Wait a second. This is the 4th time I shall discuss anti-malaria this year. Why do the questions keep pouring in. a) Doc, I took artesunate and I still have fever, which other anti-malarial drug should I take? b) Doc, I have taken laridox, malareich, amala, fansidar, camoquine etc, and I still feel weak. What next should I take? Or c) Doc, I took armatem, amatef, lumartem, halfan etc, and I am not okay, which other anti malaria drug should I take.

Now the facts

• I noticed that all those who consulted me, had already  taken anti-malaria before seeing me.

• Do you know that in Africa, because we do not operate a strict prescription system, everybody self-medicates when it comes to anti-malaria.

• Ask yourself, “when did I consult a doctor first, before treating myself for malaria?” None. You see. We are all guilty. We only consult a doctor if one or two types of anti-malaria drugs we had taken did not cure us.

• So, please imagine the dilemma of health officials, including pharmacists and chemists, where everybody is a doctor when it comes to treatment of malaria. ¤ “Please give me fansidar, that is the only drug I take when I have malaria”. Of course there will be no doctor’s prescription nor laboratory tests. ¤ “If I have malaria, and I don’t take camoquine, it will never go”, and this is a patient consulting a doctor. So now you know everybody needs help.

Some incontrovertible facts about malaria treatment

• Based on scientifically valid studies, it has been found, as I had stated ad-nauseam. In treatment of malaria, whenever we have actual fever, since we all self-prescribe. We should take anti-malaria that is a one-time-dose. Or that which dose completion should not exceed 18 hours. Reason; in case what you have is not malaria, then, there could still be room to save you from the complication of whatever caused your fever, say enteric fever.

• If you are only feeling weak and no fever, since you always treat yourself for malaria, you can then buy your artesunate and similar drugs which  treatment last 3 to 5 days, since there is no actual fever, then there will be no fear of complications.

• Listen carefully, any anti-malaria drug that has a-green-leaf-logo, with “ACTm”, on its packet – has been highly subsidised up to 95% by five charity organisations namely i) National Malaria Elimination Programme (NMEP), ii) Society for Family Health (SFH), iii) Global Fund(GF). iv) Melinda Gates Foundation (MGF). And v) Dangote Foundation (DF).

Mrs Ernest Nwokolo, a Malaria Programme Director of the Society for Family Health, has advised citizens to look out for drugs with the green leaf logo on their packets. She explained that, the Private Sector Procurement Mechanism means that the Global Fund pays money to the manufacturer. If the drug is supposed to cost one dollar(100cents), they subsidise 95 cents that is 95%.

The manufacturer sells the drug to people we call, first-line-users, who buy at 5 cents. So they can now sell all those drugs at very cheap rates. Mrs Nwokolo asked citizens not to be misled into buying  higher priced anti-malaria drugs, of the same quality with that of the green-leaf-logo, with the erroneous assumption that they are of superior quality. She said that malaria drugs with green logo, are produced by same company that produces those expensive malaria drugs, and accused pharmacies of exploiting and maximising the ignorance of the masses for company gains.

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Now, if you enter any pharmacy or chemist, and any anti-malaria drug with a green-leaf-logo is sold for more than 200 naira(to accommodate rising exchange), it used to be 100 naira, please notify the nearest Malaria Programme Secretariat or your Primary Health Centres i.e those who distribute mosquito nets free-of-charge.

What is the essence of malaria treatment?

• Of course we know that we have 4 types of malaria parasites called Plasmodium(P) – 1) Plasmodium  vivax. 2) Plasmodium ovale. 3) Plasmodium malariae. And 4) Plasmodium falciparum

• We also have 3 types of malaria fever viz – 1) Benign tertian malaria – caused by P vivax and P ovale. The fever occurs each third day. 2) Benign quartan malaria – caused by P malariae, the fever occurs each 4th day, that is day 1, 4, 7, 10 etc. Relapses occur in benign malaria, sometimes many years after the first attack, because the parasite is able to hide in the liver, and through recrudescence would release schizonts into blood stream causing periodic chills ad rigours. 3) Malignant tertian malaria – This is the most dangerous type and  is caused by P falciparum. There are many modes of presentation.

• It sometimes presents in an indistinguishable form from benign tertian malaria: fever, prostration, abdominal pain, rigours, jaundice and splenomegally.

• Cerebral malaria: the patient presents with delirium, coma, fits or psychosis. The patient might develop Disseminated Intravascular Coagulation(DIC). There may be no pyrexia (fever).

• Algid malaria – The patient is shocked, listless and moribund.

• Blackwater fever – This refers to the colour of the urine, which is black by fulminant haemolysis.

• Now you know why it is important to consult your doctor for the treatment of malaria. The doctor knows how to differentiate the type of malaria you have, and what specific anti-malaria to use.

• Always remain medically guided.

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