Making malaria deaths easier to count.

News Making malaria deaths easier to count Autopsy for medical purposes is illegal in Rwanda, so it is difficult to know how many people die of a specific disease. But a change in the law expected this year has spurred researchers to establish Rwanda's first postmortem programme that would start by helping with one of the most difficult of diagnoses in children: cerebral malaria. As the only Rwandan pathologist in his country, Dr Eugène Mutijima is unique in many ways. Not only does he provide much-needed diagnostic support to clinicians at hospitals in Rwanda – saving these institutions from spending scant funds on outsourcing abroad – but he is also unusual among African medical graduates in choosing to work in his home country after training in Europe. If a new medical research bill is passed this year as expected, Mutijima may soon be helping doctors in his country diagnose cerebral malaria and ascertain how many children actually die of this, the severest form of malaria. One of those doctors , Professor Cyprien Baribwira, from the Paediatrics Department at the University Hospital in Kigali, explained that this research project has a vital public health purpose. It will certainly improve treatment. " When one knows the causes of death, one can improve treatment. But when one does not know, one cannot, " Baribwira told the Bulletin. Mutijima has been re-establishing the Pathology Laboratory in Butare, about 130 km from the Rwandan capital of Kigali, since returning to his native country last year following five years of specialist training at Belgium's Liège University. In his laboratory, Mutijima, head of the Pathology Department at the University Hospital of Butare, analyses pathological specimens from people admitted to the country's two main public hospitals as well as all the private and some district public hospitals. But despite his training, Mutijima is unable to ascertain specific causes of death in many of these cases because under current law he cannot perform full autopsies in order to do this. (See Malaria deaths are the hardest to count, Bulletin of the World Heath Organization 2006; 84(3): 165-6.) Cerebral malaria is responsible for many deaths among children in Rwanda and is fatal within days unless treated. But symptoms are ambiguous and resemble those of several other illnesses including bacterial meningitis, Mutijima explained. The standard diagnostic test for malaria is a blood smear to detect the parasites. Some centres have rapid …