The Widal typhoid test and other techno-woes

Surely, this must be part of the dirty politics of the unscrupulous marketplace versus the nobleness of advancement and moral higher ground? Half-a-mo and I’ll explain, starting from the beginning…

The Readers Forum on page four of the July 22, 2012 Government paper ‘Sunday News’ carried a letter by one ‘Dr Massimo Serventi, (Tel: 0787 567 517; <ser20@hotmail.it>’) Titled ‘Widal Test for Typhoid fever is out of date, should be revisited,’ the letter made rather startling revelations that must be of great concern to the relevant authorities in particular and Tanzanians in general…

In his own words, Dr. Serventi — an Italian pediatrician working in Dodoma, I’m made to believe — sets out to “address a medical issue that, for its importance and broad implications on the population, deserves to be raised and discussed in your esteemed newspaper...” Apparently, the good doctor had in the past “tried to do so through the channels of Health authorities — the Ministry of Health & Social Welfare, as well as Regional Medical Officers — but I never got a reply…!”

The subject-matter of the doctor’s concern is the correct way of going about diagnosing typhoid fever (‘homa ya matumbo’). Waxing professional and scientific, he writes: “typhoid fever should be diagnosed through the isolation of ‘salmonella typhi’ — the organisms which cause typhoid — in a blood culture or stool culture…

“In the absence of this sophisticated technology at the (medical) facility level, the diagnosis should be based on clinical evidence: signs and symptoms of typhoid fever that are known clearly, and are welldescribed in medical books…” Oh… there’s more of that technical mumbo-jumbo. But the crux of the matter comes next…

“Unfortunately, typhoid fever (in much of Africa) is still diagnosed through the ‘Widal Test!’” For example, a person complaining of persistent fever even after being successfully treated against malaria is subjected to the Widal Test. “The result will be positive, and treatment (for typhoid) using antibiotics will start, Dr. Serventi says. “This happens (in Tanzania, anyway) every day, all over the country, for thousands of persons…!”

By way of elaboration, the good doctor cites page 598 of a book written/edited by David Mabey, Geoff Gill, Chris Whitty and Martin Weber, titled ‘Principles of Medicine in Africa’ and published by Cambridge University Press in 2004. The Chapter on ‘Diagnosis of Typhoid Fever’ explains in technical abracadabra how the Widal Test works; it then concludes categorically and unequivocally that “the Widal Test cannot be (effectively) used for diagnosis at present!”

Dr. Serventi continues: “this means that diagnosis of typhoid fever cannot be based on a single Widal Test... Indeed, it gives a high percentage of false positivity! To make the diagnosis of typhoid fever after a single Widal Test as it is being done now is a gross medical error that leads to unnecessary treatment, and with potentially- killing antibiotics like chloramphenicol…!” Then, in sheerness of nobleness, the doctor waxes sentimental…

“Tanzanians already have many problems of Health; why should doctors add further ones to them? Why do we continue to deprive them of their already meagre funds with obsolete laboratory testsand dangerous medicaments? Why should the noble art (and science) of Medicine abdicate in favour of the Market? “Why don’t the Health authorities discipline the whole matter (sic)? The Widal Test isn’t anymore used in Europe and the US.

Yet, they manufacture and export it to Africa; is this not sort of dumping?” Those are Dr. Serventi’s direct questions, not mine. Everything else being equal, the matter is very much of great concern all-round! This is made worse by the apparent lackadaisical manner and style in which the problem is being given the benign neglect treatment by the relevant authorities in Tanzania. These are the Government in general, and its institutions ranging from Ministries and Independent Departments to Agencies.

I have in mind here specifically the Health Ministry, the Tanzania Food & Drugs Authority (TFDA), the Medical Stores Department MSD), the Tanzania Bureau of Standards (TBS), the Fair Competition Commission (FCC)… Oh, the country is by no means short of regulatory and law enforcement organs.

Then, where does the trouble lie? It is the height of all that is wrong morally and statutorily to play politics with people’s health —and, therefore, their lives — as if it didn’t really matter that much. On the contrary, it does! Therefore, will someone out there please, please heed Dr Massimo Serventi, and take the requisite measures to save Tanzanians from the curse that puts profit for foreign manufactures before the safety of us in the developing world? Cheers!


IN my last two sports columns, I have ...


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