Believe it or not, Malaria is not the “be all” or “end all” of fevers in Nigeria. There are a multitude of things that can raise your body temperature. Seriously, there are over 1000 causes of fever, 400 of which are from infectious causes, 8 of which are associated with relapsing fever. So, out of 1000 causes of fever, 8 of them could possibly be Malaria.
Let’s take the unspoken rule in medicine of “common things being common”. What is “common” this side of the world? What diseases could possibly be the scheming perpetrators behind fevers? During my time at LSHTM (London School of Hygiene and Tropical Medicine) I was indoctrinated into the world of “Tropical Medicine”. I tend to think of it as practicing “Medicine in the Tropics”, where rules of nature and local structure (water, light, and electricity) play a huge role in determining mortality and morbidity of a nation. What has all this got to do with “common things being common” I hear you ask… well…
Scenario nr. 1: No clean water supply. Buy water from a tanker. Water placed in underground reservoir, plastic container…or whatever you may have. Water receptacle has not been cleaned and insects’ have made it their home environment. Even a rat was seen scrimmaging around looking for a meal. Water now placed in receptacle. Couple of days later….someone falls ill. Fever, chills, loss of appetite. Then the individual remembers he/she was bitten by a mosquito at his/her friends’ home at… (fill in the blank ). Everyone then assumes Malaria, they go to the local chemist and buy drugs for Malaria. Couple of days after, he/she starts having abdominal pain and maybe diarrhea. It is assumed it is typhoid…they start treatment. Symptoms do not improve.
Let’s take a closer look at the scenario. There was the water supply, the tanker, the water receptacle, the insects and of course the rat. Where do you start from? Let us take a look at another scenario.
Scenario nr. 2: A man has been doing shift work. This week it is night shift. The night before there was a problem at work and he was on his feet through out. When he got home his child was ill and had to be rushed to the hospital. Then from there, he went straight to work. He continues this way for the whole week. The following week after a rough weekend he starts his week again, this time there is an issue at work and he has to stay overtime. He starts complaining of generalized body pain and joint pain with headache. He tells a friend and they agree it is malaria as mosquitoes are their companions during the night shift. He starts treatment.
In both scenarios, there are a number of possible diagnoses other than malaria. What most of us don’t know is that increasingly, malaria parasites are becoming resistant to mainstream medications. So what do we do?
Get tested. It’s as simple as that! Get a malaria testing kit if you have to …just get tested!
Ifeoma Okogwu, MD, DTMH