Wrong Perceptions About Malaria and Typhoid Fever in Nigeria

Brief Introduction

Malaria is a disease caused by malaria parasites. There four known Plasmodium parasites: P. falciparum, P. vivax, P. malariae and P. ovale. Plasmodium falciparum causes the deadliest form of malaria.
The parasite is transmitted by female anopheles mosquitoes. The prevalence of malaria in Nigeria is very high and the country is said to be a holoendemic zone. The reason is because malaria affects Nigerians throughout the year. There is no break in transmission and it does not follow seasonal changes.

On the other hand, typhoid fever, otherwise known as enteric fever is caused by Salmonella typhi and Salmonella paratyphi. Typhoid fever follows a faeco-oral transmission. What this means is that you can get the disease if you eat food or drink beverages handled by someone that is shedding the bacteria. Also, in Nigeria, like in other developing countries, where defecation in open places is common, transmission can also be water-borne. In this instance, some villagers drink water from streams without purifying it. And by so doing, get infected with typhoid.

Clinical Features

The clinical manifestations of malaria include fever, chills and rigor, headache, malaise, joint pains, nausea and vomiting. Others are diarrhoea, convulsion (especially in young children) and coma. Malaria is a serious disease and can cause complications like anaemia, liver failure and jaundice, dehydration, low blood sugar, acute respiratory distress syndrome, swelling and rupturing of the spleen, kidney failure and pulmonary oedema.

Typhoid on its own can cause fever, colicky abdominal pain (perforation of the small intestine can occur), joint pains, diarrhoea, cough ,nausea and vomiting  headache, muscle pain, confusion and can mimic some of the symptoms of malaria.

Diagnosis

Diagnosis of malaria involves various approaches which include using microscope to observe the presence of the parasite in blood, rapid diagnostic test (RDT), serological test to determine presence of antibodies against the parasite, and more importantly, a high degree of suspicion. This is of particular importance in a resource-poor setting where a microscope may not be readily available. In this case, the interpretation of the RDT must be done with good clinical acumen because as false positive and false negative results can be obtained.

On the other hand, the diagnosis of tyhoid fever can be done by using culture medium that allows the organism to grow on it. serological test can also identify antibodies against antigens borne on the organism. Lastly, Widal test which was used decades ago in the laboratory diagnosis of the organism is still being used in Nigeria. it must be stressed out that high titre value of the antibodies against the organism, especially in the absence of signs and symptoms, does not indicate an on-going infection.

Treatment

The treatment of malaria involves the use of antimalarial drugs of which artemisinin-based combination therapy has proved life-saving. Typhoid fever, in the absence of surgical complications can be treated with potent antibiotics. In the of complications like perforation of the viscus, surgical procedures can be carried out.

Conclusion

The notion in the most part of the country, especially the "uneducated" and rural dwellers, that every feeling of malaise is either caused by malaria or typhoid is wrong. This has transcended into the subconsciousness of a large chunk of the population; even the so-called "educated" people are not left out.  This misconception has paved ways for all sorts of dubious people who practise under the cloak of doctors and swindle poor masses of their hard-earned money all in the name of treating malaria and typhoid after laboratory investigations. We see them in every almost every corner where they run their laboratory centres or even hospitals. Some medical doctors also patronize this form of disgusting quackery in the name of making fast money.

The most heart-rendering aspect is the use of the old-fashioned Widal test in the diagnosis of typhoid fever. This is only a screening test and is not used for definitive diagnosis. We are all aware of the scarce commodity called portable drinking water. Since most rural and some slum dwellers defecate in bushes or gutters, those amongst them who are infected with S. typhi will pass the organism to others as it follows a feco-oral route of infection. The causative agent can be washed into nearby streams and rivers. Meanwhile, some people maybe using the water body as their source of drinking water, and, hence, get infected. This organism can the find its way into the gall bladder of the person affected, even after successful treatment of typhoid fever, from where its antigens get into the blood. the body immune system in turn continues to churn out antibodies against the antigens. In this manner, the Widal test maybe positive even though the causative agent has been completely walled off in the gall bladder by the body immune system and the individual is not showing any symptom of the disease. Even though, the individual might be having symptoms due to infection from the thousand and one tropical infections, he is erroneously diagnosed as a case of typhoid fever just because of the positive Widal test. This is where clinical acumen comes into play. And besides, this centres lack the necessary sophistication to run other tests apart from PCV, urinalysis, HIV screening test and Widal test, in order to exclude other possible causes.

In the case of malaria, it is either under-diagnosed or over-diagnosed because most places will RDT that can register false positive or false negative results, and some of them have already expired. This is once of the causes of development of some resistance against Artemisinin-based Combination Therapy (ACT). Sound clinical knowledge of features of malaria, in this case, becomes invaluable.

Let us join hands in saying capital no against malpractice and join hands in health education of the masses. Remember the life you are saving today might be yours.