Lab test key to fast track malaria elimination in Nigeria
Professor Wellington Oyibo is the Head of Research and Principal Investigator and Director, ANDI Centre of Excellence for Malaria Diagnosis, College of Medicine, University of Lagos. In this interview with journalists in Lagos, the university don explains the efficacy of malaria Artemisinin based combination therapies, ACTs and reliability of the Urine Malaria Test, UMT stripe and warned against self-diagnosis and medication. IJEOMA UKAZU was there for The Abuja Inquirer. Excerpts:
Can you explain the innovation behind the Urine Malaria Test, UMT stripe?
The urine malaria test as a diagnostic test stripe is reliable. It represents a destructive technology because the parasite it detects is not found in the blood but discovers parasite antigen that is found in urine, which is protein on its own. It is likely to be destroyed due to the environment of the urine since the urine is acidic and it's most likely to have destroyed the antigen.
So what did the innovators do? They tried to get the pieces of urine using recombinant technology. When it gets to the urine, the native protein is destroyed and the pieces remains in fragments using recombinant technology which develop anti-bodies against those fragments and that is the anti-bodies that is used through the test strip to develop the urine malaria test.
There are so many things science is yet to describe in all of these and we do not know how the malaria parasite concentration relates to the blood. Part of the innovation is, the level it has taken malaria diagnosis to and what it means is that, in distant places where people may not want to use blood, urine malaria test can be used to first of all know how the individual is feeling and in the absence of any other option.
Is all fever linked to malaria?
The malaria in Lagos is quite low but what we see even as we commemorate World Malaria Day, fever is caused by so many reasons but the assumptions in those days, like 15 years back, malaria was at high rate and a test is not needed. If you took Chloroquine those days, you should know that it has other properties which ACT does not have but with time, things began to change and as it is changing the prevalence of malaria is also changing. If you had fever then, there is likelihood that it could be malaria and there was over 75 percent likelihood of children with malaria.
In urban areas, you can still see like 4 percent in Lagos which means that while we are talking about malaria, we should also look at other causes of fever along that line because fever can be caused by cancers, when it is developing, fever can be caused by viruses.
Most times, it is not just malaria test that should be done to a patient but it becomes a first test whether you are using UMT, microscopy, blood diagnosis, other tests need to be done to see why that patient has fever before a proper treatment is given.
There is a saying by some medical practitioners that there is no perfect test, how reliable is the Urine Malaria Test?
It is comparable with the blood Rapid Diagnostic Test, RDT. The World Health Organisation centre which I also manage carries out quality assurance for all rapid diagnostic tests that comes into the country and bought by the Federal government before they are taken to public health centres with the assurance they are in good working condition.
What most people do not know in Nigeria is that government does a quality check for all malaria tests before they are distributed and if they cannot be used for humans, they do not distribute them.
The Federal Ministry of Health and the National Malaria Elimination Centre are working tirelessly to ensure that these things are done.
What is the consequence of a patient treating malaria when in actuality there is no malaria?
It has great consequences. If you treat a patient by assuming he has malaria while the person does not, it is bad practice that can affect the patient. A patient having pneumonia starts from fever too and pneumonia in children can kill. What we are saying is that when you treat without testing you will neglect the actual cause of that fever, and that cause of the fever maybe dangerous. In any medical diagnosis, early detection is important.
Secondly, another consequence is wastage of drugs because you may not need the Artemisinin Based Combination Therapy, ACT, but other drugs.
Also, too much intake of anti-malaria drug could drive resistance and financially, it is not healthy because you will spend the money doing the wrong thing before the actual cause is diagnosed and the second spending might require hospitalization.
That means most patients who treat malaria with persistence after some days are not sick of malaria...
Yes, you can say the patient has fever but not malaria until it is confirmed. If it is malaria, the ACTs we have in the country can deal with it. Even as we commemorate World Malaria Day and because we work for this country, we want to charge the media to create awareness to increase demand for test. Sometimes some persons do not need drugs but rest.
What can cause treatment failure?
Over usage of drugs can result to that. For example, some people still use chloroquine for malaria treatment and it is called mono-therapy. People should desist from that. Also usage of Amalar and Fansider. These drugs can drive and put pressure on the parasite and cause resistance.
The ACTs the government talks about is a combination therapy and all treatment for malaria must use that combination therapy. The artemisinin in one arm can bring about reduction of fever, clearing of malaria within 48 hours quickly while the other arm makes sure all parasite is cleared from the system.
Europe has achieved malaria elimination. Do you think Africa can get close to achieving such feat?
Yes, Nigeria is capable of attaining elimination before going to eradication and the country is making concerted effort to make sure we get there. The Federal and state government are putting a lot of efforts right now and as I speak, the malaria rate is coming down in many parts of the country.