Some time ago we were studying local perceptions of what constitutes malaria illness in eastern Nigeria and came across some syndromes during focus group discussions that verged on mental health problems.
Heavy/strong malaria or Oke Eya was attributed to too much work, too much exposure to the sun, too much thinking (worrying), or drinking too much wine. This form of malaria was evidenced by senseless talk, appearance of being mad, high fever, and strong headache.
Shaking malaria or Eya Mbaka Ise was also thought to be caused by too much thinking, charms (witchcraft), drinking too much alcohol, or taking drugs like hemp. The person suffering this form of malaria would exhibit abnormal talk and behavior, headache, and appear restless.
It is not uncommon for communities to call many conditions by the local name for “malaria”, but if mental illness is involved, it is not a simple mater of letting a rapid diagnostic test help one decide whether to use artemisinin-based combination therapy or antibiotics.
Though not speaking specifically of malaria, Prince and colleagues in the Lancet noted that, “The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury.” Furthermore, they explained that, “Conversely, many health conditions increase the risk for mental disorder, and co-morbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis.”
Severe malaria itself can also lead to mental health problems.Â Specifically Bangirana et al. highlighted the problem that, “Cerebral malaria results in short- to long-term cognitive impairments in many of its child survivors. Although some of the risk factors for impairments have been identified, no attempts have been made to address the plight of those who develop cognitive impairments.”
So far there is no Global Fund for mental health programs.Â This puts an extra burden on those programs that receive international support to ensure that they deliver their malaria, TB and HIV services in the context of an integrated primary health care that can address the total person, especially the poor and vulnerable.