Academic journal article Bulletin of the World Health Organization

Continuing Medical Education in Unstable Malaria Areas

Academic journal article Bulletin of the World Health Organization

Continuing Medical Education in Unstable Malaria Areas

Article excerpt

Sir -- Durrheim et al. reported a case-fatality ratio of 0.7% during a malaria epidemic in the Lowveld region of Mpumalanga Province, South Africa, in 1996, and identified poor case management at health care facilities as a contributing factor (1). Soni & Gouws described a malaria case-fatality ratio of 11.1% at a tertiary referral teaching hospital near another unstable malaria area in South Africa (2) and alerted clinicians to the importance of recognizing the life-threatening symptoms and signs of malaria for which urgent and special treatment is required. Professor David Warrell, one of the world's foremost authorities on malaria, has been quoted as saying "malaria is still largely unfamiliar to doctors", referring not only to British doctors practising far outside normally malarious areas but to South Africans as well, who may be expected to encounter the condition far more commonly (3).

It is encouraging to note that staff in the area studied by Durrheim (1) acknowledged their shortcomings and have been retrained in the management of malaria at health care facilities, and that medical officers have accepted the responsibility of checking for errors in prescribing, monitoring and administering medication.

Where malaria occurs seasonally, erratically, or occasionally in epidemics in unstable malaria areas, knowledge of the disease -- even among medical staff -- may also be erratic and shallow, waning rapidly during malaria off-seasons. There is no sustained, in-depth clinical knowledge among medical staff, since they tend to encounter the disease far less commonly than they treat other endemic diseases. …

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