has been ravaging both children and adults in the Bukedi region for the last one year or two.

While malaria cannot be ruled out as a provisional diagnosis in the two scenarios due to the evidence adduced by the positive laboratory and clinical findings in this regard, it is my humble plea that as residents in a country where malaria prevalence is 95% with possible and even recently reported epidemics in over 50% of country in the last two years, every effort is made by Ugandans and others of course, to avoid any mosquito bite.

Don’t mind whether the mosquito is female anophyles, culex or whatever because it is not easy for you to differentiate the female anopheles mosquito, which is the malaria vector from other mosquitoes which cause other serious diseases of in humans. So, what is malaria, viewed from the Ugandan perspective? Malaria is a disease that has killed about 40,000 persons in Uganda compared to 4,000 that have died from COVID-19 since March 20, 2020 when the first COVID-19 patient made inception on the Ugandan scene.

It is an acute febrile (feverish) illness caused by infection with malaria parasites, the commonest and most virulent of which is plasmodium falciparum in Uganda. Illness can range from mild disease (uncomplicated) to a severe life-threatening illness with subsequent immediate death.

Common signs and symptoms for simple malaria include any one or more of the following: fever/chills, headache, joint pains, loss of appetite, queasiness, vomiting and body weakness while those signs and symptoms for severe life-threatening disease may include any one or more of the following: Inability to sit or stand, vomiting everything, unable to drink or breastfeed, convulsions, lethargy, unconsciousness, stiff neck, cough with chest in-drawing or stridor, severe abdominal pain, confusion.

The above signs and symptoms can be and are almost always accompanied with syndromic evidence of Severe anemia with blood levels (haemoglobin) of less than 5g per deciliter in children and 7g in adults, high number of malaria parasites in blood (but not always) plus passing blood in urine (Haematuria) or Cocacola/Tea colored urine (Haemoglobinuria) as mentioned earlier.

Cerebral malaria, with unarousable coma not attributable to any other cause, respiratory distress with chest symptoms (Cough, difficulty in breathing, acute kidney injury/failure where a patient will not be able to form or pass urine due to the injured kidney by malaria parasites and most recently death of tissues mainly of the hands or feet or both (gangrene).

Of recent, some people have suddenly collapsed at work or while driving only to be diagnosed with severe malaria as the culprit in the equation. No wonder the Link Bus Co. driver, if we have to partake the PRO of company’s submission on” what’s up”, collapse was no surprise in this regard.

Malaria in pregnancy, like in children is even more catastrophic as it can lead to placental malaria especially in those getting pregnant for the first or second time (prime gravidas), anemia, hypoglycemia (very little sugar in the blood leading to collapsing) premature labour while in the baby adverse birth outcomes (due to prematurity, low birth weight, still birth, abortion, congenital malaria with anaemia are apt to ensue.

The vision for the Ministry of Health’s National Malaria Control Division is: A “Malaria-free Uganda” to enable social economic transformation in line with vision 2040 while the goal is that by 2025, reduce malaria infection and morbidity by 50% and malaria related mortality by 75% of 2019 levels. His Excellency the President espouse this by launching, “A Malaria Free Uganda starts with me” campaign in 2019.

In this regard, therefore, let us espouse the strategies as prescribed by WHO and the Roll Back Malaria (RBM) fraternity which include:

Reporting to the nearest health facility for treatment after a malaria test, if you feel any of the symptoms mentioned above soon as possible as but not later than 24 hours. Sleep under a mosquito treated net.

Ensure clean water-logged free environment around your home, and if you can afford to have your house sprayed with long lasting insecticides not by every Tom and Dick, but by qualified spray operators. Use mosquito repellant creams, soaps if you intend to stay out in the night. Use mosquito electric gadgets available in most super markets.

If pregnant, attend ante natal clinic where a malaria test will be conducted and malaria prevention tablets for your baby will be given at monthly intervals plus a mosquito net.

Lastly, as Uganda awaits the malaria vaccine for our little ones, lets embrace the effort in this regard rather than de campaigning, demonising and demagoguing it.

The writer is a malariologist