'Malaria Eradication In Nigeria Is A Remote Possibility'

By Chuks OLUIGBO


Philip Ikwuakolam Anukwam is a medical laboratory scientist and a naturopath, with over nineteen years experience on the job. He is also the MD/CEO of De-Lord’s Medical Diagnostic Centre, Abule-Ado, Lagos. In this interview, he speaks on the high incidence of malaria in Nigeria, measures towards reducing it, the need for proper medical diagnosis before embarking on any treatment, among other issues.

In your many years of experience as a practicing medical laboratory scientist in Nigeria, what do you consider the commonest sickness among Nigerians?

The commonest disease among Nigerians is malaria, seconded by typhoid. And malaria kills more than any other sickness, even more than HIV/AIDS. It is highly endemic. In fact, if you take statistics of patients who come in everyday, if you have twenty or thirty patients, you see about 60 or 70 percent of investigations being centred on malaria, then with secondary typhoid. There are certain species that are responsible for malaria. The commonest and the most devastating is the one called plasmodium falciparum. It is very common in Nigeria and the root cause or the vector is the anopheles mosquito.

Dr. Anukwam

What are the observable symptoms of malaria, because sometimes these symptoms look alike?

One of the major symptoms of malaria is rigour. The infected person has rise in temperature, what we call pyrexia of unknown origin (PUO). Though other symptoms in the pathology can rise temperature, but that of malaria causes higher temperature rise. You will notice dizziness, you will notice loss of appetite, and at times your vision will not be too clear. For some people, it also affects even their weight, but that usually comes when there is a secondary infection. For some people too, you notice blisters on their lips. Based on these symptoms, blood samples are collected and the necessary procedures carried out to know which of the species is responsible. And then the grading, there is a new World Health system of grading malaria. You don’t just report malaria as one plus, you must grade it in line with the white blood cell count. This is the new system which is being followed by any accredited medical laboratory scientist.

Now the symptoms you mentioned also often seem to be present in typhoid cases. What’s really the difference?

Typhoid is caused by a bacterium called salmonella typhi, which is a gastro-intestinal (GIT) infection. The symptoms, as you said, are almost the same, but that of typhoid usually comes within the abdominal area. You see the person complaining about pain in the stomach, and the headache is usually more severe. With the complaints of stomach ache, you know that there is a problem in the GIT. That is why in any investigation we usually advise the patient to run the two investigations so as to find out what is really wrong. Typhoid is a bacterial infection while malaria is a parasitic infection. They belong to different families. So, in order to get to the root of the matter, you have to involve the two families to know which of them is the problem before deciding whether there will be further investigations based on other parameters which could equally cause PUO. In an ideal situation of investigating any of these things, we usually carry out investigations that involve full blood count. We do a total full blood count of a patient and check his or her liver functioning level because malaria attack is on the liver. But due to the economic situation in the country, patients usually find it difficult to allow these stages to be followed. A patient will walk in and tell you: it is malaria that is worrying me and not typhoid. Then for you to talk of conducting a liver function test, you will only be worsening the case. But in an ideal setting, malaria/typhoid investigation goes with liver function test and full blood count test.

If someone notices these symptoms of malaria, what is that person expected to do?

The best bet is to carry out an investigation immediately. No need of going to a chemist or a pharmacist, or even a clinician. If it is overseas, you cannot take even Panadol without a pathological report. But here in Nigeria, many times people only come for investigation only when all the trials and errors have failed. But the ideal thing to do once you notice any foreign body in your system, once your body is no longer communicating to you, is to go for investigation, go for a real sound diagnostic analysis of your system.

Many people out there believe that no matter how healthy you are, if you go for diagnosis, they must tell you one thing or the other is wrong with you, especially malaria. How true is it?

Well, it’s not entirely true, although sometimes it depends on the scientist on bench. That is why at the recent conference held by Prof Agbolohor and the governing council of the Medical Laboratory Scientists of Nigeria, they were educating people of the need to go to accredited medical lab scientists for real thorough diagnosis to be carried out. That was why I talked about the new system of reporting malaria. So, if the investigation is carried out by a qualified personnel and a report made, then the report is authentic. And living in the kind of environment we find ourselves, no matter how you say you have fumigated your house, do you also fumigate the street where pass everyday? So, that is where body immune building should come into play because if your body immune building is okay, then the lymphocytosis should be able to fight the foreign body coming in. But when your immune system is low, you will just be carrying anything that comes in. So, that analysis that malaria must always be reported positive is not accurate.

But is there a possibility of eradicating malaria from Nigeria?

The possibility is not very near within us now because of our environment. The environment we live in is not sanitised. Once there are gutters here and there, there will always be malaria. But if it is overseas where you don’t see open gutters, where there is underground drainage system, malaria only occurs in isolation. That is why when they see anybody with malaria, that person is quarantined because they wonder how come. But here where there are open and dirty gutters here and there, the anopheles mosquito must still feed and come back to the body to infect it. So, the only half remedy is to maintain at least up to 50-60 percent of environmental cleanliness and also through fumigation, though fumigation has its own hazards too because it is insecticide which when it goes too deep into the system causes something else altogether. So, the surest bet is to keep your environment clean, leave no stagnant water around, and use mosquito nets.

