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Malaria is known to be the largest single  component of the burden of diseases in Tanzania for both morbidity and mortality especially for under fives and pregnant women. In Dodoma region, the prevalence of malaria among underfives is 12.5% while, in Bahi District Council, about 60,000 people of all ages suffer from malaria every year.

Malaria diagnosis is first suspected on defined features and then confirmed by laboratory tests mainly through microscope; however in the year 2010, the cheapest and easiest laboratory test was introduced in Bahi District Council namely Malaria Rapid Diagnostic Test (m-RDTs).

Malaria Rapid Diagnostic Test (m-RDT) is a test that assists in the diagnosis of malaria by providing evidence of presence of malaria parasites in the human blood within a very short period of time and it’s considered to be user friendly as it doesn’t need one to have advanced lab training.

The prevalence of malaria in our district council was reported to be higher prior to introduction of m-RDTs, and malaria was always ranked number one in the district’s top ten diseases. However, after the introduction of  m-RDTs in the year 2010 there has been changes on the trend of the top ten diseases as the number of malaria cases is  currently on the decline compared to the same period of time before the use  this rapid test. The aim of this study was to determine the success obtained after introduction of m-RDT as a tool for diagnosis of malaria in Bahi District Council.

The study design was descriptive comparative study, in which District Health Information System data base gathered from Health facility reports were used. The information obtained was organized and computerized in a soft ware. Analyses were based on descriptive and comparisons between two periods of January – June 2011 and the same time period of the year 2010. All tests were done using relevant statistical tests.

The findings reported a high number of malaria cases between January and June 2010 when both microscope and clinical diagnosis for malaria were still used in the diagnosis of malaria, compared to the same six months-period of January to June, 2011 when we started using malaria rapid diagnostic tests (m-RDTs) as an adjuvant doagnostic modality for malaria. In overall malaria case diagnosis was reduced by 65% for under fives, 58% for above five years and 63% for patients of all ages. This difference was found to be statistically significant. In the year 2010 malaria was leading among the district’s top ten diseases reporting 39,295 cases followed by Acute Respiratory Tract Infection (ARI) which had 17,126 cases. On the contrary, until June 2011, ARI was reportedly leading with 21,244 cases followed by malaria with 17,126 cases.

Microscope remains the gold standard for malaria diagnosis, however due to reasons such as lack of skilled laboratory personnel and unavailability of microscopes and reagents, the best diagnostic modality at the moment would be malaria rapid diagnostic tests which can help in the over- and/or mis-diagnosis of malaria and patients’ mismanagement who actually have other diseases than malaria.

From our findings we recommend that, it is time now we review our malaria treatment guidelines including its testing algorithms  in order to improve the quality of health care delivery through proper management of malaria cases by use of m-RDT especially for the developing countries.

The author declares no conflicts of interest.


The author is Public Health Specialist, and a District Medical Officer (DMO) for Bahi District Council in Dodoma, Tanzania.


 

Photo Credit: NMCP

Chandarua hutoa kinga dhidi ya mbu, nzi na wadudu mbali mbali wasambazao magonjwa, hivyo kuzuia magonjwa kama malaria, homa ya dengue na homa ya manjano.

Ufanisi wa kazi wa chandarua huwa maradufu kinapowekwa dawa ya kuua wadudu.

Vyandarua vilianza kutumika lini?

Vyandarua vilianza kutumika kuanzia katikati ya karne ya kumi na nane (mid-18th century), inasadikiwa kuwa hata yule malkia maarufu wa Misri Cleopatra alitumia chandarua. Vilevile vyandarua vilitumika wakati wa ujenzi wa mfereji wa suez baada ya malaria kutishia umaliziaji wa ujenzi wa mfereji huo.

