KARACHI: Doctors call for urgent steps to fight malaria
KARACHI, Nov 14: Doctors associated with Jinnah Postgraduate Medical Centre, registering their serious concern over recent rise in the number of falciparum malaria cases reported at its varied wards, have called for urgent and concerted measures on part of communities and concerned agencies to contain any further spread of the ailment to epidemic proportions.
In 10 days, no less than 12 cases of confirmed falciparum malaria, one of the most perilous parasitic diseases with prospectively rising death rate, have been reported at JPMC from Nov 4 to 13.
All cases reported high fever, chills and rigours with sweating, besides abdominal pains. While one of them came with renal failure and expired, two of them also had jaundice and altered behaviour. Malaria parasite test in all of them reflected positive falciparum. The patients were provided prompt treatment, besides all necessary health care contributing to their recovery.
However, doctors say it is alarming that all those who may have been inflicted with the ailment, but yet to be adequately diagnosed and treated are not themselves at high risk but also a potential threat for others. Moreover, the mosquitoes stinging such patients and then stinging others are also a potential threat.
Prof Jamal Ara of JPMC suggested that all those going to Shah Noorani should be necessarily provided a prophylactic treatment for malaria, as high prevalence of mosquitoes were cited at the place. She said that there should be centres in the area so that such cases were not allowed to go unreported till they lead to an epidemic.
She strongly recommended that spray and necessary measures be carried out at the shrine and its vicinity to eliminate and prevent any further breeding of mosquitoes.
Answering a query regarding the required treatment for those already inflicted with the parasitic disease, she said this depended on the intensity of disease itself, however, normally it could be fully treated within two weeks. But, she added these two weeks themselves were extremely crucial as the patients were highly infectious.
Prof Mashoor Alam Shah of JPMC said that falciparum malaria was resistant to a number of drugs including cholroquin, hence, doctors had to prefer second level of drugs.
“In fact second level of drugs as Quinine, Arthemeter, Halofantrin are to be taken as first level of drugs in these cases,” he said mentioning that these drugs are generally to be administered in injectable form.
He warned that since these medicines had their respective side-effects hence must be taken only under supervision of qualified and competent medical practitioner.
According to him, what is a matter of serious concern is the fact that diagnosis of the disease itself is extremely difficult. He said that doctors with high index of suspicion must not under any condition overlook such cases and resort immediately to necessary treatment procedures.
He said that the level of infection used to fluctuate in blood making the diagnosis difficult. Moreover, he said a large majority of local laboratories lack good technicians, hence, large responsibility was on doctors not to ignore symptoms.
“Delay in diagnosis enhances chances of mortality,” he stressed mentioning that besides treatment for the ailment itself the concerned patients are also to be provided with conditions consequent to the disease including blood loss, unconsciousness and so forth.
Dr Rushi mentioned that reluctance was also witnessed even among the patients to follow the instructions of doctors strictly and go for necessary tests enhancing their vulnerability as well as of those around them.
Dr Nadia said that pregnant women, specifically living in the vicinity of Shah Noorani as well as at places with cases pouring in must be immediately provided prophylactic treatment, as they and children to be borne to them are at high risk of cerebral malaria.
She said that malaria was not only transmitted by anopheles mosquito bite, but, could also be transmitted by blood transfusion, needle stick injury, sharing of needles by drug addicts and from a pregnant woman to her baby.
According to her, eradication of malaria is not feasible because of widespread distribution of anopheles breeding sites and a great number of infected persons and inadequacies in infrastructure and control programme.
Personal protection against malaria, she said, could be a considerably effective strategy, which included avoidance of exposure to mosquitoes at their peak feeding times (dusk and dawn). Moreover, she said that the use of insect repellent, suitable clothing, use of bed nets and regular spray of insecticides could help get protection against malaria.
To a query, she said all pregnant women, children three months to four years, all new born in an endemic area, travellers at least one week before going to an endemic area must necessarily receive antimalarial prophylaxis. For travellers it was suggested that they should continue treatment for four weeks after leaving the particular endemic areas.
Prof Shah of JPMC also appealed to the masses that they in their individual capacities must see that water was not allowed to stand in their area. However, if they found this difficult, he said that public must at least ensure prompt spray, even mobil oil to get rid of mosquitoes.
In this context, he also expressed his surprise as to how an area like Shah Noorani in a dry and arid zone could emerge as a major breeding zone for parasites.
Dr Fatima, Dr Zeeshan and Dr Shafaat urged people not to ignore conditions as fatigue, abdominal discomfort, headache followed by a characteristics fever manifested through fever spikes, chills and rigors. These were said to be regular in vivax malaria and irregular in falciparum malaria, they added. —APP
