Treating malaria at home in Uganda.

Elsie Nakirya, 66, heard her granddaughter Paula Nakafu, 6, moan uncharacteristically in her sleep. A quick check with her palm on the child’s forehead “confirmed” a high temperature. “I sponged her off until morning, then went to a drug store and bought chloroquine syrup and a tablet of Fansidar [sulphadoxine–pyremethamine (SP)],” said Nakirya, a resident of Makerere West, a suburb of Kampala. Two days later, in spite of treating her with chloroquine and SP, Paula did not recover. Instead she developed a rash and that was when the grandmother who lives with three of her grandchildren, visited the doctor who confirmed Paula had measles. It’s hard enough for a doctor to diagnose malaria without a laboratory, but for families with limited access to health care it’s even more difficult because the early symptoms are similar to those of other diseases. While measles is relatively rare in Uganda and most cases of fever in children aged under-five can be attributed to malaria rather than other diseases, Paula’s example underlines the problem of getting an accurate diagnosis. Delays in getting appropriate treatment for malaria in sub-Saharan Africa and inadequate access to that treatment can be fatal. Paula’s grandmother not only misdiagnosed her, but also treated her for the wrong disease. Yet for people with limited access to health workers and health-care facilities, this hit-and-miss approach remains the only option in Uganda and elsewhere in Africa. One study showed that in places, such as these, where health care is not always available, home-based treatment of fever with antimalarial drugs still has the potential to dramatically reduce the Early data using the newer ACTs in home management of malaria suggests community members can be trained to administer these medications properly and avoid drug resistance.