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Two Nurses Explain How They Detected a Rare Malaria Species in Gambia

Plasmodium falciparum virus

A rare malaria species have reportedly been found in The Gambia after an eighteen year old boy was recently diagnosed with plasmodium malariae at Bundung Maternal and Child Health Hospital. 

Bundung Maternal and Child Health Hospital @puurfoundation

The nurses said Ebrima Njie, (not his real name), complained of vomiting, abdominal pain, chills, headache and a high fever. He was tested in the facility’s laboratory unit but the result was negative despite the symptoms of ill-health.  

Five days later, he returned to the hospital when his condition got worse. He was tested again and the result was negative. But this time, Ebrima also complained of lack of sleep for seven nights. 

According to the nurse who attended to him, Ebrima’s body temperature was up to 40.1 degrees Celsius against a normal average of 36.6. 

Ousman Touray

“It was with great dedication to finding out the problem of the case and getting to the bottom of it,” Ousman Touray, a nurse at the facility’s outpatients department told The Chronicle. 

The nurse could not fathom what must have been responsible for the boy’s high-level fever, which made him want to find out more. 

“He didn’t have independent symptoms of coughs and tonsillitis (sore throat) which cause a very high fever. He didn’t have the conditions that cause such a high fever as he had.” 

Thus began the painstaking exercise with the support of his laboratory scientist, they discovered a type of malaria that is very rare in the entire region.

“I sent him to the lab for a Rapid Diagnostic Test for malaria (RDT), but the test was negative,” he said. RDT tests discover the most common malaria in this country and in the region, the plasmodium flaciparum. 

“But when it was negative, I thought again what could have been the cause of a temperature of 40.1 when the patient does not have any other condition that could possibly cause it. I told the patient to go back to the lab for further tests.”

This particular test required a blood Film Test (BF) ,D50 and full blood count D200 and it could have cost Ebrima D250 as a required charge fee for every patient who needs it. However, because the mission was more than curing Ebrima, but to discover what is responsible, the test was carried out on him free of charge.

“The patient’s blood sample was taken and the laboratory scientist did the BF test and found out that there is malaria parasite 2+,” Ousman disclosed to The Chronicle.

Plasmodium malariae

“That one is hardly found in this part of the world, especially in The Gambia. It was a discovery for us because we have been here attending to malaria cases, prescribing for them but we have not seen the cases of plasmodium malariae in all the time that I have worked here.This is the first time we have followed up a case and we ended up discovering a strange species of malaria,” he said.

After the test was carried out and medication was prescribed to Ebrima, he was told to report back should his condition remain the same. However, Ebrima has not returned with any complaint Ousman believes that the boy has recovered from his illness.

Ousman calls on the government to effectively work on its research and case management so that new cases can easily be traced the very moment they appear before it causes havoc. He also called for perseverance and the dedication of nurses and other medical staff in pursuing suspicious cases to help keep a healthy country.

“It is important for a clinician to be always asking the why question – why is this happening to the patient? Unless you are able to establish why, you should not just be writing for the patient to go home. You should be able to attribute the patients’ symptoms to a particular circumstance that will make it reasonable for the prescription you are writing for the patient.”

“This type of malaria is not common in this area. In this particular instance, it happened to someone who, on history, has not travelled anywhere and stayed with anyone who recently travelled anywhere. So where is the plasmodium malariae coming from? We should definitely find out,” he tasked his colleagues. 

He conceded the possibility that some patients might have similar conditions and due to weak tests, they were let go without reaching the bottom of their cases. 

This discovery has been reported to the health authorities. The sample of the test has also been taking National Public Health Laboratory (NPHL), commonly called “Reference Lab” in Kotu for further investigations.

Kelepha Secka

Ousman’s co-discoverer, Kelepha Secka is the senior laboratory scientist at Bundung Maternal and Child Health Hospital (BMCHH) who conducted the further tests that led to the discovery.

“The patient was RDT negative. We did the BF and confirmed that he is positive. I didn’t rely on this. I went for thin film that identified whether the species is plasmodium malariae or Plasmodium Falciparum. Then I saw that it was P Malaria and I said to myself, wow this is very rare to see in The Gambia,” Secka told The Chronicle.

He said 95 percent of malaria cases in The Gambia are P falciparum, justifying how rare the new species is. 

Kelepha decried that the hospital lacks a multi-purpose RDT device which could have helped them discover other specifies of malaria beyond the most common type in the country. Kelepha challenges the health workers to improve on their coordination and persistence in following cases to save lives. 

“I am urging everyone particularly lab personnel, to be so creative and so suspicious of everything concerning laboratory tests. Further investigations are very important – when you are a scientist, do further investigations.”

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3 Comments
  1. Molly says

    Thanks for informing about this case. What is the treatment for Plasmodium malaria please? Will the same treatment used for falciparum work in this case? Thank you

  2. James Delargy says

    Congratulations to the the staff.Goverment funding is imperative now.

  3. Yerro Sowe says

    In such a situation the nurse should refer this case to a Dr. They did well but if things went otherwise the nurses will be blame. It seem they acting beyond limitations.

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