Outside the points you have just raised, are there other measures that might come into play in order to, if not totally eradicate malaria, at least reduce it to the barest minimum?

Everything still boils down to check-up. You try to do periodic check-up of your system and not wait until you have blisters or fever or headache. Once in a while, you go for check-up, your system is thoroughly checked and if the malaria is at its primary level, the necessary medications are taken. But if you allow it to accumulate, by and large, it will weigh you down.

That is in an ideal situation, but the reality of our situation here is that the majority of the people are still looking for food to eat. Talking about periodic check-up to them is like taboo. If you have to advise such people who may not have the means to go for constant check-up, what would you likely say to them?

The best way out is for them to have clean environment, as I said earlier. That one you don’t need somebody to come and tell you. Use treated mosquito nets in your house. With these you can at least put malaria in check up to 60-70 percent. If you know you don’t have money to go for constant check-ups or to a pharmacy for drugs, then you will do well to keep your surroundings clean. Once you do this, then there must be an improvement.

Are there other complications arising from improperly treated malaria cases?

Yes. As I rightly said earlier, the site of malaria attack is on the liver. The liver is the power house of the whole body system, and if this power house is denatured, then the whole system is off. The mitochondria that works with the liver is where the phagocytosis takes place. So, if the liver goes down, the next thing you see cardiac arrest coming because the liver is involved in the whole process of producing and circulating blood. Once it is weak, every other organ in the system is weakened; and once the defence mechanism is no longer there, invader comes in. Just like a country that has no military defence, you see enemies coming in from all the borders. So, if the liver is not okay, there is no way the person will not start having secondary cases. That is why I said earlier that the best way of investigating malaria is by checking the liver. We have what we call the endo-erythrocytic and the exo-erythrocytic cycle of malaria life, that is, the inside and the outside. So, if you don’t check the state of your liver, then you are giving room for future problems. Like the other day a woman came here and said she wanted to test for malaria. I tried to educate her on the need for her to check her liver but she refused. You have no right to tell the doctor what you want. It is the doctor that will tell you what tests to run. So, professionally, you cannot carry out malaria investigation without checking the liver, and once the liver is down, hepatitis, liver cirrhosis and other related cases will find their way in. And that’s what you get when malaria cases are not adequately handled.

I know this may be a bit outside your area, but just for the asking, there are too many malaria drugs in the market. Someone who has undergone proper diagnostic investigations and is found to have malaria, where does the person find good malaria drugs to take?

The first problem is that malaria drugs don’t have sensitivity setting, that is why you find almost all of them having quinine and all that. If it is something that has sensitivity setting, that would have been far better. But the best bet is to get in touch with a pharmacist or a clinician who will then know the drugs you react to and the ones you don’t react to. We have many malaria resistant drugs now in the market. At first the drug may be effective, but as time goes on, there will be mutation. But if you get a sound pharmacist, he will be able to tell you, based on the number of pluses of your malaria and your white blood cell count, the drugs that will be okay for you. So, the next port of call after the laboratory is the pharmacy desk. Overseas, doctors are seen as being spoon-fed because the medical scientist carries out the investigation, the pharmacist dispenses the drugs, and all the doctor does is to make the prescription. But here, people will first of all go to the end point before coming to where they should have been in the first place. They will first run to a pharmacist, and after the trial and error, they will run to a doctor will probably do his own trial and error, and then when the case becomes resistant, the doctor will send them to a laboratory for diagnosis. When this happens, you get a false positive result or a false negative result because the drugs they have already taken are still in the blood stream. If a patient comes at that time, you may not have any good report to make because there has been an abuse. But if the necessary steps had been taken at the onset, doctor-diagnosis-pharmacy, what we call the triad cycle of medical treatment, then a lot of hazards would be averted. But if it is the other way round, the first becoming the last; when this cycle is destabilised and turned anti-clockwise, then invariably there is bound to be a problem. There is need for proper enlightenment. My late mother, even at the age of 90, before you gave her ordinary Panadol, she would ask you: have you done that type of test that Philip my son used to do? But some people don’t even care. I don’t know whether it is as a result of ignorance or the economy or both.

Finally, looking at all the issues raised above, what is your advice to Nigerians on how to maintain good health?

Well, my advice, as I already said, is first and foremost to keep their environment clean at all times. Secondly, to carry out necessary investigations as and when due. Then, as a naturopath, I have also found out that most often some natural medicines work faster. So, there can be a small combination with orthodox drugs after thorough investigations. The first necessary step is investigation. Whatever be the case, be you a medical lab scientist or a naturopath, you must make sure that the patient undergoes proper diagnostic test before treatment. Eat the right kind of food. Let your food be your medicine, that’s what we say in natural medicine. There are certain things that once you are able to build them into your body immune system, you are ok. If you don’t have money to go to big hospitals, there are certain things within your environment that you can pick, because everything boils down to detoxifying the liver. A lot depends on the level of detoxification. If there is a total detoxification of the liver, then all these things will go away. So, if you cannot afford orthodox medicine, then make use of complementary medicine. With all this in place, then I believe one will be able to maintain a good health.