Chandarua hutengenezwa kwa kutumia: pamba, polyester, polyethylene au nylon

Vyandarua vyenye dawa

Vyandarua vyenye dawa vilianza kutumika miaka ya 1980 kwa ajili ya kuzuia malaria. Na hadi sasa vyandarua hivi vinaanza kutumiwa kama mmbadala wa vyandarua vya zamani katika nchi nyingi, Tanzania ikiwa ni mojawapo ya nchi hizo.
Inaaminika kuwa vyandarua vyenye dawa vinafanyakazi maradufu ya vyandarua visivyo na dawa. Chandarua hutoa kinga ya asilimia 70 dhidhi ya malaria kulinganisha na kulala bila chandarua.

Katika tafiti iliyofanywa na Deswal na wenzake iliyochapishwa September 2004, katika kambi za jeshi katika mji wa Allahad, nchini India waligundua kuwa maambukizi ya malaria yalipungua kwa kiasi kikubwa baada ya kutumia vyandarua vyenye dawa, na mbu aina ya Anophiline walipungua kwa asilimia 67.8 wakati culex walipungua kwa asilimia 49. Na watumiaji hawakupata madhara yoyote. Na hivyo walithibitisha kuwa matumizi ya vyandarua vyenye dawa husaidia kupunguza malaria kwa kiasi kikubwa.

Kwa sasa vyandarua vingi huwekewa dawa aina zifuatazo: Deltamethrin na Permethrin. Kwa ufanisi mzuri wa chandarua chenye dawa, ni vyema kila baada ya miezi sita kukiwekea tena dawa,ili kiweze kufanya kazi vizuri.

Kwanini watu wengi hawatumii vyandarua vyenye dawa?

Tafiti mbalimbali zimeshafanyika kuhusiana na kwanini watu wengi hawatumii vyandarua vyenye dawa hata kama watapewa bure na serikali. Katika utafiti uliofanyika pembezoni mwa mto Imo, Nigeria iliyochapishwa machi 2010 “kuhusiana na mtazamo wa matumizi ya vyandarua vyenye dawa na athari yake katika kuzuia malaria kwa wakina mama wajawazito” uliofanywa na chukwuocha UM na wenzake waligundua kuwa mtazamo wa wananchi kuhusu malaria kuwa wanawake wajawazito na watoto wapo kwenye hatari zaidi ya kupata malaria kuliko wanaume na wanawake ambao hawana watoto kabisa kwa sababu miili yao ni dhaifu. Vilevile walipata sababu za kutotumia vyandarua vyenye dawa kuwa ni:

  • Gharama na upatikanaji wake
  • Vilevile wanaamini kemikali za dawa zinazowekwa zinamadhara kwa watu wazima,watoto na wanawake wajawawazito
  • Wengi walipata matangazo kuhusu umuhimu wa vyandarua vyenye dawa
  • Wengi waliamini dawa hizo zitumikazo kwenye vyadarua huleta madhara yafuatayo:
    • huathiri upumuaji hasa kwa wakina mama wajawazito na kama zinaua mbu basi zinaweza kuua hata binadamu.
    • Wapo pia watumiaji wengi walioripoti kuhisi joto kali na kukosa hewa ya kutosha wakiwa wamelala usiku.

Nini mtazamo wa matumizi ya vyandarua vyenye dawa katika nchi nyingi za afrika?

Kwa ujumla kuna imani na mitazamo mbalimbali kuhusiana na matumizi ya vyandarua vyenye dawa kikubwa kikiwa kuhusishwa na kupunguza nguvu za kiume na kuaminini kuwa zinaweza kuleta madhara makubwa kwa binadamu.

Hitimisho

Kutokana na tafiti mbalimbali zilizofanywa zinathibitisha kuwa Hamna madhara kwa binadamu na matumizi mazuri ya vyandarua vyenye dawa hupunguza maambukizi ya malaria kwa kiasi kikubwa.

Nikisema matumizi mazuri namaanisha kuwa uhakikishe umelala katikati hamna ngozi inayogusa chandarua hasa kwa vile ambavyo havina dawa maana mbu huweza kukuuma, na kuhakikisha hakija chanika na kimechomekwa vizuri. Na kutosahau kukiwekea dawa tena baada ya miezi sita.