Testing for Malaria

Malaria is a major public health concern worldwide causing around 228 million infections and approximately 405 thousand deaths in the year 2018(WHO). About 91% of malaria-related deaths are in Africa with 86% of victims have been children under the ages of five years. Despite frantic efforts to eradicate the disease about 87% of the world population is still endemic to the disease. Malaria is endemic in Sierra Leone with a perennial transmission in all parts of the country, but the incidence increases mostly during the raining season which favors the growth of mosquitoes due to an increase in garbages. The disease is transmitted through the bite of an infected female anopheles mosquito which due to its life cycle injects the parasite into the bloodstream of the sufferer. Children under five years of age and pregnant women are more susceptible to the disease due to reducing immunity, and this increases the risk of the illness, severe anemia, and death. Malaria is caused by the parasite plasmodium and there are four different species of plasmodium, they are Plasmodium Vivax, Plasmodium malaria, plasmodium Ovale, and plasmodium falciparum which are the deadliest and most predominant in Sierra Leone. Malaria is presently the leading cause of morbidity in children under the age of five years and it accounts for 47 % of outpatient morbidity and 37.6 % for hospitalization with a case fatality of 17.6% (SIERRA LEON MALARIA STRATEGIC PLAN 2016-2020). Despite efforts by the government and non-governmental organizations’ to curtail the disease, there is still an increase in the number of reported cases. Following the infective bite of the female anopheles mosquito, a period of time, the incubation period) goes by before the first symptoms appear. The incubation period in most cases varies from 7 to 30 days depending on the plasmodium specie, the shorter incubation periods are observed most frequently with plasmodium falciparum (7 to 14 days). people who got are typically very sick with high fevers, shaking chills, and flu-like illness.

Magbenteh hospital is a secondary health facility in the city of Makeni, northern Sierra Leone that caters to the health needs of its inhabitants and beyond. And malaria is one of the many diseases and the most frequent health conditions we come across in our daily hospital operations and these patients are sent to the laboratory department of the hospital for the confirmation of their diagnosis in order to facilitate treatment. We perform approximately 80 to 100 malaria analysis weekly. From January to August 2020, the laboratory departments performed a total of 5291 malaria tests, and out of these 2106 were positive.

And out of the 5291 cases, 1094 were male adult patients, 2627 were female adult patients and 1570 were children under five years of age. But the number of patients this year dropped compared to last year and this was as a result of the COVI 19 pandemic, people were afraid of coming to the hospitals.

We use two main methods to diagnose malaria in our laboratory. One is the rapid diagnostic technique(RDT) kits and this produce results within 15 to 30 minutes .the kit is a laterally flow immune chromatographic antigen detection test, which relied on the capture of dye-labeled antibodies to produce visible bands on a strip of nitrocellulose, often encamped on plastic, housing the cassette .with malaria RDT the dye-labeled antibody first binds to a parasite antigen and the resultant complex is captured on the strip by a band of antibodies forming a visible a line (T-test line  )in the result window, a control (C –LINE )which gives integrity to the test kit. Typically a drop whole blood is added to the RDT through one hole (sample well) and then a number of drops of buffer solution usually on another hole (buffer hole) of the RDT. The results are interpreted as positive when the kit shows two lines, one in the control line section and another line on the test line section, and interpreted as negative when there is only one line on the kit (in only the control section) and the tests are interpreted as invalid if there is only one (in only the test line section) and in this situation, the test is repeated. The second method we used in diagnosing malaria in our hospital is the staining method which is the gold standard. Thick and thin blood films are made on microscope slides.

A thick blood smear is made on a microscope slide and allowed to air dry for thirty minutes, this allows the red blood cells to be haemolyse and the leukocytes and any malaria parasites present will be the only detectable elements. However, due to the hemolysis and slow drying, the plasmodia morphology can get distorted making differentiation of the specie difficult. Thick films are there used to detect infection and to estimate parasite concentrations.

Thin smear on the other hand is made on a slide and air dry for ten minutes, after air-drying the smear is fixed in methanol. The slides are then stained using Giemsa stain .the thick film is stained with 10 percent Giemsa solution with a ph of 7.1 for ten minutes. Whilst the thin film is stained with 4 percent Giemsa solution with a ph of 7.1 for thirty minutes, after staining they slides are air dry and examined using a microscope with a hundred times magnification .a positive slide will have plasmodium species whilst a negative slide shows a no plasmodium parasite.

 As a department there was certain laboratory analysis that we were known for to be performing, and patients were particularly coming to the hospital because they knew they could receive such services but presently we have to refer our patients because of not able to offer such services, notable example are the biochemistry analysis(tests), there is a lot of liver and kidney problems in this part of Sierra Leone and with such facilities, we were able to help our patients with a correct diagnosis thereby facilitating proper treatment and save them from spending more money as a result of traveling to Freetown for such services. But the machine has been broken down for a very long time and cannot be repaired.The lab is presently offering just a few services due to the unavailability of enough laboratory equipment and thus limiting our diagnostic capabilities. As a hospital with reference to the laboratory department which is the backbone of the hospital in terms of patients diagnosis, we will be hoping that all the departments be operating fully, departments like the biochemistry department, hematology department, microbiology, blood bank etc. This will help us cater fully for the health needs of our clients and by so doing improve productivity.