Drop in malaria- increased efforts or reduced errors?

The number of infections and deaths reported as malaria have dropped by at least 74 percent since the country started using rapid diagnostic tests (RDTs) in October 2007, according to the government. While the National Malaria Control Programme (PNLP) credits stronger community involvement, mosquito nets, and more effective medication to the steep drop in malaria mortality – from 8000 deaths in 1999 to 722 in 2008 – it said that RDTs have also played a big role.

From one million reported malaria cases in 2006, health workers reported only 275,000 cases for a 12-million population in 2008.

“The [rapid] tests have helped us to see the disease more clearly,” said PNLP deputy director Mame Birame Diouf. According to PNLP, about one million tests are administered every year, of which Diouf said 44 percent showed positive results – leaving open the possibility of a 56-percent rate of misdiagnoses pre-RDT.

The tests have helped us to see the disease more clearly

Karim Diop, the district medical chief for Pikine, on the outskirts of the capital, told IRIN that before RDTs doctors were forced to treat most fever diseases as malaria. “Delayed malaria treatment can mean instant death, so doctors treated malaria-like symptoms with anti-malarial drugs, even without laboratory diagnoses, which is not possible in areas far from laboratories.”

While malaria accounted for more than one-third of all infections reported in Senegal in 2006, this fell to 5 percent in 2008, according to PNLP.

Countries that have widely adopted malaria RDTs include India, Laos, Cambodia, Philippines, Indonesia, Ethiopia, Uganda, Tanzania, Zambia, Madagascar, Senegal, Togo, Liberia, Angola, according to the non-profit Foundation for Innovative Diagnostics (FIND). 

But malaria programme officer Diouf said while RDTs have helped improve the outlook for malaria in Senegal, several other factors have contributed to the drop, including cultural awareness. “There is no one solution to fight malaria. We need to take into account the economic, social and cultural reality in each village.”

He said if the only health worker available to test pregnant women is male, then women in more conservative religious areas will not seek care from male health workers and would not get the treatment used to help prevent placental malaria, sulfadoxine-pyrimethamine.

Pregnant women and under-five children are most vulnerable to malaria infections because of their lowered immunity.

“Usage rates [of sulfadoxine-pyrimethamine] may not be a problem in modern cities, like [capital] Dakar, but other areas show weaker use, caused in part by cultural barriers,” Diouf told IRIN.

By recruiting female health workers to work with pregnant women in such areas, he said communities have been able to increase the number of women receiving prenatal anti-malarial protection.

In 2008, 65 percent of pregnant women received anti-malarial treatment, according to PNLP.

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