Rethinking assumptions

New research is challenging conventional medical wisdom, forcing health workers and governments in cash-strapped countries to confront new risks and rethink old ones. IRIN looks at what has been accepted as medical truths - until now.

Fever? Take anti-malarials

Not so quick. With the advent of rapid diagnostic testing for malaria in recent years, health workers can confirm the infection within minutes. In March 2010, the World Health Organization (WHO) changed its guidelines to require diagnostic confirmation before treatment for patients of all ages.

After the Senegalese government started using rapid diagnostic tests in September 2007, the number of reported malaria cases decreased from 1.5 million in 2007 to 174,339 in 2009. Only one-third of the fevers suspected to be malaria in 2009 turned out to be so. “Aggressive vector control has been behind the drop, but some of the decrease is also from earlier misdiagnoses,” said the national malaria control program coordinator, Pape Moussa Thior.

Correct diagnoses have slashed the number of anti-malarial treatments that would have otherwise been prescribed automatically by an estimated half a million since rapid testing began.

Senegal will return this year to The Global Fund to Fight AIDS, Tuberculosis and Malaria US$2.5 million that was earmarked for anti-malarial medication.

Leading killers

• Globally, mortality due to non-malaria diseases that produce high fevers - including pneumonia, yellow fever and typhoid - is twice that of malaria, according to a May 2010 study in the UK medical journal, The Lancet.

Diabetes is expected to kill four million people in 2010, mostly in low-income countries, according to the International Diabetes Foundation. In 2008, half that many died from AIDS worldwide.

Malnutrition continues exacting its annual deadly toll, with some 39 percent of the 10.4 million under-five deaths in 2004 traced to malnutrition and its medical complications.


• Lower respiratory infections, and heart and diarrhoeal diseases are, respectively, the leading causes of death in low-income countries. Pneumonia, which kills more under-five children every year than AIDS, malaria and measles combined, received one percent of public and private research and development funds in 2007 for diagnostics and treatment. 

Takes money to have “lifestyle” diseases

Not necessarily. Countries in Africa are expected to have the biggest increase in deaths from chronic non-infectious diseases - including heart disease and diabetes - over the next decade, or an additional 28 million sufferers, according to WHO.

Also called “lifestyle” diseases, behaviours like diet, alcohol consumption or exercise can impact recovery.

Almost 9 out of 10 deaths in 2004 caused by alcohol and tobacco use; high blood pressure, body mass index, cholesterol and blood glucose; low fruit and vegetable intake; and physical inactivity were in low-income countries, according to WHO.

Photo: Felicity Thompson/IRIN
Pregnancy - something to smile about

Pregnancy kills

Still does, but in relative terms fewer women die than before. New analysis from the US-based Institute for Health Metrics and Evaluation shows the global maternal mortality rate decreased from 422 per 100,000 live births in 1980 to 251 per 100,000 live births in 2008 - an estimated 342,900 deaths.

In the absence of HIV, there would have been 61,400 fewer deaths.

More children are also making it past their fifth birthday. In 1970, there were 40 countries with under-five mortality higher than 200 per 1,000 live births; in 1990 this had fallen to 12 countries and by 2010, no countries had rates this high.

Under-five deaths dropped from 11.9 million in 1990 to an estimated 7.7 million in 2010. Globally, child mortality rates dropped 60 percent in the past four decades, with the sub-Saharan countries of Comoros, Eritrea, Ethiopia, Madagascar, Malawi, Niger and Liberia showing annual declines of more than 3 percent.