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Teaching Health Workers Malaria Diagnosis

Posted by plosmedicine on 30 Mar 2009 at 23:41 GMT

Author: Mr Graham Icke
Position: Division of Laboratory Medicine
Institution: Royal Perth Hospital
Additional Authors: Dr Richard E. Davis AM
Submitted Date: April 15, 2005
Published Date: April 18, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Dear Editor,

Teaching Health Workers Malaria Diagnosis.

With reference to the letter commenting on our paper from Drs Drakeley, Gosling and Reyburn. They have some justification in stating that one size does not fit all. However our Web Site which is the basis for their comment was originally designed on a wholly voluntary basis for Australia. We have been overwhelmed by the interest and acceptance of this site. Weve had more than 750,000 visitors to the site and have issued free CD ROMs to Institutions in 149 countries.

The fact that it was warmly embraced by so many others from around the world, bear testimony to its usefulness as indeed do the tens of thousands of letters and emails thanking us for our efforts. We have made some modifications on our annual update in response to suggestions and changes in approach. We have not given equal weight to all sections as they suggest. The main sections of interest have been Diagnosis, Test and Teach and perhaps the reason for this is the high quality of the illustrations. One only has to look at the site to recognize this emphasis. Many large organizations have requested a substantial number of copies of the CD ROM and in Germany they have been printing their own (with permission). We are aware of some superb CD-ROMs on malaria put out from other sources but they are expensive for organizations with a very small budget.

We accept that diagnosis by thick film is the norm in Africa and a number of other countries and in fact have spent many years diagnosing malaria from thick films in India and South East Asia. We have described how to make thick films and have provided a picture. We have mentioned the staining of films but we have not described how to prepare the stains because we thought that outside our brief. It is important with web sites to be concise otherwise it wont be read. The actual diagnosis of malaria is the same for Africa, India, South America and Southeast Asia and it is the proper diagnosis which we believe is paramount. We know that language can be a serious problem. We have provided a version in French and Spanish. When other languages have been requested we have suggested that a small booklet should be written in the local language by those with local knowledge such as Dr Drakeley.

Regarding the comments on treatment. This section was written by Professor T. M. E. Davis who holds the Chair of Medicine at the University of Western Australia and is a Consultant on malaria to Thailand and Cambodia. If we sought an expert on treatment for every endemic region we would never get it into print. One is not always able to use the drugs of choice in South East Asia because up to 50% of antimalarials sold in some areas are fake. They have stated that children should not be given tetracyclines but that has already been made very clear on the site.

We are aware that the site needs to take into account various interests and situations and that is why we have included our email addresses on the site. It is perhaps unfortunate that these correspondents have never bothered to contact us. We presume that as experts in the field they would have been aware of the site either in Tanzania or The London School of Tropical Medicine where a number of CD ROMs have been requested and sent. We hope and expect that eventually a group with the enthusiasm of these correspondents will accept the challenge and produce a site which will overcome the problems that are the cause of their concern. We fully understand the difficulty of doing this on a voluntary basis. In the mean time we will continue to service the site. We hope that the very large number of users will continue to find it helpful and if concise suggestions for improvements are sent to us by email we will give them serious consideration.

Mr Graham Icke
Dr Richard E. Davis AM

No competing interests declared.