Treatment outside the health services

26 World Health • SlstYear, No. 3, Moy-June 1998 Treatment outside the health • services Halima Abdullah Mwenesi Prompt diagnosis and effective treatment of a malaria episode, whether confirmed by a blood test or not, are extremely important. However, many people living in malarious areas do not know how to diagnose the disease and have no access to prompt and effective treat- ment for it. Nevertheless, self- diagnosis of malaria is almost always followed by some form of self-treatment, with home remedies, antimalarial drugs or both. This is common practice in many countries. Although the definition of the disease varies in different localities because of the wide variety of symp- toms that may appear, fevers, headache, chills, indigestion and general malaise are usually treated as malaria. Self-misdiagnosis of this kind leads to a high level of inappro- priate treatment. Among the main reasons for self- treatment are the lack of access to formal health services (high cost, too far to travel), inadequate services (shortage of drugs in health facili- ties, long waiting time for consulta- tion) and the easy availability of over-the-counter treatments. Sources of drugs for treating malaria outside health facilities and pharma- cies include shops, markets, street vendors, traditional healers and private practitioners. All these sources have potential disadvan- tages. For example, most shopkeep- ers and street vendors are not qualified to diagnose and treat, do not know the correct dosages, do not store the drugs correctly, do not know the possible side-effects of combining different medicines, may give substandard or unnecessary drugs, and do not know when a patient needs to be referred to a qualified health professional. The ways in which people treat themselves for malaria seem chaotic and may even be dangerous, but if carried out appropriately they con save lives. While private practitioners may be trained and have the right drugs, they tend to charge more and may offer unnecessary medicines for financial gain. Delay can be fatal At the family level, especially where children are suspected to have malaria, mothers and carers may give analgesics or any available antimalarial or other drugs, includ- ing antibiotics. The lapse of time between onset of illness and reme- dial action seems to depend on the perceived cause, the prognosis and the severity of illness. Unfortu- nately, mothers and other carers very often give drugs of substandard quality, inadequate dosages or sim- ply the wrong drugs. As well as being a problem in itself, this leads to delays in seeking care which worsen the condition and sometimes result in the child's death. Drug-use practices for malaria on the periphery of the regular health services tend to be chaotic and dangerous, but if they are carried out appropriately they can save lives. Community health workers have been found to be helpful because they are close to the people, know A street vendor of drugs in Ghana. In the absence of regular networks of core and drug distribution, educating the users, vendors and shopkeepers in the proper use of antimalarials con save lives. Photo WHO/Goldschmidt how to diagnose and treat and, more importantly, know when to refer a very ill person to hospital. In addi- tion, an informed community of users, vendors and shopkeepers is needed. This can be achieved through health education specifically targeting all these categories. Clear messages on how to recognize malaria, how to treat it appropriately and when there is need to refer a patient to hospital or a clinic must be emphasized. In addition, people living in malaria-endemic areas need much better health services. Finally, further work is urgently needed on new antimalarial drugs that can be used by communities living beyond the range of regular services. • Dr Halima Abdullah Mwenesi is Scientific Coordinator, Kenya Medical Research Institute, Medical Research Centre, P.O. Box 20752, Nairobi, Kenya.