Some cases of malaria can progress to death within 24 hours of onset of symptoms. Children and travelers that haven’t had time to build up immunity are those that are at highest risk for severe disease. Children in the village that are frequently exposed and remain untreated for malaria are at risk for chronic complications. Aside from preventing malaria, early diagnosis and early treatment is the best way to avoid malaria complications.
Know the signs and symptoms:
- Fever- Suspect malaria ANY TIME your child has a fever, even if there is another cause.
- Weakness or exhaustion
- Vomiting is very common with malaria in young children
Rule out malaria:
Since you can see any of the above symptoms with typical childhood viruses it’s important to test for malaria whenever a baby or child has a fever. Those of you that have seen me in the clinic know that I am not a fan of big blood draws. Thankfully you can test for malaria two different ways with just a fingerstick. 24 hours a day 7 days a week you can get an MRDT (rapid malaria antibody test) and an MPS (microscopic test) by fingerstick at ABC Community Clinic. Simply tell the cashier you need malaria test only. You will pay there and go to lab. Check in with the nurse after 30 minutes for results. False negatives happen at every clinic, so please test again every 12 to 24 hours if symptoms persist. If your child seems quite ill, then I recommend you go ahead and see a health care provider as they may need a full blood count as well. Low platelets are another indication of malaria. This would require a full lab draw.
Home test kits– Many of the local pharmacies sell home test kits. These are testing for the malaria antigen-antibody reaction. If negative, repeat in 12 hours and continue watching your child as you would with any other fever.
The most prevalent strain of malaria that causes the most severe disease as well is P. Falciparum. Most MRDT test kits are designed to pick up this strain. If you continue to have symptoms and negative tests, then request the MRDT test that picks up the P. vivax, P. ovale, and P. malariae strains as well.
With diagnostic testing for the different strains of malaria prevalent in Malawi, no one should treat for malaria without a positive malaria test. Lab techs at major hospitals and clinics are quite skilled in detecting the parasite in the blood and the rapid tests are quite sensitive.
Do not self-treat. Malawian providers are knowledgeable of the latest malaria treatments, dosing, and resistance patterns. They know how to look for and treat malaria complications. It’s important that your child is managed by a health care provider should she become sick or have complications.
Uncomplicated malaria can often be treated with pills that you take as prescribed. When there is vomiting or a person is at risk for more severe complications, then the patient may receive an IV malaria medicine. This medicine must be followed by the pills to get full treatment. Hospitalization for malaria is common.
Remember that malaria symptoms usually appear 10-14 days after exposure. Some strains can lie dormant for up to a year. Have a high suspicion of malaria if you get an unexplained fever or flu like symptoms for up to a year after travel. I have seen cases of malaria in the United States from people that traveled from Africa. With travel becoming more prevalent, international providers are more comfortable and capable of diagnosing and treating malaria. Be sure to mention to your health care provider that you have traveled to a malaria endemic area, but you should not self-treat even while traveling.
I have been with a friend in the urban setting when she had taken her child to a community health center and had been diagnosed with malaria, but the health center had run out of the treatment medication. The health center referred her child to the hospital to get the medicine, but instead she came home to take Panadol. If you find yourself in this situation, be sure to educate your friend. Let her know that it is important that her child gets the malaria cure, or she will not improve. If the child were severely ill then the health center would have transported her to the hospital. In the case of a child being mildly ill with malaria, but needing the treatment, then taking her to a local private clinic or pharmacy is better than not treating. If you have a documented positive malaria test and the child generally looks okay, then it is okay to take the book to a private pharmacy to purchase malaria medication as prescribed. Be sure to read the packaging on the box to ensure she is getting the correct dose per weight.
Rather than pass judgement on the community health center, go visit and meet the nurses. You will find that at the most busy sites during peak malaria season people are sitting on the ground in a wide circle around the center. Find out what you can do to encourage them and help them secure the resources to best care for their patients. When possible, it’s best to work with the local system rather than against it.
Links for malaria information:
World Health Organization fact sheet