The recent World Malaria Day observances called on all partners to “Invest in the Future, Defeat Malaria.” The word ‘investments’ brings to mind huge supplies of insecticide treated nets and malaria medicines. The recent and ongoing Ebola crisis has shown how vulnerable health workers are when trying to diagnose and manage malaria when investments have not been made in safety equipment and training.
The Ebola epidemic in West Africa as well as its predecessors in Central Africa has taken a disproportionate toll on health workers. In the early stages of the outbreak, health workers regular front line clinics became infected when patients with Ebola, a disease which none had seen before, were initially thought to have malaria or other endemic febrile illnesses.
Contact with the various bodily fluids of these febrile patients during physical examination, including parasitological testing of blood for malaria diagnosis, combined with a lack of personal protection/infection prevention supplies and materials, resulted in many unnecessary health worker deaths. Many clinics closed, while those that remained open saw a drop in clients due to fears from beliefs that the unknown disease was emanating from the clinic.
It is necessary to ensure that health workers do not face such a fate again, nor be exposed to other blood borne pathogens like HIV and Hepatitis B. In addition attention is needed to protect others on the front line such as patent medicine shop workers and community health volunteers. A two-pronged approach is needed that combines education/training with a strong procurement and supply system for infection prevention and personal protection materials.
We should take advantage of World Health Organization guidance for infection prevention related to hemorrhagic fevers and within that has stressed the importance of general protection. Performing Rapid Diagnostic Tests (RDTs) for malaria is the time when most front line health workers could come into contact with a patient’s blood. Training materials and job aids as pictured here, stress the importance of hand washing and use of gloves, but the availability of regular water supplies and disposable gloves in many front line clinics is low or non-existent. The US Centers for Disease Control and Prevention (CDC) also offers the following guidance for malaria diagnosis and case management in countries where both Ebola and malaria are endemic. In addition to front line health staff, we have learned that community volunteers can safely practice infection prevention while performing RDTs by wearing gloves and correctly disposing the used materials.
Efforts to enable medicine shop workers to use RDTs have begun. They do become more vulnerable during Ebola outbreaks as public clinics may close due to health worker deaths. In Liberia medicine sellers who were taught to use RDTs were asked to stop the practice until safety could be assured.
Continuous investment in RDTs themselves as well as the safety and protective supplies and treatment is needed. RDTs if performed properly can save lives of community members. Infection prevention steps and equipment can save the lives of the health workers who care for the community.
A longer version of this posting will appear in the May 2015 issue of Africa Health.