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Malaria is a dangerous and killer disease which kills hundreds of
thousands of people annually. Despite of the availability of effective drugs
against malaria parasite and sensitive diagnostic methods remain that large
number of deaths caused by this disease for many reasons, perhaps the main reason for that is failure to follow
correct procedures in dealing with the malaria
case according to the
correct recommended standards algorithm
for management of malaria.
One of the best algorithms for management of malaria that one which
prepared by the American CDC, (attached copy is included in these papers) ]
P.5[ despite of that it is full of errors and many of these errors will reflect
at malaria patients putting them under more risk may be leads for death.
This topic highlights at the inaccurate information was included in the
algorithm for management of malaria which prepared by the CDC and how/why it
must be modified and review the modified copy then be evaluated.
Keywords: Malaria parasite, Sensitive diagnostic methods, Standards algorithm, Killer disease, Leads for death
INTRODUCTION
1.
Is early detection and treatment for malaria case the solution? “If the answer
is yes, how could we answer the question below?”
2.
Why such a huge number of deaths caused by malaria despite the availability of
effective treatments and sensitive diagnostics laboratory methods?
I think
early detection with correct accurate diagnosis and treatment are one of the
factors supplementing the case, but not the solution, so the real solution is
in the correct management of the malaria case starting from it was a suspected
case ending with the laboratory report that confirms the infection and follows
a rigorous process regularly take into account the priorities and criteria also
taking into account the importance of the time factor by which, what is
available now may become useless after a short time.
Important
questions for everyone, especially those in malaria field or those who have
dealings with many cases of malaria:
● How
many cases were diagnosed early and accurately and were given effective
treatment, yet went into pathological complications and ended in death?
● How
many cases have been introduced in critical situations and have been cured?
Honestly,
I am in the field of malaria since 40 years and had dealt with a lot of malaria
cases, where are some of them which were diagnosed early and given effective
treatment yet entered in complications ended in death and it might be the cause
of death is due to the deterioration of the situation caused by the failure to
follow standard quality procedures deal with the cases crafted science and
might be to the lack presence of a standard method is rigorous and
comprehensive for management of malaria case, or the inability of the user on
the absorption and understanding of the conclusion of the scientific rationale
for each in relation to malaria deeply and fluently.
To keep it more simple let’'s assume that the therapist is an
expert in all topics relevant as the types of antimalarial drugs, the types of
malaria infections, their complications, the most important of pathological
symptoms of the disease and the side effects to treatment, but he does no't know, for example, the schizogony
cycle which occurs in the blood (duration for each species)and maybe he knows
that, but he didn't has benefit from that information, so how he can to
continue a very important and dangerous to the life of the patient case which
it may change in ten minutes, turning
the case from a stable to a critical situation (a stroke) in other words,
infection may multiplies(the percentage of infected erythrocytes from less than
1% up to 30% in minutes), the time impact on the proportion of hemoglobin into
the blood? And what effect does that have on the rest of the body’s organs? Are
these organs will function efficiently with acute anemia and lack the oxygen?
They need to perform their normal functions, don’t they?
Based on the above which illustrated the
importance of having comprehensive and accurate an algorithm for management the
case of malaria, we have been reviewing the algorithm which was published by
the Centers for Disease Control of the US and put the following amendments:
Item one: Prepare thick and thin blood smears and
reading in a few hours* modified to become:
Prepare a thick and thin blood smears and a
reading within an hour (regarding to the important for the time factor in cases
of malaria).
Item two: From smear: calculate parasitemia and
determine species is modified to become:
From smear: calculate parasitemia and
determine species & stages (regarding to the important for determination
the presence of late trophozoites or/and schizonts stages in falciparum
infections which indicate for advanced cases).
Item three: Must add guidelines clarify the meaning of severe malaria case as shown in Figure 1.
Item four: Monitor parasitemia every 12-24 h modified to become: Monitor parasitemia after one hour of first dose of
treatment and prefer every one hour next to each new dose of treatment.
Item five: Suggestion RBCs transfusion
BACKGROUND
Malaria is the most
important parasitic disease of man. It is a major cause of anemia in endemic
areas, and in areas of higher transmission. Malaria is one of the most common
reasons for blood transfusion. Five species of the genus Plasmodium infect
humans commonly, and all cause anemia.
Most malaria
attributable deaths and severe diseases are caused by plasmodium falciparum.
The majority of fatalities occur in the community. The World Health
Organization (WHO) has estimated that there were some 228 million cases and
405000 deaths from malaria in 2018. Children aged under 5 years are the most
vulnerable group affected by malaria deaths (they accounted for 272000 of all
malaria deaths worldwide on 2018 (67%).
Suggestion: RBCs transfusion in the following
situations:
● Severe anemia.
● Patients with very high parasite loads
(>10%).
● Patients with complications as:
-
Cerebral
malaria.
-
Acute
respiratory distress syndrome.
-
Renal compromise
occurs.
The algorithm for
management of malaria is as given in Figures 2A, 2B and 2C).
1.
White (2018). Malar J 17: 371.
2.
CDC (2018) Algorithm for
Management of Malaria. – CDC
3.
World Health Organization
(2019) World Malaria Report. 2019 (WHO)
4.
World Health Organization
(2019) Basic Malaria Microscopy Part II. Tutor’s Guide/second edition. (WHO)
5.
World Health Organization
(2019) Malaria Microscopy /Quality Assurance Manual/Version 2.
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